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OBJECTIVE: This study aims to investigate the relationship between thyroid computed tomography (CT) density and serum thyroid stimulating hormone (TSH) levels in patients with hypothyroidism. METHODS: The research involved 60 hypothyroid patients aged 18 years and older, with TSH levels exceeding 5 mIU/mL or those already receiving thyroid supplementation therapy. These individuals had undergone non-contrast CT chest scans due to concurrent respiratory concerns. The thyroid CT densities, as evaluated through non-contrast chest CT, were compared to those of euthyroid patients with normal TSH levels. Correlation analysis was conducted to assess the relationship between serum TSH levels and thyroid CT densities. RESULTS: Hypothyroid patients exhibited significantly reduced thyroid CT densities (P<0.0001). The correlation analysis revealed an inverse correlation between TSH levels and thyroid CT densities in hypothyroid patients (r=-0.365, p=0.020) and a positive correlation (r=0.270, p=0.036) in euthyroid patients. CONCLUSION: This study demonstrates a substantial correlation between thyroid CT density and serum TSH levels. As TSH levels increase in hypothyroid patients, thyroid CT density tends to decrease.

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Ptosis, unilateral or bilateral, partial or complete, occurring in cases of cerebral ischemic or hemorrhagic stroke, trauma or tumor without involvement of brainstem or oculo-sympathetic mechanism can be termed as cerebral ptosis. Such eyelid dysfunction can occur with hemispheric involvement of either side. It is associated with higher frequency of gaze preference to side of lesion as well as upgaze limitation compared to patients without cerebral ptosis. Here, we present our observations in four such patients with stroke and discuss its evaluation and implications with a brief review of literature.

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Background: An increased incidence of systemic macrothrombotic phenomena such as strokes has been observed in moderate and severe COVID. However, strokes have also been increasingly observed in mild COVID, post COVID, or without obvious COVID illness. Objective: To share our experience with a specific stroke type noted during the COVID pandemic period. Materials and Methods: A single-center observational study was conducted in Western India from January to December 2020, and data regarding stroke patients admitted under Neurology services were noted. Clinical, laboratory, and radiological characteristics of strokes and subtypes were documented. Results: A total of 238 stroke patients were admitted in 2020, 76.5% during the COVID pandemic period. Among 153 ischemic strokes, 16.3% and 56.2% had large vessel occlusion (LVO) in pre-COVID and COVID pandemic period, respectively. Of all ischemic strokes, 20.9% (18 patients) and 12% (3 patients) had free floating thrombus (FFT) in the COVID versus pre-COVID period, respectively. Only 44.4% of all FFT patients could be proven SARS-CoV-2 RT-PCR positive while 50% were COVID suspect with surrogate markers of heightened inflammation at time of stroke. All patients were given anticoagulation and average mRS at discharge was 3.1 (range: 1-6) and 1.84 (range: 0-4) at 3-month follow-up in survivors. Conclusions: This study highlights the presence of FFT causing LVO as a new stroke subtype during the COVID-19 pandemic. With renewed and steeper spike in COVID-19 cases, especially new variants, the resurgence of this stroke subtype needs to be actively explored early in the course of illness to reduce morbidity and mortality.

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BACKGROUND: West Nile virus (WNV) is a positive-sense single-stranded RNA virus of the family Flaviviridae and genus Flavivirus. The virus is transmitted primarily by the bite of Culex species mosquito and is of global concern. The infection is associated with a wide spectrum of signs and symptoms and is more fatal in the elderly, infants, and immunocompromised individuals. CASE PRESENTATION: We report a case of WNV meningoencephalitis in an immunocompetent female who presented with features of acute meningitis with a 5-days history. After the radiological suspicion of viral meningoencephalitis, viral serology was performed and was reactive for IgM antibody against WNV, delaying the diagnosis for at least 5 days. CONCLUSION: The purpose of this case report is to prime the treating physicians on the usefulness of viral serology in such a scenario. Viral serology is a simple and relatively rapid technique to diagnose or rule out the suspected viral cause of meningoencephalitis and minimize the time gap between diagnosis and start of supporting treatment wherever appropriate antivirals are not available for clinical use.

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Pulmonary Nocardiosis and invasive Aspergillosis are well documented in immunocompromised patients. The coexistence of both infections is a diagnostic rarity, especially in patients with underlying structural lung diseases. We describe this rare association in a 46-year-old female with a history of pulmonary tuberculosis and COPD. The diagnosis of pulmonary Nocardiosis is challenging due to non-specific clinical features, inherent ability to mimic malignancy, tuberculosis and difficulty in the cultivation of the organism. The treating physicians should aware of the rare occurrence of such co-infections in order to prevent misdiagnosis and prompt treatment.

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BACKGROUND: Diffuse leptomeningeal glioneuronal tumor (DLGNT) is a recent addition to the World Health Organization classification schema of brain tumors, under the heading of neuronal and mixed neuronal-glial tumors. DLGNTs have a classic imaging appearance. However, it has often been misdiagnosed owing to its rarity, its resemblance to granulomatous/leptomeningeal etiologies, and the clinical presentation. CASE DESCRIPTION: We have described the case of a 3-year-old girl who had presented with complaints of nonprojectile vomiting and altered sensorium that had been initially diagnosed and treated as a case of tubercular meningitis at a peripheral health facility. However, the nonresponse to antitubercular medication necessitated a repeat magnetic resonance imaging evaluation at our institute, which had revealed the classic imaging appearance of DLGNT. The diagnosis was further established by meningeal biopsy and the histopathological evaluation findings. CONCLUSION: We have described the classic imaging appearance of this rare brain tumor. Radiologists and clinicians should be aware of this entity to avoid misdiagnosis and a delay in management.

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The Ewing's sarcoma family of tumors are aggressive malignant small round blue cell tumors of undifferentiated mesenchymal origin. Skeletal Ewing's sarcoma is a common entity that classically involves the diaphysis of the long bones, pelvis, ribs, and sacrum. Extraosseous Ewing's sarcoma (EES) is rare, most commonly presenting as a paravertebral mass lesion. Its manifestation as an anterior epidural mass lesion with extension along brachial plexus is an even rarer phenomenon. A 25-year-old male presented with neck stiffness and progressive weakness of the bilateral upper and lower limbs. Magnetic resonance imaging of the cervical spine revealed an anterior epidural mass lesion compressing the cervical cord and extending along the right brachial plexus, suggesting imaging differentials of EES and lymphoma. The patient underwent laminectomy with gross tumor resection, and histopathology confirmed a diagnosis of EES. EES should be kept in the differential diagnosis of anterior epidural mass lesions in young adults, specifically when the lesion shows extension along multiple neural foramina and nerve plexus.