Vogt–Koyanagi–Harada (VKH) disease is a systemic disorder with typical bilateral granulomatous panuveitis and variable degrees of systemic features, including meningismus, vitiligo, poliosis, and dysacusis. The exact pathogenesis remains unknown, and a theory of autoimmune response against certain antigenic component of melanocytes has been suggested [1]. Diagnosis is mainly based on clinical f...

A 62 year-old woman experienced a sudden onset severe headache and collapsed at work. EMS was called and, when they arrived, the patient was awake but confused. She was immediately transported to the ED. The patient had a history of hypertension and was on HCTZ and ACE inhibitor in addition to daily aspirin. On examination, she was somnolent and had sonorous respirations at a rate of 10 per min...

Nervous system injuries associated with epidemic hemorrhagic fever (EHF) are not rarely seen. However, cerebrovascular disease arising from EHF is rarely reported in the literature. A 50-year-old male patient suffered from subarachnoid hemorrhage (SAH). No abnormal condition was found in intracranial vascular digital subtraction angiography (DSA). But, this patient presented with positive hanta...

This 47 year old woman presented with subacute bilateral eye redness and pain. She was febrile with signs of meningismus. She had bilateral exophthalmos and chemosis, left ptosis (figure top left), and complete bilateral ophthalmoplegia. Her CSF contained 73 white blood cells/mm (63% neutrophils) and 7 red blood cells/mm, with a protein concentration of 1.3 g/l and a glucose concentrationof 0.5...

Subarachnoid haemorrhage arises from the accumulation of blood between arachnoid and pia mater resulting an aneurysmal rupture or traumatic head injury. is a life-threatening emergency that requires prompt treatment. The characteristic presenting symptom thunderclap headache, which patients may describe as “worst headache life” further imaging. Associated symptoms include nausea, vomiting, dipl...

typically found in darkly pigmented women aged 30 to 39 years. It can also be associated with systemic features including meningismus, hearing changes, and skin manifestations. To our knowledge, this is the first case report of a patient with hemophagocytic syndrome with features resembling ocular Vogt-KoyanagiHarada disease. It is possible that the hyperinflammatory state of hemophagocytic syn...

Bacterial meningitis is a severe illness with potentially dangerous consequences in any patient population. In the years from 2003 to 2007, children less than two years old had the highest estimated rate of bacterial meningitis of any age group. [1] In neonates, not only are the risks of infection profound – including death – the presentation can be atypical, making the likelihood of occult dis...

A middle-aged man with a history of smoking and hypertension complains of acute onset severe headache and neck pain last night following the use of intranasal cocaine. On examination, HR 99 blood pressure 132/90 respiratory rate 22 SpO2 95% room air. He is alert but mildly agitated. His cranial nerve, motor-sensory, and funduscopic exams are normal. The remainder of his physical exam is unremar...

An immunocompetent 51 year-old female presented to the Emergency Department (ED) with a chief complaint of transient loss of consciousness and was found to have cryptococcal meningitis. She complained of general fatigue and a 'cramping' sensation in her right arm for one week. The physical exam was significant for the presence of a right homonymous hemianopsia and the absence of fever or signs ...