Background: Intracranial calcifications are a common radiological finding, but their significance varies widely depending on the pattern and distribution. While Fahr's disease is often considered in such cases, it typically presents with bilateral and symmetrical involvement. Unilateral, extensive calcifications, especially when associated with cerebral atrophy, should prompt a broader differential. Case Presentation: We describe a 43-year-old man with no significant medical history who presented with his first-ever seizure. He was found unresponsive by his wife, with tongue biting and post-ictal confusion. By the time he arrived in the emergency department, he had returned to baseline, and his neurological examination was completely normal. Initial CT imaging revealed extensive right-sided subcortical calcifications with associated cerebral atrophy, raising the possibility of Fahr’s syndrome. However, further imaging told a different story. MRI indicated dilated convoluted signal-void formations with post-contrast enhancement, and SWI confirmed widespread blooming matching the calcifications. At the right MCA bifurcation, CT... Continue Reading

Background: Historically, the term myxedema madness has been used to describe neuropsychiatric manifestations of advanced hypothyroidism. First documented in 1888 by the Clinical Society of London, it encompasses a spectrum of mental disturbances including delusions, hallucinations, melancholia, and paranoia. Although autoimmune hypothyroidism is common in clinical practice, its presentation with acute psychosis and suicidal behavior remains rare. Case Presentation: This paper presents a compelling case of a 28-year-old male migrant worker in Qatar with no prior psychiatric history, who was admitted following a serious suicide attempt. The patient exhibited florid psychotic symptoms, including hallucinations, religious delusions, and overwhelming guilt, culminating in self-injurious behavior. Laboratory investigations revealed profound hypothyroidism with markedly elevated thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase (anti-TPO) antibodies, confirming autoimmune etiology. The episode was later attributed to severe hypothyroidism. Prompt multidisciplinary intervention; comprising levothyroxine replacement and antipsychotic therapy led to rapid resolution of psychiatric symptoms and full clinical remission.... Continue Reading

Background: Hepatic steatosis is the most common chronic liver disease, but pharmacologic options remain limited. Berberine reduces hepatic fat in randomized trials, but has very low oral bioavailability and has been studied almost exclusively as high-dose (1.0–1.5 g/day) capsules. Case Presentation: We report a single-center, retrospective, uncontrolled before–after case series of 25 adults with ultrasound-defined hepatic steatosis who used a liquid berberine-containing combination preparation during routine care, without a prescribed lifestyle intervention or control group. Twenty patients (16 men; mean age 57 years) had paired UDFF measurements and were included in the complete-case analysis; five lacked follow-up measurements. After a median of 7 weeks, UDFF decreased from 18.2 ± 6.3% to 11.2 ± 4.8% among complete cases (mean change −7.1 percentage points; 95% CI −9.1 to −5.0; p < 0.001). All 20 complete cases had a lower follow-up value, and 12 (60%) had a ≥30% relative reduction. In a conservative... Continue Reading

Background: Bilateral multiple microcystic pulmonary lesions highly suspicious for metastasis are a rare radiological manifestation of lung adenocarcinoma, and have seldom been reported in young adults. Such lesions are easily misinterpreted as infectious or cystic lung diseases, potentially leading to delayed diagnosis and inappropriate management. We report a case of lung adenocarcinoma in a young welder with multifactorial risk factors who presented with bilateral multiple microcystic lesions and achieved a sustained response to osimertinib, aiming to improve recognition and timely management of this rare presentation. Case presentation: A 35-year-old Chinese male welder presented with cough and blood-streaked sputum. Chest CT revealed a left lower lobe mass, mediastinal and left supraclavicular lymphadenopathy, and bilateral multiple microcystic lesions highly suspicious for metastasis. Despite anti-infective therapy, the pulmonary lesions persisted,and biopsy confirmed lung adenocarcinoma harboring an EGFR exon 19 deletion and a somatic TP53 co-mutation (PD-L1 TPS 10%). Osimertinib 80 mg daily achieved... Continue Reading

Background: Notalgia paresthetica is a chronic sensory neuropathy characterized by localized pruritus and associated dysesthesias. There exists no definitive treatment for the disease to date. Here we report a novel concept of dopaminergic treatment in a female patient with chronic itching due to a probably hereditary form of notalgia paresthetica. Case Presentation: We describe a 76-year-old female patient suffering from severely distressing notalgia paraesthetica. Here, itching occurred mainly during the cold season in the area medial to the left scapula. Notably the patient’s mother, uncle and cousin were also affected by the disease. Low dose treatment with levodopa 50 mg combined with benserazide 12.5 mg per day significantly reduced itching with additionally alleviating the compulsive urge to scratch. Conclusion: The neurobiological difference between A11 and A10 dopaminergic (DAergic) neurons may explain the efficacy of levodopa at low dosages. Absence of the dopamine transporter system (DAT) in A11 DAergic neurons, contrasted... Continue Reading

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