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An 89-year-old woman was admitted with a fall. She had severe dementia and was on no medication. She was mobile with carers visiting her at home twice daily. While her stay in the hospital, she was diagnosed with atrial fibrillation. Her rate was controlled with bisoprolol and was already given aspirin after risk assessment for stroke and CT scan of head. Several days into admission, she complained of sudden onset of weakness of her right upper limb with pain. On examination, there were absent brachial and radial pulses on the side along with weakness and decreased sensation below right elbow. She underwent urgent CT angiogram which revealed absent flow beyond right subclavian artery. She was treated with heparin infusion and then warfarin with regular vascular team follow-up. Further issues such as duration of warfarin therapy including possible substitution with direct thrombin inhibitor such as dabigatran etexilate is under consideration.

The authors present the case of a 25-year-old individual who presented acutely following a generalised tonic-clonic seizure. Brain MRI of the individual demonstrated the classical appearance of multiple cerebral cavernous haemangiomas (cavernomas). There was an autosomal dominant family history. Genetic testing identified a truncating mutation in the KRIT1 gene in the individual and confirmed the diagnosis of familial cerebral cavernomas as the cause of epilepsy in the family.

A 78-year-old man presented to the accident and emergency department following sudden onset of back pain, with attendant loss of power and sensation in the lower half of his body and urinary retention. Onset occurred while he was seated in a chair and he fell as he tried to get up. Neurological examination revealed symmetrical lower motor weakness (MRC grade 4/5) in both lower limbs with downgoing plantar reflexes. There was a clear sensory boundary at D4 with loss of joint position and sensation to light touch below this level. Rectal examination was unremarkable. While a CT head scan was normal, spinal MRI showed multilevel disc desiccations in the dorsal and lumbar spine. Additionally, in the dorsal spine at D4/5, there was a thin plaque of epidural tissue representing an epidural haematoma. Within 48-72 h the patient gradually and spontaneously regained full power.