Auto-brewery syndrome (ABS) occurs when the gastrointestinal tract produces excessive endogenous ethanol. This article examines various aspects of ABS such as its epidemiology, underlying etiology, diagnostic difficulties, management strategies, and social implications. By synthesizing the existing medical literature, we hope to identify understanding gaps, pave the way for further research, and ultimately improve detection, treatment, and awareness. The databases we used are PubMed, PubMed Central, and Google Scholar. We carefully screened all published articles from inception till date and narrowed down 24 relevant articles. We at Richmond University Medical Center and Mount Sinai are one of the leading medical centers for diagnosing and treating this rare condition in the United States.

A 66-year-old female patient with a past medical history of obesity and ORBERA @ intragastric balloon placement presented with Wernicke's encephalopathy (WE) features without social history of alcoholism. The patient was subjected to ORBERA @ balloon bariatric procedure in Egypt and subsequently developed episodes of uncontrolled emesis which prompted removal of the intragastric balloon placement one month later. Two weeks after removal of the intragastric balloon placement, vomiting still persisted. Patient suddenly developed altered mental status and weakness which prompted admission to our hospital. Initial clinical examination was largely inconclusive, bilateral horizontal nystagmus was noted after subsequent days. A tentatively diagnosis of WE was made based on clinical presentation and magnetic resonance imaging (MRI) scan results; vitamin B1 (thiamine) levels were ordered but were still pending. Empiric treatment with vitamin B1 infusion was initiated which resulted in improvement of both motor function and cognitive functions. Patient was given 200 mg IV TID for 8 days, then 100 mg po for 6 months. Patient was also started on folic acid and vitamin B12. WE diagnosis was supported one week later after lab results showed low vitamin B1 level (21 nmol/L). The patient was sent to rehabilitation center for 6 weeks then was able to be discharged home with a 6-month supply of vitamin B1 supplements. On discharge, memory deficits, loss of appetite and docility were noted.

Brugada syndrome (BrS) is an intricate and heterogeneous genetic disorder that engenders a formidable risk of life-threatening ventricular arrhythmias (VAs). While initially regarded as an electrophysiological aberration, emergent studies have illuminated the presence of underlying structural anomalies in select BrS cases. Although mutations in the SCN5A gene encoding the α-subunit of the cardiac sodium channel were originally identified as a primary causative factor; they account for only a fraction of the syndrome's multifaceted complexity pointing at genetic heterogeneity as a contributing factor. Remarkably, BrS has been linked to a higher incidence of fatal arrhythmic incidents and sudden cardiac death (SCD) with about 4% of SCD cases thought to be caused by BrS. Patients who spontaneously exhibit type one Brugada ECGs are more likely to experience cardiac events, emphasizing the importance of early risk stratification. To aid in risk stratification, the Shanghai score; a multifactorial risk stratification scoring system that incorporates ECG, clinical history, family history, and genetic test results; is utilized to identify those most susceptible to SCD. Beyond single ECGs, evaluation of arrhythmic findings from 24-hour Holter monitoring, ECG variables, electrophysiologic study (EPS) status in the temporal domain, and EPS data collected over time are all critical factors in risk classification. Among management options avoidance of triggers, early risk stratification, and implantation of an Implantable Cardioverter-Defibrillator (ICD) are recommended for asymptomatic patients. For symptomatic patients, pharmacotherapy and ICD implantation are available, with the latter being a highly effective choice for treating and preventing lethal arrhythmias in BrS.

Patient: Female, 51-year-old Final Diagnosis: Pneumocephalus • Pneumococcal meningitis Symptoms: Worsening of mental status Medication:— Clinical Procedure: — Specialty: Critical Care Medicine • Infectious Diseases • General and Internal Medicine Objective: Rare co-existance of disease or pathology Background: Pneumocephalus is a rare occurrence without trauma, neurosurgery, or intracranial pathology. It is an uncommon complication of bacterial meningitis, and it is usually diagnosed with a CT head. Bacterial pneumocephalus in the setting of influenza B virus infection is an extremely rare complication; however, vaccination against influenza and early diagnosis and treatment help prevent mortality. Case Report: A 51-year-old woman presented to the Emergency Department in early winter because of worsening mental status over seven days prior to presentation. She was not vaccinated against influenza. Before and upon presentation to our facility, she was diagnosed with influenza B virus infection and was positive for streptococcal meningitis. A CT head revealed pneumocephalus, likely due to Streptococcus infection. She was treated with antibiotics, and a repeat CT head showed resolution of the lesion. Conclusions: Bacterial pneumocephalus in the background of influenza is an uncommon occurrence. Influenza vaccination and early diagnosis with a CT of the head and prompt initiation of antibiotics are essential in preventing mortality.