Capsular warning syndrome.

We present a case of a 72-year-old man who presented with fluctuating right-sided weakness and numbness. This was characterised by episodic sudden onset weakness with resolution of symptoms in between. His symptoms and signs were becoming persistent despite the addition of dual antiplatelet therapy. The history we describe is classical of capsular warning syndrome. The patient went on to have further definitive neuroimaging which revealed a pontine infarct, rather than the expected capsular infarct. We discuss the importance of capsular warning syndrome, the proposed pathophysiological mechanisms and different locations of infarction in previous cases of capsular warning syndrome. We also discuss the lack of consensus (within the literature) in treatment options which are used to try and prevent a completed stroke occurring in cases of capsular warning syndrome.

An unusual bump on the head. Intraextracranial meningioma presenting incidentally.

Meningiomas are common intracranial tumours which rarely extend to extra cranial sites. Here, the authors report a rare case of an intracranial meningioma with extracranial spread into the subcutaneous tissues of the scalp, with a brief overview of the literature. An 82-year-old man presented following a fall. At the time of assessment, it was noted that he had a large deformity over the frontal area of his scalp. It was unclear as to the duration of this deformity. Following an inconclusive CT head he underwent a MRI head which revealed an intracranial mass which extended across the frontal lobes. The mass permeated through the skull and extended through to the scalp. He underwent a biopsy of the extracranial component. The histology of which suggested a benign meningioma with low mitotic activity.