Typhus (FBT), caused by Rickettsia typhi, rarely causes neurological disease. Herein, we describe neurological involvement in two cases of FBT. In the first case, an adult presented with persistent fever which deteriorated into status epilepticus. He was successfully treated with doxycycline and made a complete recovery. In the second case, a patient suffered an ischemic stroke and had a protracted clinical course but ultimately made a near complete recovery. In addition to these cases, we conducted a comprehensive narrative review of 43 cases of neurologic involvement in FBT reported from 1989 to 2025. Cases were excluded if there were pathologic discrepancies with typical cases of FBT. Presentations ranged from cranial nerve palsies to meningitis and fulminant encephalitis. This review highlights the spectrum of CNS complications associated with FBT and underscores the importance of early recognition and treatment with doxycycline to improve outcomes. Given the potential severity of neurologic involvement, clinicians in endemic areas should maintain a high index of suspicion for FBT in patients presenting with a febrile illness and neurologic symptoms.

Bell palsy (BP) is an acute idiopathic peripheral facial neuropathy typically presenting with unilateral weakness. However, the differential electrophysiological involvement of its 6 main branches remains poorly defined, limiting branch-level diagnosis and targeted management. This retrospective study aimed to characterize nerve conduction parameters across these branches, compare injury severity, and refine electrophysiological protocols to enhance clinical decision-making. This retrospective study enrolled 56 patients with BP. Compound muscle action potential (CMAP) amplitude and distal motor latency (DML) were measured for each facial nerve branch on both the affected side and unaffected side. Side-to-side comparisons were performed using paired-samples t tests or Wilcoxon signed-rank tests, as appropriate. Data are expressed as mean ± standard deviation or median (interquartile range). A P value <.05 was considered statistically significant. Compared to the US, the affected side demonstrated significantly reduced CMAP amplitudes and prolonged DMLs across all branches (all P < .001). The severity of axonal injury, indicated by CMAP amplitude reduction ratios, ranked as follows: marginal mandibular > zygomatic (nasal) > buccal > zygomatic (orbital) > temporal > cervical. The severity of demyelinating injury, reflected by DML prolongation ratios, ranked as: marginal mandibular > buccal > zygomatic (orbital) > zygomatic (nasal) > temporal > cervical. The marginal mandibular branch exhibits the most severe electrophysiological involvement in BP. These findings underscore its critical role in disease severity and support the prioritization of this branch in both diagnostic assessment and targeted therapeutic intervention.

Polyneuritis cranialis is characterized by the simultaneous or sequential inflammation of multiple cranial nerves, which may occur unilaterally or bilaterally. Although it is often related to infection, its exact etiology remains unclear. Due to its nonspecific clinical manifestations, diagnosis typically relies on the exclusion of other conditions. Herein, we report a case of postinfectious polyneuritis cranialis. The patient presented to our hospital with restricted mouth opening, dysphagia, coughing while drinking, dysarthria, and posterior neck pain following a finger injury. Laboratory tests showed markedly elevated inflammatory markers. Neurological examination revealed involvement of cranial nerves V, IX, X, and XII. Motor nerve conduction studies of the facial nerve suggested partial facial nerve damage. Brain magnetic resonance imaging demonstrated mild nonspecific white matter changes. After exclusion of alternative diagnoses, the patient was diagnosed with polyneuritis cranialis. The patient's condition improved following corticosteroid pulse therapy and was subsequently discharged. This case highlights that the diagnosis of polyneuritis cranialis remains one of exclusion and is often clinically challenging. When encountering patients with rapidly progressive cranial nerve palsies, polyneuritis cranialis should be included in the differential diagnosis after more common structural or systemic etiologies have been excluded.

Necrotizing otitis externa (NOE) represents a severe progression of otitis externa, particularly threatening in diabetic patients, with limited clinico-microbiological data for Indians. Therefore, it is of interest to evaluate the clinico-microbiological profile in 60 diabetic adults diagnosed with NOE at a tertiary center. Among participants (mean age 60.51±9.6 years; 60% male), universal findings included external auditory canal edema, otorrhea and severe nocturnal otalgia; pus cultures grew Pseudomonas spp. in 43.3% (n=26), with no growth in 13.3% (n=8), mild conductive hearing loss in 16.7% (n=10) and facial nerve palsy (with/without glossopharyngeal involvement) in 6.7% (n=4). Pseudomonas dominance and characteristic symptoms align with global patterns, but high complication rates underscore local management gaps. Thus, we report the Indian cohort profile of NOE in diabetes, informing targeted antibiotic strategies and early cranial nerve monitoring.