Anticholinergic pharmacological agents are commonly misused because of their euphoric effects, increased energy, improved mood, and enhanced social interactions. Some herbal products with anticholinergic properties can also be abused for their psychoactive effects. One such ornamental plant is Brugmansia suaveolens, which contains alkaloids including atropine and scopolamine and can produce toxic effects. This case report describes a male patient with Brugmansia suaveolens abuse and coexisting multiple substance use disorders. The patient reported consuming a decoction of Brugmansia suaveolens leaves and flowers as a daily tea for four years to obtain relief. He experienced anticholinergic symptoms, including drowsiness, sedation, agitation, ataxia, dry mouth, palpitations, fever, and visual and auditory hallucinations while under the influence of the plant. The patient was discharged following a four-week treatment course. Plants like Brugmansia suaveolens, which have anticholinergic but toxic properties, may be misused, especially by individuals with a history of multiple substance use disorders.

A 49-year-old man presented with a 1-year history of red facial nodules and a 3-month history of left-sided hearing decline. A biopsy revealed mixed inflammation and emperipolesis of histiocyte-like cells. An immunohistochemical analysis demonstrated that the histiocyte-like cells were positive for S100 and CD68PGM1 and negative for CD1a and CD207, confirming the diagnosis of cutaneous Rosai-Dorfman disease (CRDD). The initial treatment consisted of oral prednisone acetate combined with methotrexate. Due to limited efficacy and adverse effects, methotrexate was discontinued, and prednisone acetate monotherapy was used. After 2 months, the patient's skin lesions gradually resolved, and hearing improved. This case demonstrates that CRDD involving the ear can lead to hearing recovery following systemic corticosteroid therapy.

Hypoglycemia is a rare but potentially serious adverse effect of second-generation antipsychotics (SGAs). Most studies have focused on SGA-induced hyperglycemia and metabolic syndrome, while hypoglycemia in non-diabetic adults remains underreported. We describe a case of severe hypoglycemia following risperidone initiation, demonstrating diagnostic challenges and safety concerns. A 41-year-old woman with treatment-resistant schizophrenia, Asperger's syndrome, and attention-deficit/hyperactivity disorder was admitted for worsening commanding auditory hallucinations and persecutory delusions. Risperidone was started at 2 mg nightly and increased to 3 mg after four days. The patient developed recurrent episodes of severe hypoglycemia (random blood glucose levels 35-50 mg/dL; hypoglycemia defined as <70 mg/dL), accompanied by hypotension, tachycardia, nausea, vomiting, dizziness, and altered mental status, shortly after increasing the dose of risperidone. Extensive laboratory and imaging evaluations were unremarkable except for persistent hypoglycemia. The episodes continued despite aggressive glucose replacement and supportive medical treatment. After risperidone was discontinued, blood glucose levels gradually normalized within 48-72 hours, and no further hypoglycemic episodes occurred. To contextualize this case, a systematic literature search was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, PubMed Central, PsycINFO, Embase, and Google Scholar, with keywords including "risperidone", "second-generation antipsychotics", and "hypoglycemia", as well as MeSH terms. Studies involving adult non-diabetic psychiatric patients with antipsychotic-associated hypoglycemia were included. Nine relevant case reports and case series were identified and evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Case Reports. Existing literature shows that hypoglycemia associated with SGAs is rare but has been reported with several agents, including risperidone, quetiapine, olanzapine, paliperidone, clozapine, and aripiprazole. Proposed mechanisms include hyperinsulinemia and impaired counter-regulatory responses related to antipsychotic receptor effects. Because symptoms such as confusion, dizziness, and weakness may mimic psychiatric symptoms or medication side effects, diagnosis may be delayed. This case highlights that risperidone can rarely cause severe hypoglycemia even in non-diabetic adults. Although limited by a single case and lack of insulin measurements, this study emphasizes the need for early recognition, glucose monitoring during SGA use, and multidisciplinary care to prevent serious complications. Further research is needed to better understand the underlying biological mechanisms and identify potential risk factors.

