Chronic migraine (CM) refractory to conventional pharmacotherapy (r-CM) remains a debilitating neurological condition with limited therapeutic options. High-frequency spinal cord stimulation at 10 kilohertz (HF-SCS) has recently emerged as a distinct neuromodulatory paradigm for this patient population. Unlike traditional spinal cord stimulation, HF-SCS operates above the frequency range that generates paresthesia, thereby eliminating stimulation-induced sensation while potentially engaging unique analgesic mechanisms.

The aim of this study was to identify risk factors associated with complications following mandibular fracture open reduction and internal fixation (MORIF). The secondary purpose was to determine if a delay in surgery contributed to complications. Analysed complications were: surgical site infection (SSI), plate removal (PR), non-union (NU), repeat open reduction and internal fixation (re-ORIF), occlusal discrepancy (OD), second operation, postoperative paraesthesia (POP) and temporomandibular joint (TMJ) symptoms. Factors analysed for association were: patient factors (sex, age, smoking, alcohol, immunocompromise, recreational drug use), surgeon factors (grade), fracture factors, single vs multiple, number of fracture sites, side, displacement, horizontal favourability for angle and site of fracture, symphysis, parasymphysis (PS), body, angle and condyle ± presence of vertical shortening (VS). A retrospective cohort study of 252 patients treated, in a single centre between October 2015 and November 2023. All patients underwent MORIF ± condyle fracture open reduction and internal fixation (CORIF) ± maxillomandibular fixation (MMF). Risk factors associated with complications were: CORIF and SSI (OR (95% CI) 7.92 (1.62-77.48) p = 0.009), age and SSI (OR (95% CI) 1.03 (1.00-1.06) p = 0.029) age and OD (OR (95% CI) 1.03 (1.01-1.05) p = 0.010), condyle fracture and OD (OR (95% CI) 2.32 (1.20-4.53) p = 0.012), immunosuppression and PR (OR (95% CI) 16.41 (2.83-113.2) p = 0.003), vs condyle fracture and PR (OR (95% CI) 0.17 (0.02-0.94) p = 0.041), age and NU (OR (95% CI) 1.06 (1.02-1.10) p = 0.008), CORIF and NU (OR (95% CI): 11.25 (1.16-1491.4) p = 0.035) and immunosuppression and second operation (OR (95% CI) 5.64 (1.03-35.6) p = 0.046). There was no significant association between delay in time of surgery with any of the complications analysed, suggesting that selected mandibular fractures may be suitable for semi-elective management.

NUP214::ABL1 generates a fusion protein with constitutively activated tyrosine kinase activity and is present in rare T-lymphoblastic leukemia (ALL), B-ALL, and in rare cases of myelodysplastic neoplasm/acute myeloid leukemia (MDS/AML). Here, we for the first time reported NUP214::ABL1 in a case of erythroblastic sarcoma (ES), a rare extramedullary form of acute erythroid leukemia (AEL). A 55-year-old female with a reported three-year history of MDS presented with worsening lower extremity paresthesia. Magnetic resonance imaging revealed an intraspinal T2-T4 extradural mass. Examination of the mass biopsy supported by extensive immunoprofiling was diagnostic of ES. Fluorescence in situ hybridization (FISH) identified concurrent deletions of 5p15.2 and 5q31 (likely monosomy 5), trisomy 8, and deletion of 7q31 while absent for translocations included in AML FISH panel. Next-generation sequencing (NGS) including DNA (406 genes) and RNA (265 genes) panels revealed NUP214::ABL1 (N31; A2) and TP53 I50fs*2 (VAF 85.9%). The patient died approximately two weeks after the ES diagnosis. This informative case emphasizes the importance for pathologists to be familiar with ES as a rare extramedullary form of AEL and a potential transformation from MDS. It is critical to apply comprehensive studies including cytogenetics/FISH and NGS in rendering prompt diagnosis for optimal management.

