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.

Pulmonary tuberculosis typically exhibits characteristic imaging findings; however, radiological manifestations can be atypical in certain cases, leading to potential misdiagnosis based solely on CT imaging. We describe a 59-year-old man who developed a 4-month history of cough and a 2-week fever during postoperative radiotherapy following esophagectomy for esophageal cancer. CT scans revealed multiple, scattered cystic cavities in both lungs, characterized by regular shape and well-defined borders. Following anti-tuberculosis therapy, the pre-existing cystic cavities collapsed and evolved into nodular opacities, a change highly suggestive of cystic metastases given the patient's history of esophageal cancer. A biopsy confirmed granulomatous inflammation, and follow-up at eight months after the initiation of anti-tuberculosis therapy showed near-complete resolution of the lesions. Although cystic pulmonary tuberculosis is rarely reported, this case is notable for its distinct cystic characteristics. To our knowledge, this is the first case to systematically document the transformation of cystic lesions into nodules during anti-tuberculosis therapy-a finding that may raise suspicion for cystic metastases and highlights the diverse and atypical radiological manifestations of tuberculosis in immunocompromised hosts.