Mönckeberg's disease, a rare medial calcific arteriosclerosis, predominantly affects lower extremity arteries with an unclear etiology. If untreated, severe complications like ischemic necrosis and gangrene may arise. We present a case of a 28-year-old male with spontaneous lower limb swelling, abscess, and itching. Despite a history of deep vein thrombosis and warfarin therapy, Mönckeberg's disease was suspected. Imaging revealed diffuse vascular calcification of the media of the arterial wall bilaterally in the right and left femoral vessels with heterogenous irregular soft tissue collection in the right with suspected infection. Following treatment, the patient's symptoms improved, and follow-up imaging showed resolution of fluid collections and improved calcification appearance. This report highlights the importance of considering Mönckeberg's disease in the differential diagnosis of lower extremity swelling and the need for timely management to prevent serious complications.

Background: Medullary brainstem lesions are rare tumors that are challenging to treat due to their location in the brainstem, which controls vital functions such as breathing, heart rate, and blood pressure. While the most common subtype is the aggressive diffuse intrinsic pontine glioma, other subtypes exist, including focal brainstem gliomas and cervicomedullary gliomas. The prognosis for patients with brainstem gliomas is generally poor, and treatment options are limited. Early detection and treatment are crucial to improve outcomes for patients with these tumors. Case Description: In this case report, the authors describe a 28-year-old male from Saudi Arabia who presented with headaches and vomiting. Imaging studies and clinical examination revealed a high-grade astrocytoma medullary brainstem lesion. The patient underwent radiation therapy and chemotherapy, effectively controlling tumor growth and improving his quality of life. However, a residual tumor remained, and the patient underwent neurosurgery to resect the remaining tumor was successful in removing the tumor, and the patient showed significant improvement in his symptoms and overall health. Conclusion: This case highlights the importance of early detection and treatment of medullary brainstem lesions. While radiation therapy and chemotherapy are primary treatment options, neurosurgery may be necessary to resect residual tumors. In addition, cultural and social factors may need to be considered in managing these tumors in Saudi Arabia.

Epidural hematomas (EDHs) are a neurosurgical emergency characterized by the accumulation of blood in the epidural space surrounding the dura mater. Spontaneous resolution of EDH is an exceptionally rare occurrence, with only 16 cases reported in the medical literature where resolution occurred within 24 hours of onset. In this case report, we present a unique instance of a chronic EDH that spontaneously resolved over a period of seven months. This case adds to the scientific literature by highlighting an extremely prolonged duration of spontaneous EDH resolution, which, to our knowledge, has not been previously documented. A 59-year-old male suffered a head injury following a fall. He presented with a progressively worsening headache and nausea, raising concerns for a potential EDH. A computed tomography (CT) scan confirmed the presence of a large right parietal EDH measuring 58 × 23 × ​​​​​​​17 mm and a large left frontoparietal EDH measuring 90 × 20 ×​​​​​​​ 12 mm. These findings were crucial in establishing the primary diagnosis and guiding subsequent interventions. Upon diagnosis of the EDHs, the patient received conservative treatment and was closely monitored. Over a period of seven months, follow-up imaging revealed complete resolution of both EDHs, with restoration of normal midline structures and ventricular sizes. Notably, this represents the longest duration of spontaneous EDH resolution reported in the literature. We attribute this uncommon outcome to the activation of endogenous fibrinolytic pathways, which are responsible for dissolving blood clots and hematomas. In addition, the formation of new collateral blood vessels around the hematoma may help facilitate its resolution. This case underscores the significance of early recognition and vigilant monitoring of EDH cases. While immediate surgical intervention remains essential in most instances, conservative management can be considered in select cases. Our report demonstrates the possibility of spontaneous resolution of EDHs over an extended period, emphasizing the importance of continued observation and appropriate management. By shedding light on this rare occurrence, this case report contributes to the limited existing literature on the topic, providing valuable insights and adding to our understanding of EDH management.

Background: Craniosynostosis, the premature closure of skull sutures, can cause a misshapen head and neurologic issues. Surgical correction may result in bone defects requiring additional surgery. Case Description: We present a 5-year-old female who underwent cranioplasty for a skull defect and bulging brain after craniosynostosis surgery. Cranioplasty corrected the defect's functional and cosmetic aspects. CT with 3D reconstruction confirmed findings and aided planning. The patient underwent cranioplasty using mesh over the defect and had an unremarkable recovery. Result: A 5-year-old had residual craniosynostosis bone defect and bulging brain. Cranioplasty used mesh over the defect, had unremarkable recovery. Early intervention and a multidisciplinary approach are key. More research is needed on this condition's prevalence, causes and management. Conclusion: This case emphasizes early intervention and a multidisciplinary approach for craniosynostosis and related defects. A team approach addressing the condition's physical and psychological impacts on the child and family is crucial for optimal outcomes. Cranioplasty is critical, and success depends on expertise. This case highlights the importance of timely, appropriate craniosynostosis management and related defect care. We hope this report contributes to literature and improves outcomes for patients undergoing cranioplasty after craniosynostosis surgery.

Objective: This study examined the perception and attitude of emergency department (ED) and primary care physicians towards subarachnoid hemorrhage (SAH) in Al-Hasa, Saudi Arabia and identified challenges in its management. Methods: A cross-sectional research design was employed in this study. A self-administered structured questionnaire with 17 validated questions was distributed electronically via email and social media to 103 eligible emergency department and primary care physicians residing in Al-Ahsa city, Saudi Arabia. The sample represented physicians from different settings. Results: Results showed physicians had moderate SAH knowledge, with age being most important in determining patient prognosis. Limited access to specialized care and trained staff were the biggest management challenges. Additional staff training and increased specialized care access were suggested to improve SAH management. Conclusion: SAH is a potentially life-threatening condition requiring immediate attention. ED and primary care physicians play a crucial SAH management role, so understanding their perception and attitude is important. Providing extra staff training and specialized care access might improve SAH management.