Autoimmune encephalitis typically presents with an acute or subacute onset of cognitive decline, altered mental status, and seizures. Here, we report a case of anti-leucine-rich glioma-inactivated 1 encephalitis characterized by an atypically protracted period of cognitive decline, followed by the delayed onset of seizures. We describe the clinical characteristics, unique neuroimaging findings, and the patient's response to treatment. By discussing the implications of this unusual clinical trajectory, we aim to enhance diagnostic awareness and prevent potential misdiagnosis in cases with atypically prolonged presentations.

Amniotic fluid embolism (AFE) is a rare but devastating complication during pregnancy. We present an instance of an embolic stroke following an AFE in labor with a concurrent patent foramen ovale (PFO). The patient was a 34-year-old G4P2 who had an acute seizure event intrapartum. She was taken for an emergent cesarean delivery during which she was noted to have cardiopulmonary compromise. A cesarean hysterectomy was performed due to ongoing DIC and hemorrhage. Postoperatively, she was found to have evidence of thrombotic emboli as well as a PFO. She had a good neurologic recovery with supportive measures even prior to discharge from the hospital and has continued to do well. When more common etiologies of intrapartum seizures have been excluded, providers should maintain a high index of suspicion for embolic stroke.

Multiple carboxylase deficiency (MCD) is a rare, treatable inborn error of biotin metabolism that may present in children in the first year of life with life-threatening metabolic crises. We report a 4-month-old child presenting with persistent seizures, eczematous rash near the orifices, unjustified loss of hair with baldness, and severe metabolic acidosis, initially mimicking septicemia. Urine organic acid investigation showed elevated levels of 3-hydroxyisovaleric acid, 3-methylcrotonylglycine, 3-hydroxypropionic acid, methylcitrate, and lactate that lead towards MCD. This diagnosis remains unconfirmed, as confirmatory testing (serum biotinidase activity and genetic analysis) was not available at our center. Early initiation of biotin (10 mg/day) led to rapid clinical and biochemical recovery. This particular case depicts the importance of biotin-responsive metabolic disorders in the first year of a child presenting with the classic triad of seizures, dermatitis, and alopecia with metabolic acidosis. Early recognition and prompt initiation of biotin therapy can result in rapid clinical recovery. Timely diagnosis is crucial to prevent avoidable morbidity and long-term neurological sequelae. This case highlights the importance of considering MCD in children. In the first year of life, unexplained metabolic acidosis as timely treatment can be lifesaving.

Tobacco consumption gets normalized with its positive portrayal through tobacco advertisement, promotions and sponsorship (TAPS) of tobacco products, to initiate or catalyze consumption. While the Cigarettes and Other Tobacco Products Act, 2003 (COTPA) bans TAPS in India, it is prevalent through social media, cable television, sponsorship of cricket matches, music or award shows, school or college events, etc., and through brand stretching to nontobacco avenues like consumer goods, hotel chains, etc., COTPA shows internal inconsistencies in its short title, preambular aim, and provisions, which carve out an exception for advertising at points of sale. Ban's implementation is also limited due to the expensive action-taking mechanism and limited fines. These lacunae are further exacerbated by the inconsistencies of COTPA with other laws governing trademarks, cable television, food safety, consumer protection, etc. that allow for the advertisement of cobranded products of tobacco companies. To address TAPS comprehensively in India, these inconsistencies need to be redressed, arguably through legislative amendments in COTPA and allied laws, better implementation mechanisms, simplifying seizure of evidence for presentation in courts, and prioritizing public health over commercial interests of tobacco companies in the judicial pronouncements.

BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a neuro-radiological disorder characterized by seizures, headache, visual problems, and vasogenic edema visible on imaging scans. While it is most frequently linked to hypertensive crises, eclampsia, autoimmune conditions, and immunosuppressive drugs, its association with post-streptococcal glomerulonephritis (PSGN) is rare, particularly in adults. Typically, PRES associated with PSGN occurs in children and can develop even when blood pressure is mildly elevated. CASE REPORT We describe the case of a 20-year-old Sudanese man who presented with a sudden, severe headache, 2 episodes of generalized tonic-clonic seizures, and complete painless bilateral vision loss. Examination showed mild hypertension, periorbital swelling, and pedal edema. Laboratory tests indicated acute kidney injury, nephritic-range proteinuria, microscopic hematuria, low complement C3, and markedly elevated anti-streptolysin (ASO) titers, supporting a diagnosis of PSGN. Brain imaging revealed bilateral parieto-occipital vasogenic edema consistent with PRES. The patient was treated with oral antihypertensives, anticonvulsants, and a short course of steroids. Clinical improvement occurred within 24 h, with progressive vision restoration by day 3 and full recovery by day 5. Renal function normalized within 2 weeks, and no neurological deficits remained. CONCLUSIONS This case highlights an uncommon presentation of PRES secondary to PSGN in a young adult with mild-to-moderate blood pressure elevation. It emphasizes the importance of early recognition of PRES in patients with recent streptococcal infection and kidney dysfunction, even if they do not have severe hypertension. Rapid diagnosis and prompt treatment are crucial to achieve full neurological recovery and prevent potential complications.

Fever is one of the most common reasons for pediatric emergency visits, yet misconceptions continue to shape caregiver behavior and clinical practice. This review examines 5 common myths and misconceptions: (1) fever is harmful, (2) higher fever signals more severe illness, (3) antipyretics prevent febrile seizures, (4) clinical improvement after antipyretics rules out serious infection, and (5) alternating antipyretics is superior to monotherapy. Emergency medicine clinicians should prioritize distress-relieving care, careful assessment for serious illness, and effective caregiver education to reduce fever phobia and promote safe, evidence-based use of antipyretics.