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The diagnosis of secondary syphilis can be challenging due to its various clinical and histopathological presentations. A late or incorrect diagnosis can result in disease progression with consequent morbidity or mortality. Due to the importance of a correct diagnosis and specific treatment, it is of the utmost importance for healthcare providers to consider the various manifestations of syphilis. We describe an atypical presentation of secondary syphilis in an African American man infected with HIV and chronic psoriasis, who presented with two months of diffuse maculopapular rash and new visual changes, found to have acute syphilitic placoid chorioretinitis (ASPCC) and a psoriasis vulgaris flare.

A 53-year-old male with history of traumatic brain injury (TBI) presented with localized dissociative amnesia following a second head injury. While memory loss due to TBI is present in the literature, presentations of this type are very rare. Although fully independent in activities of daily living, this patient demonstrated severe deficits in visual memory and processing speed upon neurocognitive evaluation. Effort testing was unremarkable. Increased awareness and study of memory loss following TBI can contribute to enhanced understanding and improved care for patients experiencing these deficits. The authors present this unique case’s profile, clinical history, and discuss their findings.

βeta-hydroxybutyrate (BHB) is a ketone body produced by the liver in a process known as ketosis, as an alternative fuel source during fasting or carbohydrate caloric restriction, and is readily used as fuel throughout the body, including in the brain. While glucose is the brain’s principal energy source, when limited, ketones derived from fats become the major energy substrate. Exogenous BHB is safe to administer orally and can enhance energy and physical performance. While the literature suggests cognitive and/or behavioural performance improvement in animal models following elevation in ketones, and in clinical human samples such as those with Mild Cognitive Impairment, Alzheimer’s disease, epilepsy, and severe traumatic brain injury, the literature investigating the neurocognitive effects of exogenous administration of ketones in nonclinical, healthy samples remains limited. For this proof of concept, we present twelve subjects who underwent exogenous administration of 11.7 g of BHB. After ingestion, participants performed significantly better in attentional accuracy compared to pre-intervention scores (p < 0.05; d = 0.65), demonstrating that exogenous administration of BHB may have positive effects on the attentional accuracy domain of neurocognition in neurotypical adults. Further analysis and its clinical implications are discussed.

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