Huntington's disease (HD) is an autosomal dominant neurodegenerative disorder caused by an unstable expansion of CAG trinucleotide repeats that lead to progressive degeneration of postsynaptic striatal medium-spiny GABAergic neurons. We report a case of abnormal [ 123 I] Ioflupane single-photon emission computed tomography/computed tomography (DaTSCAN) and a subsequent genetic test confirming HD. A 68-year-old man presented with progressive memory difficulties, auditory hallucinations, nightmares, suicidal thoughts, low mood, and involuntary limb movements. DaTSCAN showed borderline reduced putaminal binding ratios bilaterally, more prominent on the left side, and a low putamen-to-caudate ratio suggesting degenerative parkinsonism. Genetic testing revealed one pathogenic expansion (40/17 CAG repeats), confirming HD. Postsynaptic dopaminergic involvement has previously been documented in postmortem studies. However, an emerging in vivo research also suggests presynaptic dopaminergic involvement. While genetic testing remains the gold standard for diagnosis of HD, DaTSCAN may play a role in assessing dopamine transporter activity and tracking the progression of neurodegeneration in HD.

This study aims to establish a protocol for measuring the postauricular muscle reflex (PAMR) and to characterize both short- and mid-latency responses under controlled conditions in adults with normal hearing. PAMR electromyography was recorded in 43 adults with normal hearing. Auditory stimuli (50 ms, 80-100 dB (A)) were presented at four frequencies (500, 1000, 2000, and 4000 Hz), with systematic variation in stimulation side (ipsilateral/contralateral) and eye position (forward/rotated). The influence of these factors on PAMR amplitude and latency was analyzed using linear mixed-effects models. A short-latency PAMR (10-25 ms) was observed in all but one participant in at least one frequency. Reflex amplitude was significantly affected by stimulation side, eye position, frequency, and intensity. Contralateral stimulation produced stronger responses than ipsilateral stimulation. Additionally, a mid-latency PAMR (37-50 ms) was identified in 91% of participants, exhibiting lower amplitude and a higher detection level compared to the short-latency response. The mid-latency reflex was also significantly influenced by experimental conditions. The data shows that PAMR can be reliably recorded under controlled conditions in normal-hearing adults and that both short- and mid-latency components are influenced by auditory and oculomotor factors. These results provide us with normative data that can serve as a reference for future investigations in clinical populations, such as cochlear implant users and individuals with hearing loss.

Background: RASopathies represent a clinically and genetically diverse group of syndromes resulting from germline mutations in genes regulating the RAS/mitogen-activated protein kinase (MAPK) signaling cascade. Methods: The aim of this study was to describe the clinical features and genetic variants identified in patients with genetically confirmed Noonan syndrome (NS) in a limited cohort from Romania. A total of 25 patients with positive genetic testing for NS-associated genes were included. Genetic testing was performed primarily using next-generation sequencing. Results: A total of twenty-six variants were identified in twenty-five patients, as one patient carried two pathogenic variants in the PTPN11 gene (c.188A>G and c.922A>G). Of these variants, twenty-four (92.31%) were classified as pathogenic and two (7.69%) as variants of uncertain significance (VUS). Pathogenic variants were found in different genes, including PTPN11, LZTR1, SOS1, and RAF1, with PTPN11 being the most frequently affected gene. Males predominated (17/25), with a male-to-female ratio of approximately 2:1. Two patients inherited the pathogenic variant from an affected parent. Cardiovascular involvement was present in 21 patients (84%), with pulmonary valve stenosis (PVS) being the most common finding (48%), followed by hypertrophic cardiomyopathy (16%). Additional cardiac anomalies included atrial septal defect, valvular regurgitation, dysplastic valves, coarctation of the aorta, and sinotubular junction narrowing. Short stature was observed in 64% of patients, and craniofacial dysmorphism was present in 96%. Cutaneous, ectodermal, dental, ophthalmologic, and auditory manifestations were variably observed. Conclusions: Although based on a limited cohort from Romania, this study provides insights into clinical features suggestive of NS. Our findings highlight the genetic heterogeneity of NS and emphasize the importance of comprehensive genetic testing for confirming diagnosis, guiding clinical management, and supporting family counseling.

