Primary intracranial leiomyosarcoma (PIL) is a rare non-infectious aetiology of focal mass lesions among HIV-infected individuals. With only 16 published cases worldwide, information on its pathophysiology, risk factors, clinical course and management options is limited. We report two cases of PIL in HIV-infected Filipino men who presented with 1–3 months history of persistent headache, progressing in severity. Both had cranial MRI revealing intracranial mass diagnosed as leiomyosarcoma by excision biopsy and immunohistochemical staining. Both patients underwent adjuvant cranial radiotherapy and chemotherapy. Biologics were initiated in one patient. Both patients were alive with evidence of the disease.

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Background: Wernicke-Korsakoff syndrome (WKS) is a triad of ophthalmoplegia, ataxia and memory deficits due to thiamine insufficiency resulting from under- or untreated Wernicke’s encephalopathy (WE), which may be associated with hyperemesis gravidarum (HEG). Case presentation: We present a case of a 36-year-old Filipino woman in her first trimester with HEG, along with the WKS triad and abnormal hyperintense signals in the bilateral thalami and midbrain, left occipital lobe, periaqueductal gray matter and pontine periventricular areas. Neurologic deficits partially improved but persisted despite intravenous thiamine administration. Evidence review: A review of current treatments for WE, and the prevention and neurocognitive recovery of WKS was done. The beneficial effects of thiamine for acute WKS are supported by several case reports and clinical experience. Evidence from one randomized controlled trial wherein thiamine was given in various doses for treating WE or preventing WKS in an alcohol-dependent population is limited by methodological issues. Rehabilitation and pharmacotherapy for neurocognitive recovery seems promising, but they have inadequate evidentiary support. More robust studies on multi-modal strategies are warranted to facilitate the neurocognitive recovery of patients with WKS.

Primary leptomeningeal lymphoma (PLL) is an extremely rare condition, with only a handful of cases reported in literature. Most often, these are misdiagnosed as other disease entities that are more commonly observed in practice. Currently, there are no clinical algorithms that may guide clinicians to clinching a diagnosis of PLL. This paper discusses a remarkable case of PLL presenting with atypical symptoms namely dementia and low back pain. This is a case of an apparently well adult male who initially presented with low back pain that was treated for two years as a case of lumbar disc herniation. This developed into lower extremity weakness and was subsequently followed by dementia and seizures. The patient was initially treated for tuberculous meningitis after CSF findings showed lymphocytic predominance. However, lack of clinical improvement prompted further work up revealing a malignant process in the lumbosacral meninges. Dural biopsy showed atypical mononuclear infiltrates consistent with a B-cell non-Hodgkin lymphoma with immunohistochemistry showing CD20 positive, CD79a positive, CD3 negative. Being MUM1 positive and BCL2 positive suggests it being a diffuse large B cell lymphoma. A primary malignancy of the leptomeninges was ruled in after PET CT showed no other sites of high metabolic activity. The patient was able to complete 6 cycles of high dose Methotrexate and three Rituximab doses. Remarkably, after more than two years after his initial presentation, he still has mild signs of dementia but is able to carry out most activities of daily living with minimal assistance. The patient has survived beyond the expected life expectancy for PLL.