An unusual presentation of cortical venous thrombosis and its association with typical antipsychotics.

A 41-year-old patient with schizophrenia was admitted to hospital following episodes of unexplained collapse attacks and on and off episodes of frontal headaches for 3 months. After three such episodes of loss of consciousness in 2 weeks duration and subsequent spontaneous recovery, his evaluation which included MRI scan of head revealed extensive cortical venous thrombosis. He was on zuclopenthixol (thioxanthene group) for several months for schizophrenia and was under regular psychiatric evaluation. He was treated for simple lower respiratory infection a week prior to admission. Other causes for any clotting disorders including vasculitic and thrombophilic screen were negative. There was no evidence of focal neurology on examination. Systemic examination was otherwise unremarkable. He was treated initially with unfractionated heparin and subsequently changed to warfarin with target international normalised ratio between two and three for at least 6 months and psychiatrist was advised to stop zuclopenthixol.

Septic arthritis affecting pubic symphysis.

A 26-year-old man presented to accident and emergency with a 1-week history of fever, rigors and sudden onset of severe left testicular pain. The symptoms started without trauma and pain radiated to the abdomen and was worse on walking. He had raised temperature and inflammatory markers. He reattended 2 days later with progressive bilateral groin pain, night sweats and the blood cultures grew Staphylococcus aureus. Repeat cultures were sent and the patient was arranged to be followed up in clinic. He returned 5 days later with worsening symptoms. S aureus was grown from the second blood culture, so he was admitted for intravenous flucloxacillin. MRI of the pelvis showed a small fluid collection around the pubic symphysis and extensive periarticular bone marrow oedema consistent with septic arthritis and a retropubic abscess. He was treated with a 8-week course of flucloxacillin with complete resolution.