Psychiatric and neurodevelopmental disorders such as schizophrenia (SZ) and autism spectrum disorder (ASD) are challenging to characterize in part due to their heterogeneous presentation in individuals, with symptoms now believed to exist on a continuum. Conventional diagnostic and neuroimaging analytical approaches rely on subjective assessment or group differences, but typically ignore progression between groups or heterogeneity within a group. To estimate the neuropsychiatric continuum and heterogeneity, we proposed a functional network connectivity (FNC) interpolation framework based on a variational autoencoder (VAE) using static FNC (sFNC) and dynamic FNC (dFNC) data from controls and patients with SZ or ASD. We demonstrated that VAEs significantly outperformed a linear baseline and a semi-supervised counterpart. For both sFNC and dFNC interpolation, the generated results effectively captured representative and generalizable properties in the original data. The interpolated continua from controls to patients in both SZ and ASD revealed group-wise gradients characterized by reduced positive correlations within the auditory, sensorimotor, and visual networks, as well as between the subcortical and cerebellar domains. In contrast, anti-correlations weakened between the subcortical domain and the sensory domains, and between the cerebellar domain and the sensory domains. Finally, we showed examples of how to generate continuous FNC data following group- or state-based trajectories in the VAE latent space. The proposed framework offers added advantages over traditional methods, including data-driven discovery of hidden relationships, visualization of individual differences, imputation of missing values along a continuous spectrum, and estimation of the stage where an individual falls within the continuum.

We report the first documented case of facial-stapedial synkinesis (FSS) secondary to Ramsay Hunt syndrome (RHS) by describing the clinical manifestations and definitive surgical treatment outcome of this rare condition. A 35-year-old female presented with initial symptoms of severe right-sided facial weakness, otalgia, hyperacusis, ear fullness, and erythematous vesicles in the external auditory canal and tympanic membrane, suggestive of RHS. She later developed an intermittent "quivering" or "buzzing" sensation in her right ear initiated by facial movements such as closing her eyes and smiling. We performed magnetic resonance imaging of the brain and serial audiometric testing, and administered pharmacological treatment, including prednisone and famciclovir, for the initial infection, followed by stapedial tendon tenotomy for the definitive management of FSS. This case provides valuable clinical insights as the first reported instance of FSS secondary to RHS. RHS causes a more severe facial paralysis with lower rates of complete recovery, with an increased risk of aberrant facial nerve regeneration. FSS should be considered in patients presenting with persistent auditory symptoms after facial paralysis. Stapedial tendon tenotomy is an effective treatment option for patients with severe refractory symptoms.

Triple X (47,XXX) syndrome is a sex chromosome aneuploidy associated with learning disabilities, attentional deficits, and social impairments. Its psychiatric manifestations, particularly psychosis, remain underrecognized. This case report describes a 13-year-old girl with 47,XXX syndrome who developed two recurrent psychotic episodes during adolescence and ultimately achieved sustained remission under clozapine, illustrating the need for individualized, genetically informed care. The patient initially presented with persecutory delusions, auditory hallucinations, behavioral changes, and functional decline. Comprehensive neurological, neuropsychological, and audiological assessments showed average overall cognitive functioning and no syndrome-specific sensory abnormalities. Psychotic symptoms emerged years after methylphenidate initiation and persisted during medication-free periods, arguing against stimulant-induced psychosis. Following partial response and poor tolerability to risperidone and aripiprazole, clozapine was introduced using a "start low, go slow" strategy. Low-dose clozapine (150 mg/day) produced complete remission within two months without hematological or cardiovascular adverse effects. Preventive metformin successfully mitigated antipsychotic-associated weight gain. A coordinated multidisciplinary follow-up integrating psychiatry, general medicine, neuropsychology, genetics, and school-based interventions proved essential to maintaining stability, supporting adherence, and promoting academic and social functioning. At one-year follow-up, the patient remained asymptomatic with improved daily functioning. This case reinforces emerging evidence that women with 47,XXX syndrome have an elevated lifetime risk of psychosis and may require tailored antipsychotic strategies due to syndrome-associated comorbidities. It highlights clozapine's potential effectiveness at low doses in genetically vulnerable adolescents, the value of preventive metabolic management, and the importance of integrating psychoeducational and environmental supports. More systematic data are needed to guide evidence-based management of psychosis in sex chromosome aneuploidies.