We describe here a case of a 70 yr old man with long-standing rheumatoid arthritis who presented with low grade fever, fatigue, loss of appetite and weight, bluish discoloration of the fingers and patches of gangrenous skin on the fingers. There was intense pain in the fingers which prevented him from sleep. Along with these symptoms he developed loss of sensation in the dorsum of left foot, then left foot drop. We give below full account of the case and review of the causes of vasculitis. We want to emphasize on the importance of identifying vasculitis as one of the complications of rheumatoid arthritis and intensive treatment of this complication, as it is a life-threatening complication.

A case of systemic lupus erythematosus like induced by carbamazepine therapy in a 27 year old female patient with left sided trigeminal neuralgia had been recorded, 9 years from starting carbamazepine therapy. The patient condition improved clinically 3 days after withdrawal of
carbamazepine , the titer of antinuclear antibodies dropped from 1/640 to 1/80 after 3 weeks, and disappear completely after 6 months follow up.

HTH Ahmed Dheyaa Al-Obaidi,", Ali Tarik Abdulwahid', Mustafa Najah Al-Obaidi", Abeer Mundher Ali', eNeurologicalSci, 2023

ABSTRACT Pulmonary alveolar microlithiasis is rare infiltrative pulmonary disease characterized by intra-alveoli deposition of microliths. We present a familial case of an adult female with complaint of progressive shortness of breath on exertion. Chest radiograph showed innumerable tiny dense nodules, diffusely involving both lungs mainly the lower zones. High-resolution CT scan illustrated widespread intra-alveolar microliths, diffuse ground-glass attenuation areas and septal thickening predominantly in the basal regions. Chest radiograph is all that is needed for the diagnosis of this case but CT scan was done to demonstrate the extent and severity of this disease

Aim: is to report a case of trans-oral pin, penetrating base of skull and upper cervical region, which is rarely reported in the literatures and to compare it with other studies reporting similar case.
Patients Methods: the details, the presentation, both clinical and radiological finding, and surgical approach of such a case are presented.
Results: the diagnosis was verified with plain x-rays and C.T. scan with bone study. Surgery was conducted under G.A., the patient was recovered well without neurological deficit.
Conclusion: meticulous and close pre-operative care with safe operator and careful fellow up is mandatory. Surgery only offers the best chance of care.