The thrombosis of the superior mesenteric vein (SMV) can result in ischemia of the intestine. A 71-year-old male presented with pain in the abdomen and a black tarry stool. The findings from computed tomography (CT) with the contrast of the abdomen suggest the thrombosis of the SMV. Heparin was administered, followed by thrombectomy and stenting of the SMV. The patient reported no complications and was shifted from heparin to apixaban and then discharged after a five-day hospital stay.

This report describes a case involving the diagnosis and treatment of squamous cell carcinoma (SCC) of the duodenum, which was found to be a metastatic lesion originating from recurrent head and neck cancer (HNC) in a 74-year-old female patient. The patient had a past medical history of gastroesophageal reflux disease (GERD), tonsillar SCC, and recurrent HNC. She presented with symptoms of burning, tingling, and numbness of the throat and left side of the tongue. Upon examination with an esophagogastroduodenoscopy, an ulcerated hard area mass was detected in the third portion of the duodenum. Biopsy results confirmed the mass to be a metastatic poorly differentiated SCC. The incidence of head and neck squamous cell carcinoma (HNSCC) metastasis to the duodenum is rare, likely due to the unique anatomic location and the lack of lymphatic drainage in the area. The patient was treated with a combination of paclitaxel, carboplatin, and pembrolizumab. This case underscores the significance of considering unusual sites of metastasis in HNSCC patients and utilizing advanced imaging modalities and immunotherapy to detect and treat these locations effectively.

A cervicogenic headache (CH) originates from a cervical source. Multiple diagnostic criteria and treatment strategies for CH are present. Rimegepant is a calcitonin gene-related peptide receptor (CGRP) antagonist. We present a case series of three patients with CH who reported varying degrees of decreased headache intensity after using rimegepant.

Background: Brain arteriovenous malformations (BAVMs) are a tangle of abnormal vessels that directly shunt blood from the arterial to venous circulation and are a significant cause of intracranial hemorrhage (ICH). DNA methylation, an epigenetic mechanism, can regulate gene expression. Previous studies revealed significant correlations between BAVM development and DNA methylation levels of gene promoter regions in WTAP , METTL3 , NOS1AP , PLA2G7 , CDKN2A , CDKN2B , and PDGFD . Therefore, we investigated whether genetic variants in these candidate genes are associated with risk of ICH at clinical presentation in BAVM patients. Methods: A total of 383 single nucleotide polymorphisms (SNPs) were investigated using genome-wide data from 338 BAVM Caucasian patients, mapping within 20kb of the genes: WTAP (n=15), METTL3 (n=12), NOS1AP (n=190), PLA2G7 (n=15), CDKN2A / CDKN2B (n=22), and PDGFD (n=129). We used multivariable logistic regression analysis, adjusting for age, sex, and 3 principal components to adjust for population stratification. The Bonferroni method was used to correct for multiple comparisons (p=0.05/383 SNPs=0.00013). RegulomeDB scores were used to identify putative functional variants. Results: Two SNPs were associated with increased risk of ICH with BAVM at nominal p<0.05 but were not statistically significant: rs1263806 in METTL3 (OR=1.45, p=0.04) and rs1964052 in NOS1AP (OR=1.69, p=0.04). Ten SNPs were associated with decreased risk at nominal p<0.05: rs10757261, rs10757261, rs2811711, rs575427 in CDKN2A / CDKN2B ; rs528027, rs260866, rs260842, rs260850, rs7128670, and rs7113370 in PDGFD . No SNPs in WTAP and PLA2G7 were associated with ICH (p>0.05). One SNP, rs2811710 mapping to CDKN2A / CDKN2B (OR=0.6, p=0.02), is predicted to be functionally relevant as an expression quantitative trait loci (eQTL). Conclusions: Genetic variants in WTAP , METTL3 , NOS1AP , PLA2G7 , CDKN2A , CDKN2B , and PDGFD are not significantly associated with risk of ICH presentation in patients with BAVM.