Leptospirosis is a zoonotic tropical disease with worldwide distribution caused by bacteria from the genus Leptospira. The clinical picture is assorted, from asymptomatic subclinical disease to more severe forms affecting several organs, including lungs, liver, and kidneys. Neurologic manifestations account for 10%-20% of the cases. The most common neurological presentation is aseptic meningitis, but other syndromes, such as cranial nerve palsies, and encephalitis, are also seen. To our knowledge, this is the first reported case of this type of neurological presentation of leptospirosis in Panama. We present an unusual manifestation of leptospirosis in a 43-year-old man from Panama City who presented with constitutional symptoms and developed bilateral facial palsy and liver involvement during his hospitalization.

Facial nerve palsy at birth is an uncommon neurological condition that may arise from perinatal trauma or developmental abnormalities involving the facial nerve or its nucleus. While traumatic facial palsy is relatively common and often demonstrates spontaneous recovery, developmental causes such as facial nerve hypoplasia or aplasia are rare and usually associated with persistent deficits. In many cases, developmental facial palsy occurs as part of congenital syndromes involving multiple cranial nerves or systemic anomalies. Isolated absence of the facial nerve without associated syndromic features is extremely rare. This case report presents the case of a 13-year-old child with isolated congenital left facial nerve palsy who presented with the inability to completely close the left eye and mild facial asymmetry since birth. High-resolution magnetic resonance imaging (MRI) demonstrated a complete absence of the facial nerve on the affected side. While most previously reported cases are described in infancy with limited evidence regarding long-term outcomes, this case demonstrates gradual functional adaptation despite congenital facial nerve absence.

High-risk smoldering multiple myeloma (HR-SMM) carries an increased risk of progression to multiple myeloma, making it an ideal setting to test whether chimeric antigen receptor (CAR) T cell therapy can achieve curative outcomes. Here in this phase 2 study, patients with HR-SMM received ciltacabtagene autoleucel (cilta-cel) at 0.3-0.5 × 10[6] or >0.5 × 10[6] viable CAR[+] T cells per kilogram without induction or bridging therapy. Patients with >40% marrow involvement were excluded. Primary endpoints were dose-limiting toxicities (DLTs) and treatment-emergent adverse events; secondary endpoints included response and minimal residual disease (MRD) negativity. As of 11 February 2026, 20 patients had been treated. The trial met the prespecified endpoints. No DLTs occurred. Adverse events included transient cytopenias (90% grade 3/4) and cytokine release syndrome (100% grade 1/2). Non-immune effector cell-associated neurotoxicity syndrome neurologic toxicities (NINTs) occurred in seven patients, with four comprising cranial nerve palsies that completely resolved. Three patients had persistent grade 1 symptoms. At a median follow-up of 15.3 months, all patients achieved MRD negativity 10[-6] by 2 months and have remained MRD negative. Sixteen patients with follow-up >6 months achieved a complete response; no progression or deaths were observed. Cilta-cel produced rapid, deep, sustained MRD-negative responses in HR-SMM without induction therapy. Toxicities were consistent with the safety profile of cilta-cel. ClinicalTrials.gov: NCT05767359 .

Thyrotoxic periodic paralysis is an uncommon endocrine emergency marked by sudden muscle weakness linked to hypokalemia in the context of thyrotoxicosis. Cases have increasingly been reported worldwide, even though they are more common in Asian populations. Early detection is crucial because of the risk of life-threatening complications such as arrhythmias and respiratory failure. We present the case of a 42-year-old man with no significant medical history who exhibited sudden palpitations, diaphoresis, and anxiety, subsequently developing rapidly progressive lower extremity weakness, culminating in flaccid quadriparesis and acute respiratory failure requiring endotracheal intubation. Neurological examination indicated generalized weakness (0/5 strength) and areflexia, with no sensory deficit or cranial nerve involvement. Laboratory tests showed severe hypokalemia (1.3 mEq/L) and biochemical thyrotoxicosis, with low thyroid-stimulating hormone (TSH) levels (0.01 μIU/mL) and high free thyroxine (T4) levels (3.07 ng/dL). Neuroimaging and cerebrospinal fluid analysis yielded normal results. After carefully replacing potassium, the patient showed rapid clinical improvement with complete neurological recovery. Respiratory failure requiring mechanical ventilation is an uncommon presentation of thyrotoxic periodic paralysis and highlights the importance of early recognition. Thyrotoxic periodic paralysis must be contemplated in patients exhibiting acute flaccid paralysis and significant hypokalemia. Prompt diagnosis and treatment are crucial to prevent potentially fatal complications, such as respiratory failure or cardiac arrhythmias, which can arise from untreated thyrotoxic periodic paralysis.

