Recurrent bilateral periorbital and circumoral bruising due to vomiting

Periorbital ecchymosis is due to extravasations of blood into the periorbital skin and the subcutaneous tissues around the eyes. 'raccoon eyes' or 'panda sign' is a distinctive type of periorbital ecchymosis where the bruising is characterised by tarsal sparing. This sparing is due to an anatomical structure called the orbital septum, which limits the spread of the discolouration beyond the tarsal plate. Hence 'raccoon eyes' description should be limited to orbital ecchymosis due to basal skull fractures only. While the bilateral bruising due to direct trauma to the eyes, or non-traumatic medical conditions, can spread beyond the tarsal plate as in our case. The differential diagnosis varies from trivial benign conditions to serious life-threatening illnesses. We describe a case of recurrent bilateral periorbital ecchymosis and facial bruising due to vomiting.

A case of almost painless herpes zoster presenting with symptoms of cystitis, penile numbness, and acute vestibular failure

Herpes zoster (shingles) is an acute, painful, vesicular, and cutaneous eruption caused by varicella zoster virus, the same virus which causes chicken pox. It is due to the reactivation of the virus which remains dormant in sensory ganglions following chicken pox. It is usually confined to a single dermatome but may involve 2-3 dermatomes. Typically, it is a unilateral lesion which can affect both cranial and peripheral nerves. It is usually a self-limiting disease; however, it may cause significant morbidity especially in the elderly. It is more common in older people and individuals with immunocompromised conditions. Antiviral drugs can shorten the duration and the severity of the illness and need to be started as soon as possible after the appearance of the rash. Gabapentin and tricyclic antidepressant are effective in postherpetic neuralgia. Vaccine can reduce the risk of infection and its associated pain. Typically, it occurs once in a lifetime, but some individuals may have more than one episode.

Locked-in syndrome caused by basilar artery ectasia

Despite various presentations of vertebrobasilar artery ectasia, the true incidence and its distribution and the frequency with which it produces symptoms are still uncertain. We report on a case of Locked-in syndrome caused by an ectatic elongated basilar artery, which predisposed to thrombosis and brain stem infarction.