Bilateral thalamic infarct involving artery of Percheron: a case report.

Introduction and importance: The thalamus and the midbrain have marked variations and overlapping in their blood supply; one of those variations is the artery of Percheron. Artery of Percheron occlusion is a rare cause of infarction in the bilateral thalamus and midbrain. Case presentation: In this case, a 60-year-old female with chronic hypertension presented with unconsciousness, motor impairments, and oculomotor disorders. Clinical discussion: Due to highly variable clinical manifestations and possible negative findings during initial imaging, these conditions are often overlooked, causing delays in therapeutic intervention and leading to bad patient prognosis. Various imaging techniques can be used for diagnosis and treatment should be started early. The treatment aims to promote recanalization as soon as possible and prevent future episodes. The involvement of the midbrain is unfavourable. Conclusion: Early clinical assessment and neuroimaging are vital for timely diagnosis and early administration of therapeutic measures for better patient prognosis.

Meningeal Signs and Cerebellar Involvement in Scrub Typhus: A Case Report.

Scrub typhus is an arthropod-borne fever that follows the bite of the larval form of Leptotrombidium mite carrying Orientia tsutsugamushi. It remains a serious health problem in the Asia-Pacific region. While it commonly presents as an undifferentiated fever with chills and an eschar, complications like pneumonitis, acute respiratory distress syndrome, disseminated intravascular coagulation, and meningoencephalitis may cause scrub typhus to be fatal. However, regardless of the dramatic presentation, treatment with antibiotics, preferably doxycycline or even azithromycin, is effective in recovery.  In this case report, we present a case of meningitis and cerebellar involvement in an adolescent with positive scrub typhus serology in the absence of an eschar. This brought forward a diagnostic delay as other infections including tuberculosis were considered before scrub typhus due to unusual presenting symptoms and the lack of an eschar. Thus, in cases like these, it becomes imperative to be aware of the unusual manifestations to initiate antibiotics on time and prevent further complications.