In primary care setting, headaches are often referred routinely to neurologist for further management. However, more insidious causes for a headache, such as viral infections, should not be ruled out; and if the symptoms are acute and severe, an immediate inpatient work-up with empiric treatment for the most probable etiology may be warranted, despite unequivocal exam and laboratory findings.Sacral fatigue fractures in the young population usually occur due to repetitious physical strain from vigorous athletic activity; they are extremely rare in those younger than 13 years without intense physical activity. We report a case of sacral fatigue fracture in a healthy elementary school girl without any history of trauma or excessive athletic activity. A healthy 11-year-old girl experienced sudden low back pain upon standing after a short break in a normal running exercise for physical education at school. At her first orthopaedic visit, she was unable to walk independently and was limping on her left leg. Neurological examination revealed that the left straight leg raising test was positive at 80 degrees with associated left buttock pain but without motor and sensory deterioration. Radiological examination showed no obvious fractures in the lumbar vertebrae or pelvis. Magnetic resonance imaging demonstrated high intensity signal changes on the short tau inversion recovery image of the left ala, and sacral fatigue fracture in the left ala was diagnosed. She was instructed to rest at home and allowed minimal walking with a crutch under endurable pain for 4 weeks. Within 3 weeks, her low back pain gradually reduced, and after 4 weeks, she could walk independently without gait pain. Sacral fatigue fractures should be considered in the diagnosis of young patients who present with unexplained low back pain.The left-sided gallbladder (LSG) is a rare type of anatomical variation (ectopia) defined by the location of the bladder to the left side of the liver falciform and round ligaments. Initially reported in 1886 by Hochstetter, the finding is usually accidental since it is mostly an asymptomatic condition, thus not causing the patient any harm and being few reported cases in the current literature. Surgical cases are most associated with gallstones such as presented in this case report. Our patient was a 60-year-old man from Manaus who presented with symptomatic acute cholelithiasis submitted to laparoscopic cholecystectomy which allowed the visualization of true LSG concomitant with a polyp suggestive lesion. A diagnosis post-cholecystectomy of true gallbladder diverticulum was confirmed by histopathological analysis. Being one of three types of LSG, true LSG is more associated with other structural changes in the biliary tree and also some liver changes, in our case we identified no such alterations. True gallbladder diverticulum has, as the main characteristic, the herniation of all tissues of the gallbladder wall. When presented with LSG, is important to correctly identify the altered structures and adjust the surgical technique in the best way possible, it is up to the surgeon to adapt to the situation presented and ensure the best treatment for his patient.Over the several years, only few cases of consciousness was diagnosed as pulmonary embolism in the world. The obstruction of the pulmonary arterial tree is viewed as the source of pulmonary embolism, and eventually trigger the severe cardiopulmonary failure. Diagnosis of pulmonary embolism is dependent on the imaging data, such as the computed tomographic detection. THAL-SNS-032 chemical structure Above 50% of patients with pulmonary embolism are normotensive and they have neither echocardiographic nor laboratory signs of right heart dysfunction. Therefore, the precise prognosis of acute pulmonary embolism presented with rare characteristic is important to improve risk management. In some circumstance, the diagnosis of pulmonary embolism remains a challenge with atypical characterization presented in this case. A case report of this is given to accumulate the diagnostic experience for further analysis. Herein, we report a case of a severe pulmonary embolism that revealed by consciousness disorders. This report highlights the extracorporeal membrane oxygenation (ECMO) could be the only life-sustaining and the possibility of the solution treatment of acute pulmonary embolism.Nuclear protein in testis (NUT) carcinoma (NUT-C) is an exceedingly rare and aggressive squamous tumor characterized by an acquired rearrangement of the NUT gene involving the NUTM1 (Nut midline carcinoma, family member 1, NUT) gene encoding the nuclear protein of the testis on 15q14. As a rare tumor, there is little information available on the clinicopathologic and molecular cytogenetic findings of NMC. We herein reported a case of a 69-year-old man diagnosed with lung NMC involving the rearrangement of chromosomal region 15q14 harboring the NUTM1 gene. It was exceptionally rare for the patient's involving of the lung but having the chance to be totally resected. After radical surgery, the patient accepted further four cycles of chemotherapy and remains disease-free after 10 months. The immunohistochemical staining of PDL1 was negative and next-generation sequencing technology identified genomic alterations in discoidin domain receptor tyrosine kinase 2 (DDR2), cyclin D1 (CCND1), B-cell leukemia/lymphoma 1 (BCL1), colony-stimulating factor 1 receptor (CSF1R), runt related transcription factor 1 (RUNX1) and death domain-associated protein 6 (DAXX6) from the paraffin-embedded tissue. This case will contribute to not only a better understanding of the molecular mechanism of the primary pulmonary NUT carcinomas but also the potential therapeutic option for the patient.Cerebrovascular disease is the second leading cause of death in the United States in adults aged 65 years and older and is most commonly caused by atherosclerosis. More so, cryptogenic strokes account for one-third of all ischemic strokes. At the same time, iron deficiency anemia is prevalent worldwide and mostly affects females of childbearing age. Here we report a case of a 42-year-old female who presented with symptoms of acute ischemic stroke and was found to have severe iron deficiency anemia. After prompt investigation of other secondary causes, it was determined that her stroke was likely secondary to her iron deficiency anemia. Upon review of the literature, a few case reports showed an association between iron deficiency anemia and strokes in the adult population, but little evidence exists supporting a direct relationship between the two entities. In this case, we aim to evaluate the complex relationship between iron deficiency anemia and stroke and to define a new potential cause of ischemic stroke, which would have been considered earlier as cryptogenic.