This report describes the case of a 58-year-old female patient with a history of hypertension, dyslipidemia, and childhood asthma, who presented with neck stiffness, headache, and mild fever, raising concern for meningitis. Despite her high BMI and reluctance to undergo a lumbar puncture, she was initially treated with intravenous aciclovir and ceftriaxone while microbiological tests, including procalcitonin, ruled out bacterial infection. Laboratory markers, such as CRP and white blood cell count, improved over time, and cervical spine X-rays revealed cervical spondylosis with C4-C5 protrusion, explaining her symptoms. As a result, antimicrobial therapy was discontinued, and she was referred to a local spine specialist. This case underscores the need to consider cervical spine pathology as a differential diagnosis in patients with meningitis-like symptoms, particularly when invasive investigations are not feasible.

Carcinoma ex pleomorphic adenoma (Ca ex PA) is an uncommon but highly aggressive malignancy arising from long-standing pleomorphic adenoma. Malignant transformation typically presents with rapid enlargement, pain, and facial nerve involvement. Metastatic spread is exceptionally rare. We describe a 67-year-old man with a decades-long right parotid mass that underwent malignant change after prior surgical excision confirmed Ca ex PA. After being lost to follow-up, he re-presented with neck stiffness, hearing loss, and facial nerve palsy. Imaging demonstrated a recurrent parotid mass infiltrating adjacent space, accompanied by cervical lymphadenopathy and bilateral pulmonary nodules suggestive of metastases. This case highlights the severe consequences of untreated or inadequately followed salivary gland neoplasms and underscores the necessity of early excision, thorough histopathologic assessment, and consistent long-term surveillance to prevent advanced Ca ex PA.

Flexible intramedullary nails (FINs) are commonly used in children and adolescents to treat long bone fractures, but few studies exist in animals. This study aimed to evaluate the biomechanical performance of FINS for the stabilization of transverse femoral fractures in cats. Fifteen bones were kept intact, while in another 15 bones, a mid-diaphyseal transverse fracture was induced and stabilized with two steel FINs of equal diameter, advanced divergently toward the greater trochanter and femoral neck, with end caps applied to the free ends. Five constructs and five intact bones were subjected to axial compression, four-point bending, and torsion tests. In axial compression, intact bones showed higher mean maximum force (1090.51 N vs. 608.43 N) and stiffness (845.98 vs. 298.86 N/m) than constructs. In bending, intact bones reached a maximum force of 1384.75 N, whereas a distinct maximum force could not be determined for the constructs; stiffness was also greater (1580.92 vs. 13.32 N/m). In torsion, intact bones demonstrated substantially higher mean maximum force (6.764 vs. 0.166 Nm) and stiffness (32.11 vs. 1.04 Nm/rad) than constructs. In conclusion, FINs with end caps demonstrate low construct stiffness, particularly under torsional loads, when used to stabilize mid-diaphyseal transverse femoral fractures in cats.

Severe generalized tetanus causes autonomic dysfunction with hemodynamic instability. While thromboembolic and hemorrhagic complications are recognized, cerebral infarcts secondary to tetanus-related dysautonomia have not been documented. A previously healthy 79-year-old unvaccinated woman presented with trismus and neck stiffness and was diagnosed with severe generalized tetanus. She received human tetanus immunoglobulin, tetanus toxoid, and intravenous metronidazole, and was intubated and managed in the ICU under deep sedation. She developed severe dysautonomia requiring vasopressors. Fever on day 6 was attributed to ventilator-associated pneumonia, treated with ampicillin-sulbactam for seven days; sepsis and infective endocarditis were excluded. Subcutaneous heparin calcium was administered for deep vein thrombosis (DVT) prophylaxis from day 1, and was switched to edoxaban on day 14 for both prophylaxis and treatment of internal jugular vein thrombosis. Neuroimaging after ICU transfer revealed asymptomatic multiple cerebral infarcts presumed to result from hemodynamic instability. A left iliopsoas hematoma was incidentally identified on day 21, leading to edoxaban discontinuation. Thereafter, no pharmacological treatment was administered for the hemodynamic stroke or iliopsoas hematoma. Follow-up MRI examinations demonstrated progressive improvement in imaging findings. The patient underwent rehabilitation and was transferred to a rehabilitation facility on day 51. A literature review revealed that iliopsoas hematoma occurs in approximately 20% of patients with tetanus, yet remains underrecognized by physicians. This is the first documented case of tetanus complicated by cerebral infarction suggestive of hemodynamic stroke. Physicians should be aware that severe tetanus-related dysautonomia may cause cerebral infarction, and that iliopsoas hematoma may represent a disease-related complication.