Schwannoma is a benign, encapsulated, slow-growing tumor that arises from Schwann cells. Approximately 25%-45% of extracranial schwannomas occur in the head and neck region, accounting for 1%-8% of all neoplasms. However, involvement of the infraorbital nerve is exceptionally rare. This report describes the surgical management of an infraorbital nerve schwannoma using a transconjunctival approach with lateral canthotomy, and documents the clinical, functional and aesthetic outcomes at 12 months. A 32-year-old woman with a history of hypochromic microcytic anemia presented with a progressively enlarging mass in the right infraorbital region that had been present for four years, associated with mild paresthesia in the nasolabial region. The main reason for consultation was aesthetic concern due to facial protrusion. Physical examination revealed a firm, painless subcutaneous mass without local inflammatory signs. Contrast-enhanced computed tomography revealed a solid, lobulated lesion measuring approximately 60 mm in maximum diameter in the right infraorbital region. Imaging features suggested an origin from the infraorbital foramen and involvement of the corresponding nerve; there was no evidence of osteolysis. Fine-needle aspiration cytology (FNAC) suggested a mesenchymal neoplasm. Surgical excision was performed under general anesthesia via a transconjunctival approach with lateral canthotomy. The infraorbital nerve was identified and preserved intraoperatively. Histopathological examination confirmed a schwannoma, showing spindle-shaped cells with Verocay bodies. The patient had a favorable clinical course. At the 12-month follow-up, facial symmetry and preserved sensory function were confirmed, as was the absence of recurrence.

Lambert-Eaton myasthenic syndrome (LEMS) is a rare autoimmune neuromuscular junction disorder characterized by muscle weakness and autonomic dysfunction. While amifampridine is the established first-line symptomatic treatment, longitudinal data regarding the evolution of therapeutic regimens over time and the use of immunosuppressive therapies remain limited. This retrospective study analyzed 70 LEMS patients treated at the Leiden University Medical Center (LUMC) between 1992 and 2023. Treatment was evaluated and a four-point "leg score" was developed and used to retrospectively quantify functional impairment and response to amifampridine. Sixty-six percent of the cohort was female, the median age of diagnosis was 54 years and non-tumor LEMS was more prevalent (77%). All patients used amifampridine at some point, and 91% initiated it within six months of diagnosis. Amifampridine improved leg scores in 57% of patients. Although 58% of patients reported side effects (mostly paresthesia), discontinuation was rare (7%). Pyridostigmine was used in 81% of patients. Immunosuppressive drug use-predominantly prednisolone and azathioprine -increased over time, reaching 44% after five years. Conversely, azathioprine, prednisolone and pyridostigmine were discontinued by 50%, 38% and 32% of patients, respectively, often due to adverse effects. In conclusion, amifampridine provides significant clinical benefits and remains the cornerstone of LEMS therapy. Immunomodulatory therapies were introduced gradually and their use increased over time. Compared with autoimmune myasthenia gravis, immunomodulatory therapy was used less frequently during the early disease course of LEMS.

Osmotic demyelination syndrome (ODS) is a rare neurological disorder typically associated with rapid correction of hyponatremia, whereas alcohol-related peripheral neuropathy (ALN) is a common complication of chronic alcohol use. The coexistence of ODS and ALN is uncommon and may obscure timely diagnosis. We report the case of a 51-year-old man with a long-standing history of alcohol dependence who presented to the emergency department with vomiting and diarrhea persisting for six days. Laboratory tests revealed hyponatremia, macrocytic anemia, thrombocytopenia, and electrolyte imbalances. Neurological examination demonstrated distal paresthesia, diminished reflexes in the lower extremities, and positive Babinski and Chaddock signs. MRI revealed a hyperintense trident-shaped lesion in the pons consistent with ODS. These findings suggested the concomitant presence of ALN and ODS. The patient was treated conservatively with vitamin supplementation, careful correction of electrolytes, and gradual nutritional rehabilitation. Sodium levels normalized without the need for rapid correction, and the patient's symptoms improved, leading to discharge on the eighth hospital day. This case underscores two essential points: ODS was identified before any documented rapid in-hospital correction of hyponatraemia, and alcohol-dependent patients may present with overlapping features of ALN and ODS. Recognition of pyramidal signs is critical for differentiating central from peripheral neurological complications in this population. Clinicians should maintain a high index of suspicion for concomitant ODS in alcohol-dependent patients with neuropathy, particularly when pyramidal signs are present.

