The coexistence of Guillain-Barré syndrome with a spinal cord syrinx is extremely rare. This report presents the emergency admission of a 57-year-old female presenting with an abrupt and progressive loss of motor function and abnormal sensation in her lower extremities. MRI of the cervical spine revealed a syrinx extending from C2 to C7. Neurology referred the case to neurosurgery, who assessed the patient and recommended nonoperative and supportive treatment given the size of the syrinx and the patient's status as a poor surgical candidate. She was subsequently discharged to a local extended care facility (ECF) with a diagnosis of syringomyelia. Despite physical therapy and rehabilitation, her symptoms progressed to include loss of motor function in bilateral lower extremities, worsening paresthesia in bilateral upper and lower extremities, and progressive dyspnea. Nerve conduction studies performed during neurologic evaluation at the ECF demonstrated a sensorimotor demyelinating polyneuropathy, and she was urgently transferred to the emergency department, where Guillain-Barré syndrome was confirmed. The patient developed respiratory failure requiring mechanical ventilation and was treated with intravenous immunoglobulin. Although she experienced transient stabilization, her clinical course was complicated by progressive functional decline. This case highlights how a cervical syrinx may obscure the initial presentation of Guillain-Barré syndrome, contributing to delayed treatment, and demonstrates the importance of maintaining a broad differential diagnosis in patients with atypical or overlapping neurologic findings.

Background/Objectives: Hip arthroscopy is a minimally invasive procedure with rare complications that can occur due to air entry outside the joint space. Case Presentation: A 19-year-old patient underwent right hip arthroscopy with attempted joint venting. The next morning, she had pain in her right leg, neck, and chest with paresthesias over her hands and feet. A subsequent emergency department physical exam revealed crepitation of the lower extremities, abdomen, chest, and neck caused by air entrance during arthroscopy. The patient also reported blurred near vision. Additionally, the pupils were fixed, did not accommodate, and were dilated at 7 mm. Computed tomography scans revealed subcutaneous emphysema, pneumoperitoneum, pneumomediastinum, and cervicofacial emphysema. Magnetic resonance imaging of the brain revealed a Chiari I malformation. The patient received four hyperbaric oxygen treatments. By the fourth treatment, near visual acuity had improved, but far visual acuity had worsened. Vision had returned to normal eight days after discharge. Conclusions: It is proposed that the patient's reduced near vision, accommodation paralysis, and fixed and dilated pupils were brought about by pneumomediastinum and cervicofacial emphysema, inhibiting the ability of the pupils to constrict, causing bilateral mydriasis and accommodation paralysis for near targets. Additionally, the subsequent transient myopic shift is a known complication of hyperbaric oxygen therapy, which increases the refractive index of the crystalline lens.

Background: Cervical osteochondromas invading the vertebral canal are rare but may cause spinal cord compression requiring surgical resection. Conventional open laminectomy may disrupt posterior stabilizing structures and potentially increase the risk of postoperative cervical deformity. This technical note describes a contralateral-structure-preserving endoscopic technique for cervical osteochondroma resection. Methods: A 25-year-old man with multiple hereditary exostosis presented with neck pain, mild numbness, and a positive Lhermitte's sign. Computed tomography and magnetic resonance imaging revealed a 9 × 6 × 10 mm osteochondroma originating from the base of the C3 spinous process and extending into the vertebral canal with spinal cord compression and cord signal change. Preoperative clinical assessment included a Visual Analog Scale (VAS) for neck pain of 6/10, a modified Japanese Orthopedic Association (mJOA) score of 16/18, a Neck Disability Index (NDI) of 30%, and Nurick grade 1. The lesion was treated using unilateral biportal endoscopic spine surgery through a partial unilateral laminectomy and sublaminar endoscopic corridor, aiming for en bloc resection while preserving the contralateral lamina, posterior ligamentous complex, and posterior tension band. Continuous intraoperative neurophysiological monitoring (SSEP and MEP) was used throughout the procedure. Results: The osteochondroma was completely resected en bloc using a diamond burr and Kerrison rongeur. Histopathological examination confirmed osteochondroma, and negative margins were identified without residual tumor. The patient's symptoms resolved completely without postoperative complications, and he was discharged on postoperative day 3. At the 18-month clinical and radiological follow-up, the patient remained symptom-free, with VAS improved to 1-2/10, mJOA improved to 18/18, NDI improved to 4%, and Nurick grade improved to 0, with partial regression of the cord signal change and no evidence of tumor recurrence on follow-up imaging. Cervical lordosis was maintained at the immediate postoperative timepoint. Conclusions: Contralateral-structure-preserving endoscopic resection may represent a potential minimally invasive alternative to conventional wide laminectomy or fusion-based approaches in carefully selected cases of benign cervical osteochondroma. Larger comparative studies with long-term follow-up are required to confirm the potential biomechanical and clinical benefits of this approach.

