Tuberculous meningitis with stroke: A case report of diagnostic dilemma and therapeutic triumph.

Tuberculous Meningitis (TBM) is a rare manifestation of Mycobacterium tuberculosis infection affecting the meninges. We present a case of a 40-year-old male initially presenting with neurological deficits mimicking ischemic stroke. Despite classic signs, including fever, headache, and neck stiffness, TBM was initially overlooked, leading to delayed treatment. Comprehensive assessment, imaging findings, and characteristic cerebrospinal fluid findings, confirming TBM with tubercular stroke. The patient responded positively to antitubercular therapy and steroids. This case underscores the diagnostic challenges of TBM, emphasizing the need for a broad differential diagnosis, particularly in regions with a high tuberculosis prevalence. Recognition of atypical presentations is crucial for timely intervention and improved outcomes.

Perforation of oesophagus and aorta by an unusual migratory fish bone: case report.

This report describes a migratory fish bone which was not found during 1st surgery causing perforation to the superior part of the arch of aorta. The patient presented with feeling of something stucked in her throat after eating fish subsequently followed by progressive excruciating pain in the neck. During 2nd surgery the fish bone was found to have migrated from the superior aspect of the arch of aorta to the anterolateral aspect of the arch of aorta after piercing the aortic lumen. We report a case of migratory fish bone which was not found during 1st surgery. The clinical examination of the throat revealed no foreign body. The CT scan of the neck and upper thorax demonstrated a 1cm linear foreign body part of which had perforated into the superior part of the arch of aorta with mediastinal hematoma. The most likely cause was a fish bone. The patient's condition slowly deteriorated, median sternotomy and exploration of mediastinum then followed. Unfortunately no fish bone was found and only mediastinal hematoma was discovered. After the first operation the patient condition did not improve and repeat CT scan of the neck and upper thorax was done 3 days later. A similar foreign body has now moved from the superior aspect of the arch of aorta to the anterolateral aspect of arch of aorta. Exploration was done again and this time the fish bone was found.