Gallstone ileus as a cause of distal jejunal obstruction is rare. Herein we present a case of gallstone ileus without any previous biliary symptoms and with Rigler's triad on radiological investigation. As the signs and symptoms of gallstone ileus is nonspecific high index of suspicion is necessary to make a diagnosis of gallstone ileus. One staged cholecystectomy, fistula repair and enterolithotomy was done and patient recovered uneventfully.

Background and Importance:Tuberous sclerosis, also known as Bourneville's disease is a rare autosomal dominant disease affecting multiple systems. In this case report, we emphasize the importance of clinical criteria instead of genetic analysis in diagnosing tuberous sclerosis and the need for rigorous follow-up of patientsto prevent complications. Case Presentation: Here we present a case of a 10-year-old boy presenting with intractable seizure and hypo-pigmented patches on his face and back of trunk. In neuroimaging evaluation, subependymal giant cell astrocytoma was diagnosed. Further, hisabdominal ultrasound showed multiple hamartomatous lesions in the liver and bilateral kidney. His cardiology and dental evaluation were normal. The dermatologist diagnosed a shagreen patch on the back of his trunk. Based on the latest clinical diagnostic criteria, he was diagnosed with a case of tuberous sclerosis and has been on the rigorous follow-up ever since. Conclusion: Since tuberous sclerosis is a multisystem disease, early diagnosis is necessary to prevent acute symptoms and prevent long-term complications. Here we emphasize the need to use clinical criteria instead of genetic study for early diagnosis of tuberous sclerosis.

Background and Importance: Skull base osteomyelitis (SBO) is a complex disease process often confused with malignancy due to clinical and radiological masquerade. Extensive changes have recently occurred in the clinical course and management of the disease, attributed to improvements in neurosurgical procedures, diagnostic modalities, and the introduction of new antibiotics and management techniques thus reducing the associated morbidities and mortalities. However, SBO continues to pose a major challenge in the form of early diagnosis and management and can be the cause of devastating complications and high fatality associated with the disease. Case Presentation: Here we provide the clinical profile, investigation, management, and outcome of 5 cases of SBO, all of whom were thoroughly examined for the neurological deficit, complete blood count, inflammatory markers, and radiographic imaging. Biopsy and microbiological culture reports were collected and patients were followed up. Conclusion: Early diagnosis and culture-specific antibiotic treatment have been shown to provide good outcomes. Due to its rarity, large case series of SBO are insufficiently found in the literature.

Background and Importance: Anaplastic Oligodendroglioma (ODG) constitutes 24% of all pediatric ODG. The mean age of presentation of ODG is 12±6 years. They are most common in frontal and temporal lobes; however, rare cases of intraventricular ODGs are reported. Most commonly they arise from the anterior part of lateral ventricles. Third ventricle ODG is extremely rare and only a few cases of lateral and third ventricle anaplastic ODG are reported. ODGs infiltrate locally to meninges and rarely have leptomeningeal spread. Thus, ODG forms a differential diagnosis of pediatric intraventricular tumor. Case Presentation: Here we present a case of a 15-month-old male child with raised intracranial pressure due to obstructive hydrocephalus. The patient was detected to be COVID-19 RT–PCR (Reverse Transcriptase Polymerase Chain Reaction) positive in the preoperative period and underwent emergency Right-sided Ventriculo Peritoneal (VP) shunt. His contrast MRI (Magnetic Resonance Imaging) Brain showed a 50×24×39 mm heterogeneously enhancing mass epicenter at third ventricle and extending to lateral and fourth ventricle with spinal drop metastasis. Preoperative differential diagnosis of Ependymoma was made and definitive surgery was done once the child recovered from COVID-19. However, his biopsy specimen pathology and Immunohistochemistry (IHC) were suggestive of anaplastic oligodendrogliomas and the child responded well to chemotherapy. Conclusion: Intraventricular ODG is an extremely rare pediatric tumor. Patients usually present with obstructive hydrocephalus. Contrast MRI findings are nonspecific and help in detecting leptomeningeal spread to the spine. IHC and chromosomal analysis are important diagnostic and treatment prognostication tools. These tumors have a high recurrence and poor prognosis despite gross total resection.

Introduction: Hemangiopericytomas are rare CNS Neoplasms constituting <1% of CNS tumours. They are more commonly seen in cranium than in spine where they present as Intradural extramedullary in location. They rarely metastasize to Lung and Bone.World Health Organization Classification of Tumors of the Central Nervous System (CNS WHO) assigned the combined term solitary fibrous tumor/ hemangiopericytoma (SFT/HPC) to such lesions in 2016 due to their same genetic makeup. Case report: Our case is about a 61-year-old diabetic male who presented with insidious onset, gradually progressive thoracic backache and asymmetric weakness with tightness and numbness of both lower limbs for last 6 months with no sphincter incontinence and bed bound for last 15 days. Clinically he had asymmetric spastic paraparesis of lower limb. His MRI Dorsal spine showed a 1.5 ґ 2 cm heterogeneously contrast enhancing Intradural lesion at D6-D7 compressing the cord from dorsolaterally with extensive cord edema from C5 to L2. Preoperative diagnosis of Meningioma/ Metastasis was made and patient underwentD5-D7 laminectomy and tumour excision. Intraoperative findings, there was no dural attachment, there were multiple tortuous blood vessels overlying greyish pink, fleshy, suckable, highly vascular, capsulated tumor posterolateral to cord. The superior aspect of tumor was adherent to cord with no clear interface. Tumor was seen separate from Left D7 nerve root. Post operatively patient improved symptomatically and neurologically. His HPE was suggestive of Hemangiopericytoma WHO Grade II (IHC markers CD34 and CD 31 was positive and KI 67% index of 10-15%). Patient has been on follow up and planned for metastatic workup. Conclusion: Spinal Hemangiopericytoma are rare disease with nonspecific radiological features making preoperative diagnosis difficult. Differential diagnosis of hemangiopericytoma should be kept in case of atypical and high - grade radiological features. Gross total resection without compromising the neurological status should be the goal to prevent local recurrence. Proper consensus regarding the follow up and adjuvant therapies of spinal Hemangiopericytoma are still lacking.