Primary oculomotor nerve schwannomas that involving the cavernous sinus represent an exceptionally rare entity. The surgical management of these tumors is complicated by the need to maximize resection while safeguarding oculomotor function. We report a middle-aged female who presented with headache, dizziness, and visual decline. Examination showed right ptosis and decreased visual acuity. MRI demonstrated a lesion in the right parasellar region that involved the cavernous sinus, circumferentially surrounded the cavernous segment of the internal carotid artery, and extended into the optic canal. A right pterional craniotomy was performed with a microsurgical resection under endoscope assistance. Following microsurgical debulking through the oculomotor trigone and supratrochlear triangle, neuroendoscopy was used to explore and curette deep residual tumor within the cavernous sinus. Histopathology confirmed schwannoma of Schwann cell origin. Postoperatively, ptosis showed partial improvement and visual acuity showed mild improvement, with oculomotor and pupillary function preserved without postoperative deterioration. Postoperative MRI obtained within 72 hours confirmed an intentional subtotal resection with a minimal residual enhancing focus, for which adjuvant stereotactic radiosurgery has been recommended. In this patient, endoscopic visualization facilitated inspection of areas not directly visible through the microscope and supported an intentional function-preserving resection. The surgical strategy illustrated in this case may inform the management of this rare pathology, although long-term outcomes remain to be evaluated.

Case report A 31-year-old previously healthy man who had sex with men presented with a two-day history of acute-onset dizziness, nausea, and vomiting. On admission, he was afebrile with generalized lymphadenopathy and a truncal and lower-limb rash. Neurological examination revealed no motor weakness or hyperreflexia, but he could not walk unassisted due to dizziness. Brain MRI diffusion-weighted imaging (DWI) showed characteristic V-shaped hyperintense lesions in the bilateral medial medulla (Fig. 1A) and at the pontomedullary junction (Fig. 1B). MR angiography (MRA) showed no stenosis or dissection of the basilar or vertebral arteries (VA) (Fig. 1C).

Dizziness is one of the most common complaints encountered in outpatient clinical practice, and is associated with a wide range of underlying conditions, ranging from peripheral vestibular disorders to cerebrovascular disease, cardiovascular abnormalities, and psychological factors. Traditional classifications based on the quality of dizziness symptoms have inherent limitations in diagnostic accuracy. In contrast, the ATTEST approach, which structures clinical reasoning according to temporal profiles and triggering factors, has been shown to be useful. In this article, we outline the practical strategies for evaluating patients with dizziness and emphasize the importance of a thorough basic assessment and the avoidance of premature diagnostic closure to ensure an appropriate differential diagnosis.

Oropouche virus is an emerging arbovirus whose neurotropic potential is increasingly recognized across the Americas. During the 2024-2025 outbreak in Panama, we identified six patients with confirmed or probable infection who developed a broad range of neurological manifestations. Neurological symptoms arose several days after the onset of systemic illness and included ocular motor disturbances such as nystagmus and opsoclonus, cerebellar signs including ataxia and vertigo, seizures, altered mental status, and meningeal irritation. Cerebrospinal fluid analyses frequently demonstrated mononuclear pleocytosis, while neuroimaging was largely unremarkable. Viral RNA was consistently undetectable in cerebrospinal fluid but was identified in urine beyond the acute phase, extending the diagnostic window in patients with delayed presentation. Most individuals recovered with supportive care; however, one patient died following refractory status epilepticus, and another required prolonged intensive care. This case series represents the first report of neurologically symptomatic Oropouche virus infections in Panama and expands the recognized neurological spectrum of the disease. These findings underscore the importance of maintaining clinical suspicion for neuroinvasive presentations, incorporating alternative diagnostic specimens, and strengthening surveillance efforts as Oropouche virus continues to emerge regionally.

Children admitted to pediatric intensive care units (PICUs) are at risk of acquired weakness, delirium, and long-term functional and neurocognitive morbidity. Although early rehabilitation is recommended to mitigate these adverse outcomes, its delivery remains challenging. Virtual reality (VR) has been proposed as a means of enhancing engagement in rehabilitation in this setting. This systematic review evaluated the feasibility, safety, and outcomes of VR delivered to children during routine pediatric intensive care to support rehabilitation, participation in rehabilitation, or emotional regulation. Three databases were searched through 8 August 2026, and the reference list of one relevant scoping review was screened; two reviewers independently screened all records (Cohen's κ = 0.85). Six studies involving 188 children were included: one randomized pilot trial, one prospective single-arm trial, two cross-sectional single-arm studies, and two case reports. Risk of bias was high, serious, or critical in every appraised study, and the certainty of evidence was very low across all outcome domains. The randomized trial found higher consciousness scores at 2 weeks in the VR group but no difference in social and personal functional ability at 3 months. In uncontrolled studies, most children were rated as highly engaged and reported enjoying VR, while parents reported a calming effect more frequently than the children themselves; a transient increase in one heart rate variability parameter occurred during VR but was not sustained afterward. Adverse events were reported in four of the six studies at rates of 3.1% to 20%, comprising dizziness, nausea, visual discomfort, and mild irritability, with one serious event adjudicated as unrelated to VR; the two studies that applied pre-specified criteria recorded no events and one unrelated event, respectively. VR appears feasible and safe for hemodynamically stable, alert children in the PICU and is consistently associated with high engagement. However, whether VR improves functional outcomes remains uncertain. Eligibility, rather than tolerability, may be the principal barrier to implementation, and the available evidence applies to only a minority of the PICU population.

Heat exposure can harm pregnant and postpartum women, yet heat strain symptoms in this population remain underexplored. This study implemented a novel mobile application and assessed the environmental context of five self-reported heat strain symptoms: skin rashes, sleep disturbances, dizziness, thirst, and exhaustion among pregnant and postpartum women in Tshwane, South Africa. Symptoms were assessed through interviewer-administered questionnaires at three time points over six months (N = 201). Self-reported heat strain was analysed against maximum Wet Bulb Globe Temperature (WBGTmax) and air temperature (Tmax). An additional symptom, wetness sensation, was collected continuously via self-reporting using the application and related to the Universal Thermal Climate Index (UTCI). Generalised Estimating Equation models and General Linear Mixed Models accounted for repeated measures. Four of five symptoms showed significant associations with both WBGTmax and Tmax. Wetness sensation was significantly correlated with UTCI. Thresholds for heat strain symptoms identified through Receiver Operating Characteristic curves ranged between 18.53 °C and 26.16 °C WBGTmax, reflecting differences in perceived severity. Urine specific gravity showed inconsistent association with heat, likely due to measurement timing limitations. Although risk varied across symptoms and threshold modelling was exploratory, this study highlights the adverse health consequences of heat exposure for pregnant and postpartum women, which may inform future interventions.