This case report highlights the importance of considering scrub typhus as a differential diagnosis for acute encephalitis with cranial nerve palsy in the region of the tsutsugamushi triangle.

Background: Tuberculosis (TB) is a global public health issue, particularly in resource-constrained countries like Nepal. This case report highlights the consequences of prolonged self-treatment and non-compliance with TB management protocols, emphasizing the need for increased awareness and intervention. Case Presentation: A 50-year-old male from Nepal self-medicated with anti-tubercular drugs for 13 years after completing the recommended course of treatment. He experienced worsening symptoms, including respiratory distress and visual impairment. Upon evaluation, he was diagnosed with chronic cavitary pulmonary aspergillosis, a complication of prolonged self-medication. The patient received comprehensive treatment, including antifungal therapy, steroids, antibiotics, and respiratory support, resulting in significant improvement. Conclusions: This case highlights the dangers of self-treatment and non-compliance with TB management protocols. It emphasizes the importance of patient education, awareness programs, and regular follow-up to ensure treatment adherence and detect complications. The case also reveals gaps in the DOTS (Directly Observed Treatment, Short Course) program, including the need for improved surveillance, and a multidisciplinary approach. The complications arising from prolonged self-medication underscore the need for increased awareness, intervention, and patient education in TB management. Improving patient education, raising awareness about the risks of self-medication, and integrating ophthalmologic evaluations into standard management are essential for better TB control in Nepal.

Background: Bilateral thalamic infarction resulting from the occlusion of the artery of Percheron (AOP) is an exceedingly rare cerebrovascular event. The intricate interplay between neurovascular anatomy, midbrain function, and clinical manifestations in such cases remains an area of clinical interest and exploration. Case Presentation: We present the case of a 48-year-old male farmer with a known history of Diabetes mellitus, who presented with diplopia, bilateral drooping of eyelids, and eventually loss of consciousness while working in the field. Initial management centered around suspected meningioencephalitis, given fever and unresponsiveness. Advanced evaluations, including brain MRI and MRA, led to the diagnosis of bilateral upper midbrain infarction involving the artery of Percheron. The patient's clinical course revealed an improvement in consciousness and responsiveness over three weeks of conservative management. Conclusions: This case report highlights the clinical rarity and diagnostic challenges associated with bilateral thalamic infarction due to AOP occlusion. The complex neurovascular interplay revealed by this case emphasizes the importance of precise diagnosis and tailored management in rare cerebrovascular events. The insights gained from this case contribute to a deeper understanding of the clinical impact and potential implications of such occurrences within the realm of stroke and cerebrovascular diseases.

We would like to acknowledge the patient herself and her relatives who allowed us to share their clinical report to the global platform, so that others will be benefitted.