Thigh compartment syndrome after blunt athletic trauma can be difficult to recognize when symptoms evolve in a delayed fashion. We present the case of a previously healthy 20-year-old male football player who developed progressive right thigh pain and swelling after blunt trauma sustained during play. Initial radiographs and venous duplex ultrasonography showed no acute osseous abnormality or deep venous thrombosis, and he was discharged with a presumed soft tissue injury. He returned nine days later with worsening thigh and knee pain, progressive swelling, inability to ambulate, paresthesia, tachycardia, hypotension, leukocytosis, elevated creatine kinase, and elevated lactate. Compartment pressure measurements and clinical examination were concerning for thigh compartment syndrome, and he underwent emergent decompressive fasciotomy. Intraoperatively, purulent material was encountered within the muscle compartment, prompting further evaluation for an infectious process. Subsequent imaging and operative exploration demonstrated a large intramuscular abscess involving the thigh and septic arthritis of the knee. Blood and synovial anaerobic cultures grew Fusobacterium necrophorum. Further history revealed recent pharyngitis, supporting a presumed but unproven mechanism of transient bacteremia with hematogenous seeding of traumatically injured thigh musculature and secondary involvement of the knee joint. Dental disease identified on imaging represented an alternative potential portal of entry that could not be excluded. The patient required serial operative debridement, arthrotomy with irrigation and debridement, targeted antimicrobial therapy, and delayed primary closure. He was discharged in stable condition with close outpatient follow-up and demonstrated clinical improvement. This case emphasizes that delayed progression after blunt extremity trauma should prompt consideration of occult infection, particularly when pain, systemic findings, or operative findings are disproportionate to the presumed injury.

Oral dysaesthesia is a chronic pain condition which can significantly impact patients' quality of life. Due to the multifactorial aetiology of the condition, it can be challenging for both primary and secondary care clinicians to identify and treat all possible causative factors. Comprehensive history taking and focussed chairside examination are imperative in the determination of predisposing factors for oral dysaesthesia.Immunotherapy is a concept in cancer therapy which is becoming the standard of care in the management of certain malignancies. Patients may be well enough to attend general dental appointments while on immunotherapy treatment and therefore increasingly primary care clinicians can expect this cohort of patients under their care.Obinutuzumab is a monoclonal antibody which can be used as a first-line therapy in subsets of non-Hodgkin lymphoma. We present our experience of a patient who suffered severe, therapy-limiting oral dysaesthesia, while undergoing treatment with obinutuzumab for follicular lymphoma. We present the clinical findings and investigations undertaken, which lead to a diagnosis of oral dysaesthesia in this case, and discuss the evidence base surrounding immunotherapy associated with oral dysaesthesia. To the authors' knowledge this is the first reported case of oral dysaesthesia associated with obinutuzumab therapy, but as more patients are treated with novel immunotherapy agents, this may be an important treatment side effect to highlight for future research and dental clinicians' knowledge.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and represents a substantial source of pain, disability, and healthcare expenditure. Ultrasound-guided perineural corticosteroid injection (CSI) remains the most established injectable treatment for CTS; however, hydrodissection with 5% dextrose in water (D5W) has emerged as a promising alternative that may address both inflammatory and mechanical contributors to median nerve entrapment. Our objective is to review the current evidence comparing ultrasound-guided perineural CSI and D5W hydrodissection for the nonoperative treatment of CTS and to discuss clinical considerations regarding their use. A narrative review of the literature was performed using PubMed/MEDLINE and Google Scholar through January 2026. Search terms included "carpal tunnel syndrome," "median nerve," "corticosteroid injection," "hydrodissection," "perineural injection," "dextrose," and "D5W." Priority was given to randomized controlled trials, systematic reviews, meta-analyses, clinical practice guidelines, and prospective cohort studies evaluating CSI, D5W hydrodissection, or direct comparisons between these interventions. CSI remains supported by a robust body of evidence demonstrating reliable short-term improvements in pain, paresthesias, and functional outcomes in patients with mild-to-moderate CTS. D5W hydrodissection has demonstrated favorable clinical and sonographic outcomes, with several studies reporting sustained symptom improvement beyond the time frame typically observed with CSI. Direct comparative studies suggest that D5W hydrodissection may provide longer-lasting symptom relief in some patients; however, current evidence remains limited by small sample sizes, heterogeneity in hydrodissection techniques, and a lack of large multicenter randomized controlled trials. Both ultrasound-guided perineural CSI and D5W hydrodissection are effective nonoperative treatment options for CTS. CSI remains the current first-line injectable therapy because of its extensive evidence base and established efficacy. D5W hydrodissection represents a promising alternative that may provide longer-lasting symptom improvement while avoiding corticosteroid-related adverse effects. Additional high-quality comparative studies are needed to further define optimal patient selection and the long-term role of D5W hydrodissection in CTS management.

