Granulomatosis with polyangiitis (GPA) is a systemic necrotizing vasculitis associated with anti-neutrophil cytoplasmic antibodies (ANCA). Although pituitary involvement is rare, it represents a clinically relevant manifestation that may present as a sellar mass mimicking a pituitary neuroendocrine tumour (PitNET), leading to diagnostic delay and inappropriate management. We report the case of a male patient who initially presented at 24 years of age with recurrent epistaxis and nasal crusting, with histopathological evidence of chronic granulomatous inflammation of undetermined aetiology. Four years later, he developed headache, diplopia, bitemporal hemianopia, polyuria, and polydipsia. Magnetic resonance imaging revealed a pituitary mass with suprasellar extension. Endocrine evaluation demonstrated hypopituitarism and arginine vasopressin (AVP) deficiency. The patient underwent transcranial resection under the presumptive diagnosis of a non-functioning PitNET; however, postoperative imaging showed lesion progression. Further investigation revealed positive C-ANCA and systemic features consistent with GPA. Histopathological reassessment with immunohistochemistry supported the diagnosis of granulomatous hypophysitis in the context of GPA. Induction therapy with cyclophosphamide achieved initial disease control, but pituitary relapse occurred during maintenance therapy with azathioprine, prompting treatment escalation to rituximab. Rituximab led to reduction of the pituitary mass and sustained clinical stability over four years. Persistent hypopituitarism required long-term hormone replacement. Pituitary involvement in GPA is an uncommon but important diagnostic challenge and may closely mimic a PitNET. This case highlights the need for careful integration of systemic clinical features, endocrine findings, imaging, and histopathological reassessment when evaluating sellar masses. Immunosuppressive therapy with cyclophosphamide and rituximab was effective in controlling pituitary involvement, although permanent pituitary hormone deficiencies may persist despite disease control.

The 1920s was a formative period in the development of neurosurgery in Ireland. This study examines a 1922 brain tumour case treated by Adams McConnell, father of Irish neurosurgery, that illustrates the clinical limitations and defining practices of early neurosurgical interventions. A 19-year-old female was admitted with progressive neurological symptoms, including paraesthesias, diplopia, worsening vision, persistent vomiting, and gait imbalance. On clinical examination, signs of severe raised intracranial pressure and brainstem involvement were present, including papilledema and ataxia. Following diagnostic ventriculography, the patient then underwent two surgeries, including attempts at posterior decompression and posterior fossa exploration. Her condition rapidly declined postoperatively, marked by escalating fever and tachycardia, resulting in her death. Autopsy revealed a right-sided skull base tumour originating from the Gasserian ganglion. The tumour had eroded the middle cranial fossa and extended posteriorly to compress the pons, so it was not visible to the surgeons during craniotomy. Without modern medical technology and imaging, careful history taking, meticulous clinical observations, and the neurological examination were relied on to formulate a diagnosis. This study offers a snapshot of early neurosurgery amid diagnostic constraints; through which we can appreciate the remarkable advancements in the field over the past century.

Binocular vision requires that the brain integrate input from both eyes to form a unified percept. Small interocular differences support depth perception (stereopsis), while larger disparities can cause diplopia or binocular rivalry. The neural mechanisms by which early visual circuits process concordant versus conflicting binocular signals remain incompletely understood. Here, we used visually evoked potentials (VEPs), unit recordings, and 2-photon calcium imaging in the binocular region of mouse primary visual cortex (bV1) to examine how distinct forms of binocular disparity engage local circuits. We found that interocular phase disparities reduced VEP magnitude through decreased neuronal firing early in the response (40-80 ms after stimulus onset). Orientation disparities also decreased VEP magnitude, but via increased firing later in the response (100-200 ms). This late activity was enhanced in both regular-spiking (putative excitatory) and fast-spiking (putative parvalbumin-positive inhibitory) units. In contrast, calcium imaging revealed that somatostatin-positive interneurons were suppressed during orientation conflict. These findings suggest that phase differences suppress bV1 responses via feedforward mechanisms, while orientation disparities prolong activity through a process associated with suppression of somatostatin-positive interneurons. Our results reveal cell-type specific circuit mechanisms engaged by different forms of binocular conflict and provide a foundation for mechanistic investigations of perceptual suppression and rivalry.

