Solitary fibrous tumors (SFTs) of the central nervous system are uncommon mesenchymal neoplasms that may remain clinically silent until they reach a significant size or produce neurological manifestations. Although these tumors are typically slow-growing, they can occasionally present with acute neurological deterioration when associated with intracerebral hemorrhage. Such presentations are uncommon and can make diagnosis and management particularly challenging. We report the case of a 46-year-old woman with no previous medical history who experienced sudden-onset severe headache, vomiting, and rapid neurological decline, ultimately requiring emergent airway protection. On arrival, she presented with a markedly depressed level of consciousness, anisocoria, absent pupillary responses, and severe hypertension. Brain computed tomography (CT) revealed a large left fronto-temporo-parietal intracerebral hematoma producing mass effect and midline shift. The patient underwent emergency decompressive craniectomy with evacuation of the hematoma, during which an underlying tumor was identified and completely resected. Histopathological examination demonstrated a collagen-rich lesion composed of cellular nodules with elevated mitotic activity, without necrosis or marked atypia. Immunohistochemical staining showed strong nuclear STAT6 expression, supporting the diagnosis of SFT. This case illustrates the potential for SFTs to present with acute intracerebral hemorrhage, leading to abrupt clinical deterioration. The hemorrhagic event likely contributed to the patient's severe neurological status at admission and prompted urgent surgical intervention. Complete resection was feasible and allowed for histological diagnosis. Given the possibility of delayed recurrence and the unpredictable behavior of these tumors, long-term postoperative surveillance remains essential. This case highlights the importance of considering underlying neoplasms in spontaneous intracerebral hemorrhage and emphasizes the role of timely surgical management in improving diagnostic accuracy and clinical outcomes.
Introduction: Acute epididymitis (AE) in children usually responds to conservative therapy. However, in rare cases (1% to 2%), it may progress to severe complications such as testicular infarction or necrosis due to vascular compromise. We report a case of progressive segmental testicular necrosis following presumed post-infectious AE after a recent viral respiratory illness. Methods: An 8-year-old boy presented with a 2-day history of left testicular pain, swelling, and erythema. Initial Doppler ultrasound revealed epididymal enlargement, hyperemia, and reactive hydrocele without signs of torsion. Urine culture was collected, and empirical ibuprofen and trimethoprim-sulfamethoxazole were prescribed. Results: Six days later, symptoms worsened with increased swelling and pain. Repeat Doppler ultrasound demonstrated hypoechoic avascular areas and reduced flow, consistent with necrosis. Urine, blood, and smegma cultures were negative. Surgical exploration revealed extensive testicular necrosis without torsion, leading to simple orchiectomy. Histopathology confirmed ischemic necrosis secondary to an inflammatory process. The observed evolution supports the concept of TCS, in which rising intratesticular pressure due to venous congestion and extraluminal compression within the noncompliant tunica albuginea leads to impaired microcirculatory perfusion and ischemic necrosis. Conclusions: Testicular necrosis is an exceedingly uncommon but serious complication of AOE in children. Persistent pain, increasing testicular size, or poor clinical response should prompt early Doppler reassessment and consideration of surgical exploration. Recognition of TCS as a possible pathophysiological mechanism may help guide timely diagnosis and intervention to prevent irreversible ischemic injury.
Background The facial artery's variability in course and depth makes it essential to understand its morphology, particularly by age and sex, for safe non-surgical aesthetic procedures. Objective This study analyzes the three-dimensional anatomy of the facial artery in a Latin population using computed tomography angiography (CTA) to assess morphological variations according to age, sex, and anatomical landmarks. Methods A descriptive cross-sectional observational study was conducted at the Radiology and Imaging Department. CTA scans from 201 patients over 18 with clear visualization of the facial artery were analyzed. Using RadiAnt Dicom Viewer software, measurements included the artery’s diameter at the mandibular border, distance from the oral commissure and mandibular angle, and depth at specific anatomical points. Results The mean patient age was 58, with equal sex distribution. Type 3 facial artery, extending to the lateral nasal branch, was observed in 67.2% of cases. Males had larger artery diameters and greater distances from the mandibular angle, masseteric border of the zygomatic bone and oral commissure. The facial artery becomes progressively more superficial along its ascending midfacial course. With increasing age, the depth of the facial artery at the inferior border of the mandible and its distances to the nasolabial sulcus and oral commissure decrease. Conclusions Significant anatomical variations in the facial artery by sex and age highlight the need for individualized approaches in aesthetic procedures to enhance safety and effectiveness. This study adds critical data on Latin populations, which is lacking in existing literature, guiding practitioners toward safer, more tailored aesthetic practices.
Autism in adulthood remains underrecognized across psychiatric settings despite epidemiological evidence supporting its persistence across the lifespan. Recognition is often hindered by heterogeneous presentation, misattribution of autistic traits to co-occurring psychiatric conditions, camouflaging processes, and limited integration of developmental history in adult assessments. This narrative review aims to synthesize current evidence on adult presentation and co-occurring conditions, examine barriers to identification, and propose a developmental, dimensional, and contextual framework for psychiatric assessment and formulation. A narrative review guided by the Scale for the Assessment of Narrative Review Articles was conducted. Peer-reviewed literature published between January 2010 and December 2025 was identified through structured searches of PubMed, Scopus, and Web of Science, with additional sources identified through reference list screening. Studies were selected based on conceptual relevance and applicability to adult psychiatric contexts. The literature indicates that autism in adulthood is characterized by marked heterogeneity, with presentations often shaped by internalized features, compensatory processes, and co-occurring psychiatric conditions. Across studies, these factors contribute to diagnostic overshadowing, delayed identification, and fragmented care trajectories. Developmental, neurobiological, and service-level evidence further highlights the influence of contextual and structural factors on recognition within adult psychiatric settings. Autism in adulthood is best conceptualized within a developmental, dimensional, and contextual framework. Improving identification in psychiatric practice requires systematic attention to developmental history, internal experience, compensatory processes, co-occurring conditions, and structural barriers. Integrating these elements may enhance clinical formulation, reduce diagnostic fragmentation, and improve care for autistic adults within psychiatric services.
