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Purpose: The osmotic demyelination syndrome (ODS) has been identified as a neurological complication of the rapid correction of hyponatremia. In recent years, however, various medical conditions have been associated with the development of ODS, irrelevant to changes in serum sodium. We present a rare case of a eunatremic patient who developed ODS with manifestation of parkinsonism., Case: A 55 years old woman who has hypertension, type 2 diabetes nephropathy in end-stage renal disease under maintenance hemodialysis came to us with complaint about newly developed resting tremor of bilateral upper limbs, slowness of movements and small shuffling steps. Brain magnetic resonance imaging (MRI) showed bilateral lentiform nuclei demyelination. ODS was diagnosed concerning the comorbidities and her medical history. Her neurological deficits improved dramatically after treatment of Ropinirole., Conclusion: ODS may develop in patient with risk factors regardless of change in serum sodium concentration. Brain MRI could help in early detection of the demyelination. Secondary parkinsonism may occur as a rare manifestation of ODS. Supportive treatment, monitoring of vital signs and neurological deficits are warranted. Dopaminergic agent may be beneficial in symptomatic control.

Purpose: To present a case of orbital cellulitis initially mimicking giant cell arteritis., Case Report: An 80-year-old man with a history of hypertension and type 2 diabetes mellitus was referred with a prominent progressive headache over the right temporal and periorbital areas. Non-contrast brain CT results were normal, but ESR was elevated. Giant cell arteritis was suspected initially. However, the symptoms progressed under oral corticosteroid therapy. The subsequent brain MRI with contrast revealed extensive contrast enhancement along the right optic nerve and optic canal with a rim-enhancing lesion in the posterior aspect of the optic nerve. Treatment included intravenous antibiotics and surgical drainage. Culture of the drainage revealed growth of Pseudomonas aeruginosa., Conclusion: Orbital cellulitis should be considered in patients with progressive headache over the unilateral temporal and periorbital areas, in addition to giant cell arteritis. Brain imaging with contrast should be performed for detecting occult orbital infection or other intracranial etiologies.

Purpose: To present a case of salivary gland malignancy initially mimicking Bell's palsy., Case Report: A 75-year-old woman with hypertension visited our neurological outpatient department,complaining of persistent right facial paralysis for more than a year after oral glucocorticoid therapy with recent development of vertigo and unsteady gait. She was previously diagnosed as having Bell's palsy and was prescribed oral glucocorticoid. However, her right facial muscles were still completely paralyzed, with no signs of improvement. The patient visited the outpatient department of neurology for 3 weeks, seeking treatment for the recent onset of vertigo and ataxia. Brain contrast magnetic resonance imaging (MRI) revealed the right mastoid air cells to be filled with high T2 signal intensity and low T1 signal, with destruction of the bony structure of mastoid, extending to the right jugular bulb. Results obtained from excisional biopsy and pathological analyses were used to diagnose the patient with adenoid cystic carcinoma of the salivary gland. The patient then received a thorough cancer workup and chemoradiotherapy, with the malignancy being under control. However, after a 1-year follow-up, the patient still had permanent right facial palsy., Conclusion: Salivary gland malignancy should be considered in patients with acute and subacute facial nerve paralysis, in addition to Bell's palsy. Brain imaging with contrast agents should be performed for differential diagnosis.

Background: Although Sjögren's syndrome has been known to complicate with white matter lesions, encephalopathy, or stroke, reports of cerebral venous sinus thrombosis due to Sjögren's syndrome with atypical antibodies are rare., Case Report: A 50-year-old woman was admitted to our neurological ward with nausea and vomiting following acute onset of severe headache in the left occipital region. Brain computed tomography revealed no abnormalities. The patient was fully conscious, with normal cognitive functioning, but exhibited unsteady tandem gait. Both magnetic resonance venography and computed tomography venography suggested left transverse sinus blockage. Intravenous enoxaparin, followed by oral warfarin, was initiated as treatment for cerebral venous sinus thrombosis. After investigation, Sjögren's syndrome was diagnosed and lupus anticoagulant antibody test was positive. The patient was treated with hydroxychloroquine, and appeared fully recovered at the 6-month follow-up, with no clinical or radiological signs of relapse., Conclusion: This case reports the relationship between cerebral venous sinus thrombosis and Sjögren's syndrome. It is necessary to screen autoimmune disorders in patients with cerebral venous sinus thrombosis that present with no common risk factors of venous thrombosis in order to prevent inappropriate management, and potentially adverse outcomes.