Background Isolated lateral rectus (LR) palsy is a common cranial nerve palsy with a variety of causes. Horizontal diplopia is frequently caused by isolated LR palsy, a common cranial nerve palsy in adults. The abducens nerve is vulnerable to a variety of vascular, inflammatory, traumatic, viral, and compressive diseases because of its lengthy intracranial journey. This study aims to describe the clinical profile, etiological distribution, and outcomes in adults with isolated LR palsy. Methodology This retrospective observational study included 29 consecutive adults diagnosed with isolated LR palsy. Demographic characteristics, clinical presentation, investigation findings, etiological diagnoses, and recovery outcomes during follow-up were systematically recorded and analyzed using descriptive statistical methods. Results The mean age was 48.17 years (range = 19-85 years), with a male-to-female ratio of 15:14. Etiologies included diabetes-related microvascular ischemia in seven (24.1%) patients, hypertension-related microvascular ischemia in seven (24.1%) patients, infection with inflammation in four (13.8%) patients, trauma in four (13.8%) patients, idiopathic causes in two (6.9%) patients, tumor in one (3.4%) patient, cavernous sinus thrombosis in three (10.3%) patients, and microvascular ischemia associated with both diabetes mellitus and hypertension in one (3.4%) patient. At the last follow-up, 19 (65.5%) patients had complete recovery, two (6.8%) had partial recovery, one (3.4%) had no recovery, and seven (24.1%) were lost to follow-up. Conclusions Microvascular ischemia associated with diabetes mellitus and hypertension was the leading cause of isolated LR palsy in adults. Most patients demonstrated improvement during follow-up, whereas traumatic and compressive etiologies showed relatively poorer outcomes. Careful systemic evaluation and targeted neuroimaging are important in patients with atypical presentations or suspected non-microvascular causes. These findings emphasize the importance of systematic clinical assessment, etiological evaluation, and follow-up in adults presenting with isolated LR palsy.

Traumatic third cranial nerve palsy is a rare complication of head injury, with an incidence of approximately 1% and a characteristically poor prognosis. Conventional management remains conservative, often yielding unsatisfactory outcomes. We report the case of a 13-year-old girl who developed complete right third cranial nerve palsy following a 15-meter fall, presenting with exotropia (35Δ), ptosis, complete ophthalmoplegia, and pupillary dysfunction. Brain CT revealed hemorrhage in the right cavernous sinus, and subsequent MRI demonstrated focal nerve damage. Thirty-eight days post-injury, a single botulinum toxin type A (BTX-A) injection (5 units) was administered to the right lateral rectus muscle. Progressive improvement in ocular alignment and motility was observed, with resolution of diplopia by 4.5 months and sustained orthotropia at 10 months post-injury. Although pupillary dilation persisted, functional recovery was substantial. This case demonstrates that early BTX-A intervention may prevent lateral rectus contracture and promote functional recovery in traumatic third cranial nerve palsy. BTX-A represents a promising minimally invasive therapeutic option that warrants further investigation in larger patient populations.

Facial nerve (FN) palsy is a significant complication of microsurgical resection of vestibular schwannoma (VS) and can profoundly impact patient quality of life. Patients exhibit two distinct trajectories of FN dysfunction: immediate facial nerve palsy (IFNP), occurring early in the postoperative period, and delayed facial nerve palsy (DFNP), characterized by new-onset weakness after an initially normal postoperative examination. In this study, we aimed to identify preoperative, intraoperative, and postoperative predictors of facial nerve trajectory to inform patient counseling and improve long-term functional outcomes. Electronic health records at our institution were reviewed to identify patients who underwent microsurgical resection of VS between July 2016 and April 2024. Preoperative data included demographic characteristics, tumor features, and baseline facial nerve function, classified according to the House-Brackmann (HB) grading scale. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of IFNP and DFNP. Cox regression analysis was used to evaluate factors associated with intrinsic recovery among patients with IFNP. Among 433 patients who underwent vestibular schwannoma resection, 36.3% developed IFNP and 10.9% DFNP. DFNP was typically transient, with 90% of patients (27/30) achieving good recovery within two months. In contrast, only 35% of IFNP patients (N = 55) experienced intrinsic recovery, and approximately 60% of those without recovery (N = 66) required facial reanimation surgery. On multivariable analysis, larger tumor size (> 2 cm) independently predicted IFNP, while younger age (< 33 years) independently predicted DFNP. In this study, we found that larger tumors increased the risk of immediate FN palsy, while younger age was associated with delayed onset palsy. High HB scores at discharge predicted slower or incomplete recovery in immediate cases, whereas nearly all delayed cases recovered without intervention. Systematically characterizing these postoperative trajectories can enhance patient counseling, guide risk stratification, and inform timely interventions to optimize long-term facial nerve function.