Insulinoma is the most common functional pancreatic neuroendocrine tumor, typically benign, solitary, and sporadic, with an estimated incidence of 1-4 cases per million per year worldwide. It causes recurrent hypoglycemia through inappropriate insulin secretion, classically presenting as Whipple's triad and confirmed by a prolonged supervised fasting test. Surgical enucleation remains the preferred treatment for small, well-localized benign insulinomas, allowing maximal preservation of pancreatic parenchyma. We report two cases of sporadic pancreatic insulinoma managed by open enucleation at a tertiary referral center in Senegal, West Africa, where advanced diagnostic modalities such as endoscopic ultrasound (EUS), somatostatin receptor scintigraphy, and selective arterial secretagogue injection (SASI) testing were unavailable. The first case was a 30-year-old woman presenting with a severe hypoglycemic coma complicated by status epilepticus on postpartum day 10. Abdominal CT scan identified a pancreatic head lesion. Biochemical workup confirmed insulinoma with a fasting blood glucose of 0.30 g/L (30 mg/dL; 1.7 mmol/L), elevated fasting insulin at 32.7 µU/mL, and C-peptide at 2.92 ng/mL. Open enucleation was performed; the postoperative course was complicated by a transient infectious syndrome managed with broad-spectrum antibiotics. Histopathology confirmed a well-differentiated Grade 1 neuroendocrine tumor. Complete resolution of hypoglycemic episodes was achieved with no recurrence at 1 year. The second case involved a 55-year-old man with a 12-year history of recurrent neuroglycopenic episodes. CT scan revealed an isthmic pancreatic lesion. Enucleation was performed; the postoperative course was complicated by a high-output pancreatic fistula (Grade B, ISGPS 2016 classification), managed conservatively with fasting, parenteral nutrition, and close radiological monitoring, without surgical reintervention. Histopathology confirmed a low-grade neuroendocrine tumor. No recurrence of hypoglycemia was observed at 5 months. These cases demonstrate that open enucleation is a feasible, effective, and parenchyma-sparing option for benign sporadic insulinomas, even in resource-limited settings where advanced localization and intraoperative techniques remain unavailable.

Brain death is a complex clinical diagnosis with significant medical and legal implications that sometimes requires the use of ancillary tests to confirm the absence of electrical activity or cerebral blood flow (CBF). Among the ancillary tests used to assess CBF are: transcranial Doppler ultrasound, digital subtraction cerebral angiography, CT angiography (CTA), MR angiography, and scintigraphy. This article reviews these techniques, with particular emphasis on CTA, its multiphase protocol, the imaging findings that support the diagnosis of brain death, recommendations for radiology report writing, and potential pitfalls in interpretation. We also review specific considerations for paediatric patients and the discrepancies between international societies on the use of ancillary tests both in adults and children.

Severe trauma remains a major global cause of death and disability, particularly among individuals younger than 45 years. Emergency departments are the main gateway to trauma care, where rapid risk stratification guides resuscitation, surgical decision-making, intensive care admission, and resource allocation. Conventional tools, including the Revised Trauma Score, Glasgow Coma Scale, Injury Severity Score, and Trauma and Injury Severity Score, standardize early assessment but rely largely on static variables and may not capture dynamic physiological changes during resuscitation. Dynamic biomarkers offer additional biological information. Glial fibrillary acidic protein, S100B, neuron-specific enolase, serum lactate, and lactate clearance may reflect neuronal injury, tissue hypoperfusion, metabolic stress, and how effectively resuscitation is restoring perfusion. Artificial intelligence and machine-learning models can integrate vital signs, laboratory findings, imaging data, biomarkers, and demographic variables to generate individualized predictions of mortality, clinical deterioration, intensive care requirements, and complications. Recent studies suggest that some machine-learning models may outperform conventional scoring systems; however, limitations involving data heterogeneity, algorithmic bias, interpretability, external validation, privacy, and clinical workflow integration remain. This narrative review synthesizes current evidence on conventional trauma scoring systems, dynamic biomarkers, and artificial intelligence-based prediction models for early risk stratification of severe trauma in emergency departments. It also examines the potential of multimodal frameworks that combine physiological, anatomical, molecular, and computational information. Although integrated prediction systems may improve accuracy and clinical decision-making, prospective multicenter validation and evidence of real-world clinical benefit are required before routine implementation.

Hypoglycemic encephalopathy (HE) is a rare yet critical consequence of extended low blood sugar, often resulting in altered mental status, seizures, and coma. Because its presentation mirrors various other neurological disorders, prompt recognition is difficult, and treatment delays risk permanent brain damage. This report describes a 56-year-old Black man with Type 1 diabetes mellitus (DM) on Neutral Protamine Hagedorn (NPH) insulin who discovered nonresponsiveness roughly eight hours post insulin injection. Upon admission, he was presented with a blood glucose of 43 mg/dL and a Glasgow Coma Scale (GCS) score of 7/15, with brain magnetic resonance imaging (MRI) findings consistent with HE. Despite immediate treatment with intravenous (IV) 40% dextrose (50 mL), a continuous dextrose-saline infusion, and antiepileptic medication to control seizures, his neurological function stabilized without further improvement, leaving his GCS score between 8 and 10. Following a four-month period of stabilization during home care the patient developed pneumonia and septicemia in the fifth month. This complication triggered progressive neurological deterioration, ultimately resulting in death at five months postevent. This case underscores the importance of timely detection and treatment of hypoglycemia in diabetic patients, particularly those receiving insulin. Regular glucose monitoring, patient education, and careful insulin adjustment are essential to prevent HE and its devastating outcomes.