Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease characterised by subcortical high-signal white matter lesions on T2 weighted MRI. It most commonly occurs in children following an acute viral illness. We present a case study in which ADEM was the presenting condition in an adult female with small cell lung carcinoma. We discuss the evidence in the literature suggesting that ADEM may be viewed as a paraneoplastic syndrome.

Highlights Pleomorphic adenoma benign mixed tumor is a benign heterogeneous tumor. Infratemporal fossa infarcted neoplasms may present clinically as an abscess. The combination of CT scan and MRI might be a helpful diagnostic tool. Treatment of Infratemporal fossa infarcted neoplasms tumors is surgical. Transcervical approach allows excellent control of the tumor and neurovascular elements.

A previously healthy young man presented to hospital with severe traumatic brain injury following a motor vehicle collision. Within 24 hours of admission, and despite antibiotic coverage, he developed a fever. On the second day, the source of infection was discovered to be purulent pneumococcal meningitis. At 48 hours post-accident, he developed brain-stem death without evidence of raised intracranial pressure or trans-tentorial herniation. Initial CT scans of the head were essentially normal, but early repeat scans revealed evidence of pneumocephalus and possible frontal bone fracture. Current recommendations do not make room for targeted antibiotic prophylaxis in traumatic brain injury patients with traumatic skull fracture. We argue that our case demonstrates the need for aggressive targeted antibiotic prophylaxis in the presence of certain features such as frontal or sphenoid bone fracture and pneumocephalus.

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