Diagnosis of Patients with Acute Dizziness

Using an algorithmic approach to acutely dizzy patients, physicians can often confidently make a specific diagnosis that leads to correct treatment and should reduce the misdiagnosis of cerebrovascular events. Emergency clinicians should try to become familiar with an approach that exploits timing and triggers as well as some basic "rules" of nystagmus. The gait should always be tested in all patients who might be discharged. Computed tomographic scans are unreliable to exclude posterior circulation stroke presenting as dizziness, and early MRI (within the first 72 hours) also misses 10% to 20% of these cases.

A Case of Intracranial Solitary Fibrous Tumor/Hemangiopericytoma Repeatedly Misdiagnosed as Hypertensive Intracerebral Hemorrhage

Because solitary fibrous tumor (SFT) and hemangiopericytoma (HPC) contain identical genetic abnormalities, the World Health Organization coined the term SFT/HPC to describe these lesions. Here, we present a rare case of SFT/HPC in a 40-year-old man with massive repeated intracranial hemorrhage (ICH) in right medial temporal lobe. ICHs from a SFT/HPC were repeatedly misdiagnosed as hypertensive ICH by several departments and hospitals over approximately eight months, and the patient underwent inappropriate treatments. The amount of repeated ICH accompanying the tumor has increased significantly compared to the first ICH, which may suggest rapid tumor growth. To avoid misdiagnosis and inappropriate treatment, surgeons should carefully examine all past and current patient-related radiological images and medical records before considering surgery.

Syringocystadenoma papilliferum of the upper lip

Syringocystadenoma papilliferum (SCAP) is a rare skin tumour believed to arise from the apocrine or eccrine sweat glands. It appears predominantly in childhood, usually at birth. It is exceedingly rare for it to appear on the upper lip. We report a case of SCAP in a 10-year-old Omani girl who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in February 2012 with a non-tender, non-pruritic, solitary verrucous papule of 4 × 5 mm on the left side of the upper lip. It had been present since birth and had slowly been increasing in size over the years. It was occasionally associated with recurrent ulceration and bleeding and had previously been misdiagnosed and mismanaged. An excisional biopsy was performed and the whole lesion was removed. The surgical site was then sutured and the patient was discharged on the same day.