Stroke at a young age is a rarely reported entity whether it is uncommon or overlooked. When it occurs, it can result in lifetime neurological deficits and disabilities for the child and an overwhelming emotional and mental challenge to caregivers. One of the reasons that can lead childhood stroke to be overlooked is an atypical presentation onset with a headache or acute symptomatic seizure. As time is brain, these differences in childhood stroke can lead to a delay in diagnosis and symptoms considered as a stroke mimic.

We report a case of Osborn waves occurring in a 55-year-old normothermic male patient with spontaneous pneumothorax that resolved with the resolution of the pneumothorax. The patient was presented with a 2 week history of shortness of breath, pleuritic chest pain, and cough. He was found to have a left sided pneumothorax that persisted even after chest tube placement. 

Objectives: Here, we review opioid-sparing or opioid-free anesthesia and pain management for urologic procedures and pathologies–urological pain syndromes, kidney stone pain management, development of post-surgical pain syndromes, and prevention. We explore acute management of perioperative pain during and after urologic procedures; additionally, we review the pathophysiology of various urologic pain syndromes along with a variety of interventions, including pharmacologic management, nerve blocks, neurolysis, and neuromodulatory therapies in hopes of educating providers who treat the urologic patient.

An elderly male patient, aged 90 years, presented to the outpatient department of our institution with a documented history of constipation persisting for a span of twenty days, accompanied by bleeding per rectum exacerbated by straining. Notably, there were no alarming signs such as weight loss, loss of appetite, or anemia. The patient’s general and systemic examination yielded normal results, with laboratory parameters, including tumor markers such as serum CEA, within normal limits. Further evaluation through a proctoscopy examination revealed normal findings, following which the patient was prescribed laxatives and supportive treatments. However, the patient reported back following a few days with persistent symptoms including fever, chills, and rigors.

Hypoplastic internal carotid artery (HICA) is a rare congenital vascular anomaly, typically asymptomatic due to collateral circulation. However, in certain cases, it may present with ischemic stroke. We report a 17-year-old male with a history of smoking and illicit drug use who presented with acute left-sided weakness. Imaging revealed an infarct in the right middle cerebral artery territory and a hypoplastic right internal carotid artery.