This case report illustrates the difficulties that can arise when diagnosing a CNS infection. Following an episode of gastroenteritis, our patient developed dizziness, a fever up to 39 °C, photophobia, double vision, multiple cranial nerve deficits, and a resting nystagmus with alternating directions, and presented to the emergency department. Blood inflammatory markers were unremarkable, and a contrast-enhanced head CT scan revealed no abnormalities. The patient was discharged home with a provisional diagnosis of Meniere's disease. Two days later, the patient developed increasing lethargy and was transferred by his wife to the central hospital. Clinical evidence of multiple cranial nerve deficits and a central oculomotor disorder, accompanied by impaired consciousness and tetraataxia, were found; neurocranial MRI revealed rhombencephalitis and cervical myelitis, whilst cerebrospinal fluid analysis showed an inflammatory-infectious profile with Listeria monocytogenes cultured from the sample. Magnetic resonance imaging is the examination of choice for the diagnostic imaging of Listeria meningoencephalitis. Identifying the pathogen in the cerebrospinal fluid in cases of neurolisteriosis can be difficult. A relatively normal cerebrospinal fluid glucose level, moderate lymphocytic pleocytosis and a moderately elevated cerebrospinal fluid protein level may be erroneously attributed to a viral or mycobacterial infection. Cerebrospinal fluid cultures are positive in 33-43 % of cases of brainstem encephalitis and in 90 % of cases of meningitis. Listeria monocytogenes causes a neurological infection and usually presents as meningoencephalitis. Around 10 % of patients with bacterial meningitis have cranial nerve involvement, and hearing loss usually resulting from purulent labyrinthitis is observed in approximately 10-20 % of patients.

Tracheostomy is a critical surgical procedure for securing airways in infants and children with respiratory tract diseases. The prevalence in pediatric intensive care units ranges from 0.5-2% of hospitalized patients, carrying a significant morbidity and mortality risk. The article explores the complex medical and therapeutic aspects of pediatric tracheostomy, emphasizing personalized care. It highlights the importance of carefully selecting cannula types tailored to each child's unique clinical characteristics, and describing common surgical techniques. Post-operative care requires specialized attention in intensive care units, involving meticulous monitoring and comprehensive discharge preparation. This includes extensive parent training, medical equipment usage practice, and ensuring suitable home care conditions. The emotional and psychological dimensions receive profound attention, recognizing that tracheostomy is more than a medical intervention - it's a complex family experience that impacts child development and family dynamics. A key recommendation is implementing a multidisciplinary approach. This collaborative strategy brings together professionals from various fields: ENT specialists, pediatric intensivists, nursing staff, speech therapists, social workers, and nutritionists. The goal is to provide holistic care that addresses both medical needs and broader support requirements including emotional, social and economical aspects.

Placenta accreta is associated with severe postpartum hemorrhage (PPH) and may require massive transfusion and emergency hysterectomy, contributing to substantial maternal morbidity and mortality. The prophylactic use of the Ghosh uterine compression suture (Alternate Sequential Suture Tightening Technique (ASSTT)) may reduce hemorrhagic complications. This report describes two patients (one primigravida and one gravida 2) with antenatally diagnosed placenta accreta based on ultrasound and magnetic resonance imaging (MRI), without other comorbidities, who underwent elective-term cesarean delivery with prophylactic ASSTT and circumferential cervical suturing. The mean time to place the Ghosh suture was four to five minutes, and the mean estimated blood loss was 450 mL (range: 450-500 mL). Neither patient required a transfusion, and both were discharged on postoperative day 3 without complications. After lactation, both resumed regular menses and subsequently achieved uncomplicated pregnancies. The first patient conceived spontaneously three years later and underwent an uncomplicated term repeat cesarean delivery. The second patient conceived via in vitro fertilization (IVF) for sex selection 3.5 years later; antenatal imaging was unremarkable. However, a morbidly adherent placenta was identified intraoperatively, and ASSTT with circumferential cervical suturing was repeated. The patient was discharged on postoperative day 3 without complications. These cases suggest that prophylactic ASSTT, combined with circumferential cervical suturing, may be a feasible uterus-sparing strategy in selected patients with placenta accreta.

Tetanus is a rare but potentially fatal infectious disease caused by Clostridium tetani, characterized by muscle rigidity, trismus, and dysphagia. We report a case of tetanus mimicking post-radiotherapy dysphagia in a 68-year-old male with a history of hypopharyngeal and esophageal cancers treated with chemoradiotherapy. The patient presented with acute-onset dysphagia and speech difficulty, which were initially attributed to radiation-induced sequelae. Because dysphagia and pharyngeal discomfort are common complaints in post-chemoradiotherapy patients, and laryngoscopic findings were unchanged from his recent baseline, multiple physicians-including head and neck cancer specialists-did not suspect tetanus on the initial visit. Detailed history-taking on the following day revealed a preceding hand injury, leading to a diagnosis of tetanus. Clinical examination revealed trismus with an interincisal distance of 20 mm. The patient required endotracheal intubation due to hypercapnia and anticipated airway compromise from progressive trismus, and subsequently underwent tracheostomy, but eventually recovered full oral intake (Functional Outcome Swallowing Scale Grade 0) after intensive swallowing rehabilitation. Additionally, we reviewed eight tetanus cases treated at our institution over the past decade. Of these, 87.5% required endotracheal intubation, 75.0% underwent tracheostomy, and 50.0% had persistent dysphagia at discharge. This case underscores the importance of obtaining a thorough trauma history in head and neck cancer survivors presenting with rapidly progressive dysphagia, as tetanus-induced symptoms can closely resemble post-radiation sequelae.