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Diabetic striatopathy (DS) is an acute hyperkinetic movement disorder characterized by hemiballismus-hemichorea (HBHC) due to nonketotic hyperglycemia. DS manifests a fascinating interplay between endocrinopathy (diabetes), striatal (putamen, caudate nucleus, globus pallidus) pathology, and a dramatic neurological movement disorder, HBHC. The striking hyperintensity on imaging modalities such as computed axial tomography (CT) scan of the brain and T1-weighted magnetic resonance imaging (MRI) of the brain can mislead the clinician to an erroneous diagnosis of a cerebral hemorrhage and/or ischemic infarct, especially in an acute setting. We present an acute case of DS and outline the natural history, semiology, typical radiological findings, and therapeutic options. With careful and thoughtful analysis, an accurate diagnosis can be exacted, sparing the patient unnecessary anxiety and medical costs.

Trigeminal neuropathies (TNp) are a group of well-characterized disorders that involve damage to or infiltration of the trigeminal nerve. The underlying etiology of trigeminal neuropathy can be traumatic, inflammatory, autoimmune, paraneoplastic, malignant, and very rarely infectious. We present a case of trigeminal neuropathy due to local malignant invasion of the mandibular nerve with mandibular nerve enhancement at the foramen ovale and foramen rotundum. In the process, we review various etiologies of trigeminal neuropathy associated with trigeminal nerve involvement at the foramina. We emphasize the importance of a comprehensive evaluation in patients with trigeminal neuropathy, which includes searching for perineural spread or invasion by a local head and neck malignancy, as well as ruling out an inflammatory or autoimmune etiology. Our case also demonstrates that a higher field strength magnet can reveal pathology unseen with a lower field strength magnet.

Intracerebral hemorrhage (ICH), accounting for 9-27% of all strokes, carries substantial rates of morbidity and mortality that have not shown much improvement in the past decades. The poor outcomes of ICH can be attributed to the primary and secondary brain injuries caused by mass effects and inflammatory mechanisms, respectively. Early ICH evacuation is a critical component of treatment, as it mitigates the effect of both the primary and secondary mechanisms of brain injury and is associated with significant improvement in patient outcomes. However, no standardized evacuation technique exists. This technical report introduces a novel stereotactic vacuum-assisted minimally invasive (MIS) aspiration of a hemorrhagic stroke with its effectiveness evidenced by excellent patient recovery.