Guillain-Barré syndrome (GBS) is an immune-mediated disorder of the peripheral nervous system characterized by progressive weakness and often triggered by infections. GBS has an estimated mortality rate of approximately 5%, with a worldwide incidence of 0.81-1.91 cases per 1,00,000 person-years. This case reported a 23-year-old man presented with progressive weakness in all four extremities. An initial neurological examination revealed bilateral total ophthalmoplegia, ptosis on both eyes, bilateral facial palsy lower motor neuron (LMN) type, dysarthria, dysphagia, flaccid tetra-paresis, gloves, and stocking paresthesia. Lumbar puncture showed cytoalbumin dissociation. Nerve conduction studies showed a demyelinating sensorimotor polyradiculoneuropathy lesion. The patient received intravenous immunoglobulin (IVIG) treatment 0.4 g/kg/day for 5 days, physical rehabilitation therapy, nutritional support, multidisciplinary care involving anesthesiology and intensive care teams, and other symptomatic treatments. At five-month follow-up, the patient demonstrated complete recovery. GBS typically presents as an acute ascending sensorimotor neuropathy; however, atypical presentations may occur. Extensive cranial nerve involvement-including complete ophthalmoplegia, bilateral facial palsy, and bulbar dysfunction-in AIDP is uncommon and may mimic other GBS spectrum disorders. Early recognition, prompt immunotherapy, and careful electrophysiological evaluation are essential for optimizing patient outcomes. Because electrodiagnostic classification of GBS may evolve over time, serial nerve conduction studies should be considered whenever feasible to improve subtype classification and diagnostic confidence.

Orbital floor fractures are among the most common fractures in the maxillofacial area. Nonetheless, muscular entrapment and enophthalmos are the only known reasons for orbital floor reconstruction, with little data supporting infraorbital nerve paresthesia as an indication. This case report presents a 30-year-old female patient who developed chronic infraorbital nerve paresthesia for 3 weeks as a result of an orbital blowout fracture involving the infraorbital canal. The patient underwent infraorbital nerve decompression and orbital floor reconstruction. The outcome was satisfactory, as the patient reported an immediate postoperative neurosensory recovery, confirmed by a light touch test and comparison to the contralateral healthy side, which was confirmed over 6 months of follow-up. If infraorbital paresthesia lasts more than 2 weeks, orbital floor reconstruction may be considered. However, further research is needed to validate the findings of this report.

Failed back surgery syndrome (FBSS) frequently involves mixed mechanical, inflammatory, and neuropathic mechanisms and remains challenging to treat, particularly when systemic anti-inflammatory therapy is limited. We report a 55-year-old woman with chronic refractory left lumbosciatica after endoscopic lumbar discectomy and L3-L4 arthrodesis, with established coronary artery disease and prior myocardial infarction limiting the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Lumbar magnetic resonance imaging demonstrated prior L3-L4 arthrodesis, multilevel degenerative disc disease, and an L4-L5 diffuse disc protrusion causing dural-sac compression, degenerative central canal narrowing, and bilateral foraminal narrowing; lower-limb electroneuromyography did not show active large-fiber radiculopathy. A single-session, single-access caudal procedure was performed using a radiopaque steerable epidural catheter-electrode system, allowing both catheter-directed adhesiolysis and sequential epidural pulsed radiofrequency (PRF) delivery through the catheter tip adjacent to the left S1, L5, L4, and L3 dorsal root ganglion/nerve-root regions. At 5 days, the patient reported approximately 60% improvement in the radiating lower-limb pain. At 8 weeks, she reported approximately 70% improvement in the radicular pain component, while overall pain intensity decreased from NRS 9/10 to 5/10, with residual axial low back pain. A transient sacral neuritis with gluteal paresthesia was the only adverse event and resolved with conservative treatment. This case illustrates a combined interventional strategy for selected patients with refractory FBSS, while the single-case, multicomponent design precludes attribution of benefit to any individual element.