Carbon monoxide (CO) poisoning typically results in bilateral globus pallidus and subcortical white matter injuries, sometimes followed by delayed encephalopathy with white matter changes. This report describes a patient with CO poisoning who initially presented with isolated cerebellar lesions on imaging. Following recovery from the acute phase, the patient developed delayed encephalopathy, manifesting as Parkinsonism and akinetic mutism. This case highlights that isolated cerebellar involvement may represent an atypical radiological finding in CO poisoning.

Background: s/Aims: This study evaluated the feasibility and outcomes of surgical treatment for metachronous periampullary carcinoma following curative resection of primary extrahepatic bile duct cancer. Methods: A retrospective review was conducted of seven patients who underwent pancreaticoduodenectomy (PD) for metachronous periampullary cancer after prior curative surgery for extrahepatic bile duct cancer. Results: The mean age at the second surgery was 66.7 years (range, 43–81 years). Initial malignancies included three hilar cholangiocarcinomas, one middle bile duct cancer, and three gallbladder cancers. Subsequent primary tumors consisted of three distal bile duct cancers, three pancreatic head cancers, and one duodenal cancer. The mean interval between the first and second cancers was 47 months (range, 13–121 months). No perioperative deaths occurred. Postoperative complications developed in three patients (42.9%):chyle leakage (Clavien–Dindo grade II) in two (28.6%) and a grade C postoperative pancreatic fistula requiring reoperation (grade IIIb) in one (14.3%). Both chyle leaks were managed conservatively. During follow-up, four patients died of recurrence at 5, 12, 19, and 24 months postoperatively. One patient underwent video-assisted thoracoscopic surgery for pulmonary metastasis 2 months after PD and remains alive 22 months later without recurrence. Two patients are disease-free at 38 and 92 months of follow-up. Conclusions PD for second primary periampullary cancer after resection of extrahepatic bile duct cancer appears feasible and potentially effective. Although no perioperative mortality occurred, major complications were observed. Larger studies are needed to confirm these preliminary findings.

The author reports a patient with anterior cerebral artery (ACA) territory infarction presenting with myelopathy-like symptoms. The patient developed leg weakness and sensory loss below T4 level on the right side. Magnetic resonance imaging revealed no abnormalities in the spinal cord, but acute infarction in the left medial frontal lobe and stenosis of the left ACA. This case presents unusual clinical manifestation of ACA infarction mimicking myelopathy.

The author reports a patient with anterior cerebral artery (ACA) territory infarction presenting with myelopathy-like symptoms. The patient developed leg weakness and sensory loss below T4 level on the right side. Magnetic resonance imaging revealed no abnormalities in the spinal cord, but acute infarction in the left medial frontal lobe and stenosis of the left ACA. This case presents unusual clinical manifestation of ACA infarction mimicking myelopathy.

The author reports a patient with anterior cerebral artery (ACA) territory infarction presenting with myelopathy-like symptoms. The patient developed leg weakness and sensory loss below T4 level on the right side. Magnetic resonance imaging revealed no abnormalities in the spinal cord, but acute infarction in the left medial frontal lobe and stenosis of the left ACA. This case presents unusual clinical manifestation of ACA infarction mimicking myelopathy.

Inflammatory myofibroblastic tumors (IMTs) of the duodenum are exceptionally uncommon, and their epidemiologic and clinical characteristics remain poorly defined because of the limited number of reported cases. We previously reported a case of duodenal IMT in the Korean Journal of Gastroenterology in 2018, with follow-up data available only up to 12 months. IMTs typically behave in a benign manner, but they may occasionally demonstrate local invasiveness and recurrence; therefore, achieving complete surgical excision is crucial, followed by long-term surveillance. In the present manuscript, we provide a subsequent long-term follow-up report of the same patient, offering an extended 88-month postoperative course and additional radiologic and pathologic details not included in the earlier publication. This follow-up report highlights the long-term benign behavior of the tumor despite positive surgical margins and anaplastic lymphoma kinase (ALK)-negative immunohistochemistry, contributing meaningful information to the scarce literature on adult duodenal IMTs.

Dry ice is a solid form of carbon dioxide and is commonly used in everyday life to keep food or medicine cold. In South Korea, there have been rare cases of carbon dioxide asphyxiation and poisoning from dry ice, though there have been no reports of its use in suicide. In the first case, a man was found lying down dead and left a large amount of dry ice in his room. In the second case, a man died by tying a belt around his neck after placing a plastic bag filled with dry ice over his head. The third death was by placing a large amount of dry ice in a large rubber basin in his room and filling it with water. Dry ice itself is mostly harmless, but if it is not handled carefully in a confined space, it can cause accidents due to accidental oxygen deprivation. Its easy availability in everyday life also means it is likely to be misused for suicidal purposes. Investigators should consider the potential for asphyxiation or poisoning incidents if they discover dry ice or its packaging at the forensic scene.

Syringobulbia is a rare neurological disorder characterized by a fluid-filled cavity in the brainstem. In this study, clinical signs, features on magnetic resonance imaging (MRI), and the diseases present concurrently with syringobulbia were investigated in 33 small breed dogs. Most dogs (97%) had concurrent syringomyelia, and some dogs (24%) presented with vestibular or cranial nerve symptoms associated with the medulla oblongata. MRIs revealed slit-like, bulbous, and vertical linear shapes of the cavities on T2-weighted hyperintense and T1-weighted hypointense signals similar to the cerebrospinal fluid. Chiari-like malformations were identified in all dogs. This study highlights the association of syringobulbia with syringomyelia and Chiari-like malformations in small breed dogs with or without brainstem-associated clinical signs.

Heat stroke is a condition of severe heat injury characterized by hyperthermia, multiorgan failure and central nervous system dysfunction. A 79-year-old woman was brought to our hospital in a semicomatose state. She was found lying unconscious on her house yard at a hot summer day. Her body temperature was 40.3°C. Laboratory findings were consistent with multiorgan failure and rhabdomyolysis. Brain magnetic resonance imaging showed multifocal infarctions in the bilateral basal ganglia, cerebellum, and occipital lobe. Despite cooling therapy and supportive treatment, her mentality was not recovered. This case suggests that multiple cerebral infarction may occur as a complication of heat stroke and prompt treatment is crucial.