Cogan's syndrome (CS) is a rare autoimmune disorder involving audio-vestibular and ocular inflammation. While systemic vasculitis is a known complication, its association with Moyamoya-type cerebrovascular remodeling has not been previously documented. A 19-year-old Asian woman was diagnosed with atypical CS following a presentation of hyperpyrexia, unintentional weight loss, and severe bilateral sensorineural hearing loss. After five years of appropriate immunosuppressive treatment, she developed subacute headaches, hypertension, and left hemiparesis and paresthesia. Despite normal inflammatory markers, neuroimaging revealed right-sided internal carotid artery occlusion and extensive collateralization characteristic of Moyamoya syndrome. Genetic testing showed a variant of uncertain significance in SLC37A4. The patient underwent a right extracranial-intracranial (STA-MCA) bypass, resulting in complete resolution of neurological symptoms. The late emergence of Moyamoya suggests that chronic autoimmune-mediated vascular injury may trigger progressive steno-occlusive disease. Clinicians should consider Moyamoya syndrome as a differential for new neurological symptoms in CS patients, even when systemic inflammation appears controlled. To our knowledge, this is the first reported case of concurrent Cogan's syndrome and Moyamoya vasculopathy at time of writing this article.
Degenerative cervical myelopathy (DCM) is a progressive condition most caused by degenerative changes that lead to spinal canal stenosis and characteristic neurologic deficits involving both upper and lower extremities. We report an atypical presentation of DCM manifesting exclusively as new-onset lower extremity weakness following lumbar decompression surgery, without neck pain or upper extremity symptoms. This case highlights the importance of maintaining a high index of suspicion for cervical myelopathy and performing whole-spine imaging in patients with unexplained postoperative neurologic deficits.
Traumatic brain injury is a major cause of death and long-term disability worldwide and can lead to persistent functional impairment and chronic pain that significantly impact quality of life. Patients with traumatic brain injury commonly experience motor deficits, impaired balance and coordination, cognitive dysfunction, and behavioral changes. Chronic pain, particularly post-traumatic headaches and musculoskeletal pain, is also frequently reported and can limit participation in rehabilitation and daily activities. This narrative literature review summarizes current evidence on the epidemiology, pathophysiology, and clinical course of traumatic brain injury, with a focus on functional restoration and pain management. Existing research supports the use of multidisciplinary rehabilitation approaches that incorporate physical therapy, occupational therapy, cognitive rehabilitation, and structured exercise to improve recovery and independence. In addition, both pharmacologic and non-pharmacologic pain management strategies play an important role in addressing chronic symptoms and supporting rehabilitation efforts. Overall, early recognition of functional deficits and integrated rehabilitation strategies are essential for improving long-term outcomes and quality of life in patients with traumatic brain injury.