Introduction Vascular stiffness and osteoporosis are independently associated with increased cardiovascular morbidity. We investigated aortic pulse wave velocity (aoPWV), a measure of vascular stiffness, and bone mineral density (BMD) in peritoneal dialysis (PD) patients. Methods AaPWV was measured in patients who had dual energy X-ray absorptiometry (DXA) scans. Results The mean aoPWV was 10.0 ± 0.3 m/s in 118 established PD patients (57.6% male; mean age 64.5 ± 15.3 years. AoPWV was negatively associated with whole body T score r=-0.23, p=0.014, and Z score r=-0.21, p=0.031, left and right leg BMD (r= -0.22, p=0.019; -0.19, p=0.049), and femoral neck BMD (r=-0.18, p=0.047), but not after adjusting aoPWV for age and cardiovascular risk factors. Conclusions Vascular stiffness and osteoporosis increase with age. We report increased vascular stiffness associated with reduced BMD, but after adjusting for confounders, these associations were no longer significant, suggesting an overlapping connection rather than causality. .

Intracranial hypertension can mimic acute meningitis, especially in immunosuppressed patients presenting with fever and meningism, often prompting urgent empirical treatment. Distinguishing infectious from non-infectious causes is crucial to avoid unnecessary antimicrobials and delayed diagnosis. We report a 20-year-old woman with systemic lupus erythematosus on rituximab and a recent corticosteroid taper who presented with fever, severe headache, photophobia, and neck stiffness. She was started on empirical antibiotics for suspected meningitis. Lumbar puncture showed a markedly raised opening pressure (43 cm H2O) with otherwise normal cerebrospinal fluid (CSF). Neuroimaging excluded structural lesions and cerebral venous sinus thrombosis, while ophthalmologic examination confirmed papilloedema. Her symptoms improved after a therapeutic lumbar puncture and acetazolamide. This case highlights the value of measuring CSF opening pressure and reconsidering the diagnosis in immunosuppressed patients with meningitic features.

The reconstruction of complex orbitomaxillary defects requires biomaterials that can simultaneously provide structural stability, biocompatibility, and accurate restoration of facial volume and contour. While rigid polymers such as polyetheretherketone (PEEK) offer reliable mechanical support, they do not adequately replicate the viscoelastic behavior of soft tissues. This report presents a translational revision case employing a personalized hybrid biomaterial approach that combines a 3D-printed PEEK implant for structural orbital floor support with a patient-specific polydimethylsiloxane (PDMS) implant for malar volumetric augmentation. Reconstruction was planned using CT segmentation and contralateral mirroring. Patient-specific implants were subsequently designed using CAD/CAM techniques, combining a rigid PEEK implant for structural orbital support with a flexible PDMS implant for malar volumetric augmentation with complementary mechanical properties. Revision surgery included the removal of inadequately positioned titanium hardware, the release of incarcerated extraocular muscles, and the restoration of orbital anatomy and facial symmetry. Postoperative imaging demonstrated stable implant positioning and sustained orbitomaxillary stability. Despite successful anatomical reconstruction, residual functional sequelae, including strabismus related to the severity of the initial orbital trauma, persisted and were addressed separately in a staged manner, resulting in satisfactory ocular alignment and resolution of diplopia in primary gaze. This case underscores the complementary functional roles of rigid and elastic polymers and highlights the translational potential of PDMS as a permanent, patient-specific implant material for volumetric and contour restoration in craniofacial reconstruction.

Background/Objective: Dizziness is managed using various therapies, including lifestyle changes, nutritional supplementation, pharmaceutical therapies, and physical therapy, each offering differing efficacy. With legalization of cannabis in Canada, patients are exploring its use in treating their dizziness and related symptoms. Limited knowledge exists regarding usage patterns, forms, doses, and effects on these symptoms. The current study aims to examine cannabis use in patients experiencing dizziness. Methods: We conducted a cross-sectional study at the Ottawa Hospital outpatient neuro-otology clinic. Eligible participants included new patients presenting with a primary complaint of dizziness and follow-up patients reporting new-onset dizziness. Participants completed a questionnaire capturing demographic data, dizziness and related symptoms, attitudes toward cannabis use, consumption patterns, and its perceived effects on their symptoms. Results: Of 154 participants, 118 (77%) expressed willingness to consider cannabis for dizziness and 78 (51%) reported previous cannabis use. Of those patients, 44 (56%) consumed it recreationally, largely via smoking (29/78, 37%). Approximately 21% of these patients reported a moderate-large subjective relief from dizziness after use of cannabis. The most common diagnoses amongst cannabis users were migraine/vestibular migraine (24%), persistent postural perceptive dizziness (22%), and benign paroxysmal positional vertigo (17%). Other related symptoms relieved by cannabis included sleep (28/78, 36%), emotional difficulties (17/78, 22%), neck pain/stiffness (14/78, 18%) and headaches/migraines (9/78, 12%). Conclusions: There is generally a positive attitude towards cannabis use in treating dizziness amongst patients, with a subset of patients reporting a subjective improvement of dizziness and its related symptoms, such as sleep and emotional difficulties.