A deceitful stroke, a hidden tumour.

A 41-year-old woman with malignant left middle cerebral artery infarction underwent an immediate decompressive craniectomy, obtaining good recovery, both clinically and radiologically. However, approximately 6 months after a successful discharge, the patient returned with gradual memory deterioration, dysarthria and progressively worsening headaches. Subsequent CT and MRI of the brain revealed a solid malignancy located in the same region as the extensive infarction. Following this finding, she underwent surgical debulking of the tumour and follow-up radiotherapy, with good progression of symptoms and overall good outcome.

Three cases of Spontaneous Vertebral Artery Dissection (SVAD), resulting in two cases of Wallenberg syndrome and one case of Foville syndrome in young, healthy men.

First patient, presented with sudden onset of headache, left hypoacusia and right hemiparesis, posteriorly developing gaze-evoked nystagmus and worsening right-sided weakness. Diagnosis of vertebral artery dissection and Foville Syndrome were made through clinical assessment and CT-carotid angiogram-MR angiography. Second patient, presented with four episodes of pain over left side of the nose and left eye pain over 1 month; admitted for acute facial pain without limb weakness. During admission, tingling over V1/V2 facial territory, vertigo, hypotension, uvula deviation and right lower limb numbness. CT-carotid angiogram confirmed vertebral artery with dissection. MRI revealed left lateral medullary infarct. Third patient, presented with sudden onset of left facial numbness and right upper limb weakness; 1 day after, right arm and leg hypoesthesia with hoarseness. MRA revealed dissection of left distal vertebral artery and MRI showed infarction in lower medulla oblongata.