Visual complaints are common after mild traumatic brain injury (mTBI), yet the scope, assessment approaches, mechanisms, and rehabilitation strategies reported in the literature remain heterogeneous. To synthesize evidence on post-concussive visual symptoms, diagnostic/assessment approaches, treatment/rehabilitation strategies, and putative mechanisms. Relevant studies published between 1997 and 2025 were identified and screened; 57 studies reporting visual outcomes following mild traumatic brain injury were included. The literature comprised cohort and cross-sectional studies, randomized and non-randomized intervention studies, case series and case reports, as well as selected guidelines and reviews. Studies were tagged to five domains (Symptoms; Diagnosis/Assessment; Treatment/Rehabilitation; Pathophysiology/Mechanisms; Epidemiology). We performed narrative synthesis with quantitative tabulation and co-occurrence mapping (symptom-test; symptom-treatment). Frequencies of symptom types, assessment modalities, intervention categories, mechanistic signals, and their co-occurrences. Publications spanned 1997-2025, with 56.1% appearing in 2021-2025. Symptoms were reported in 49 studies, dominated by oculomotor disturbances (46.9%) and photophobia (36.7%); binocular anomalies were frequent (diplopia 18.4%; convergence insufficiency 16.3%; accommodative insufficiency 14.3%). Among 21 assessment papers, clinical tests used to assess binocular-vision metrics predominated (accommodation 57.1%; vergence 38.1%; NPC 19.0%), with selective device-based testing (VEP 19.0%; eye-tracking 14.3%; OCT 9.5%). Twenty-one treatment studies most often described vision/orthoptic therapy (47.6%) and vestibular-oculomotor rehabilitation (42.9%); prisms (19.0%) and tinted lenses (14.3%) were used in targeted subgroups. Mechanistic reports (n = 29) emphasized oculomotor control abnormalities (79.3%), with smaller contributions from VOR and VEP findings; structural correlates (DTI/OCT) were less common. Co-occurrence analyses showed dense links between oculomotor symptoms and accommodation/vergence/NPC testing, and between photophobia and spectral filters. Post-concussive visual sequelae are clinically coherent and largely reflect neuro-oculomotor dysfunction with frequent binocular anomalies and photosensitivity. High-yield assessment centers on vergence, accommodation, and NPC, optionally augmented by screening tools and selective device-based measures. The most consistent therapeutic signals favor vision/orthoptic and vestibular-oculomotor rehabilitation, with prisms and tinted lenses for select indications. Standardized outcomes and well-powered comparative trials are needed to strengthen recommendations. This review integrates symptoms, objective testing approaches, and rehabilitation outcomes across the neuro-visual sequelae of mTBI and provides a structured clinical mapping of symptom-test and symptom-treatment linkages.

Background and Clinical Significance: Bilateral carotid-cavernous fistulas are rare clinical entities characterized by heterogeneous clinical presentations and variable outcomes. Case presentation: We report the case of a 69-year-old woman with a three-month history of progressive bilateral conjunctival hyperemia, proptosis, intermittent diplopia, and a left eye abduction deficit. Her systemic history included long-standing arterial hypertension and previous thyroidectomy with stable substitutive therapy. Comprehensive ophthalmologic, neurologic, and endocrine evaluations excluded more common causes of orbital congestion, including thyroid eye disease, orbital cellulitis, cavernous sinus thrombosis, and idiopathic orbital inflammation. The patient denied any history of recent trauma. Digital subtraction angiography (DSA) confirmed a bilateral, low-flow, indirect Barrow type D carotid-cavernous fistula (CCF) supplied by dural branches of both the internal and external carotid arteries, with marked reflux into dilated superior ophthalmic veins. DSA was essential, as prior CT and MRI studies did not identify any vascular abnormalities. The patient was scheduled for transvenous embolization; however, during the follow-up she noted gradual improvement in her condition. Repeat pre-procedural angiography performed approximately two months later demonstrated complete spontaneous closure of all shunts, accompanied by full clinical resolution. Conclusions: Owing to the exceptional rarity of bilateral indirect CCFs and the added occurrence of spontaneous closure, this case expands the limited existing literature and emphasizes the diagnostic challenges and the need for individualized treatment timing supported by multidisciplinary evaluation in low-flow dural carotid-cavernous fistulas.

Intravenous thrombolysis is traditionally avoided in patients with early recurrent acute ischemic stroke due to concerns for increased hemorrhagic risk. Although emerging evidence suggests that repeat intravenous thrombolysis may be safe in selected patients, nearly all published cases involve alteplase, with limited data on repeated use of tenecteplase.