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It is exceptionally rare to have posterior atlanto axial dislocation without an associated atlas or odontoid fracture and very few cases have been reported in literature. We present a case of a 50 year old female pedestrian who was hit by car while crossing a road. She presented with a depressed level of consciousness and the Glasgow coma score of 12/15, pupils were equal and reactive to light and all limbs were moving equally. She had an extensive abrasion on the forehead which extended into scalp. CT scan showed a posterior dislocation of the atlas with respect of axis with no associated fractures of C 1 and C2. She had traumatic subarachnoid hemorrhage in the basal cisterns and multiple brainstem contusions. Closed reduction of the dislocation was done successfully under fluoroscopy guidance. MRI was done post reduction because funds were not available initially and it showed increased signal in the tectorial membrane and transverse and alar ligaments with mild cord oedema at the cervicomedullary junction. However, the patient post reduction began to deteriorate and eventually passed away before definitive treatment of her cervical-spine injury. The case is reported in view of its rarity and to review literature on this uncommon condition.

Cardiovascular disease is a leading cause of mortality in all ages worldwide. Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease (CHD) accounting for 10%. There have been several reports of neurological complications associated with TOF. Although it is known, brain abscess (BA) is a serious complication in patients with uncorrected CHD mostly in the age of 4-7 years-old. We report a case of a 7 year old male who presented with a 3 month history of left sided body weakness and a 3 week history of a headache and fever. Patient was chronically unwell since birth where he would experience occasional episodes of exertional dyspnoea which was never investigated. Chest xray showed a globular-shaped heart. CT scan brain showed a 1,8 x 1,3 x 1,5 cm ring-enhancing lesion in the right parietal region with minimal perilesional vasogenic edema communicating with the body of the lateral ventricle, with enhancement of the ependymal lining of the ventricle; echocardiography revealed ventricular septal defect (VSD), overriding of aorta, obstruction to right ventricular outflow tract and hypertrophy of right ventricle consistent with a diagnosis of TOF. We elected to manage the patient conservatively on intravenous antibiotics, Patient improved significantly neurologically and was transferred to the cardiothoracic surgeons for further management of TOF.

A subdural hematoma (SDH) is usually traumatic in etiology. Non-traumatic instances of SDH are uncommon, and are rarely due to metastases involving the dura. We report a 68-year-old male patient with a one day history of, not communicating and not mobilizing and a 2 weeks history of generalized body weakness. A computed tomography (CT) scan revealed a left sided hypo-dense subdural collection. A diagnosis of left sided chronic subdural hematoma (SDH) was made. Burr hole drainage of the hematoma was performed. Intra- operatively, liquefied blood was drained and a thick dura with reddish material infiltrating the dura was noted. A specimen of the dura was submitted for histology and revealed metastatic carcinoma, confirmed at immunohistochemistry to be of prostatic origin. Conclusion: Metastatic disease should be considered when there is a chronic subdural hematoma with no history of trauma and an unusual dural appearance on imaging.

Neurofibromatosis type 1 (NF1) is an autosomal dominant condition affecting approximately 1 in 3000 live births. The manifestations of this condition are extremely variable, even within families, and genetic counseling is consequently difficult with regard to prognosis. Individuals with NF1 are acknowledged to be at increased risk of malignancy. Several studies have previously attempted to quantify this risk, but have involved relatively small study populations. Soft tissue tumors represent a heterogeneous group of mesenchymal and neural lesions. We report a case of giant scalp Fibrosarcoma of the scalp in patient with neurofibromatosis type I without intracranial extension, in a 35 year old female which was excised completely along with the involved overlying skin, and reconstruction was done to cover the defect using trapezius flap and split thickness skin graft from the right thigh. She is doing well after treatment and is in regular follow up while awaiting further management by the oncologists.