Spinal schwannomas are typically intradural-extramedullary neoplasms thought to arise from Schwann cells or their progenitors which occur proportionally throughout the spinal canal. They most typically arise from dorsal sensory rootlets and occupy a posterior-lateral location in the spinal canal. Thus, posterior surgical procedures have become the conventional method to remove these tumors providing adequate exposure in most cases. More anteriorly located tumors may be approached through a posterolateral direction with section of the dentate ligament and gentle rotation of the spinal cord. However, posterior and posterolateral approaches may be problematic for removing tumors located in the midline and ventral to the spinal cord.

Although the anterior approach has been applied widely to treat cervical spondylosis, it has rarely been used to remove intradural tumors. Here, we present a case of a ventral cervical spinal schwannoma removed through an anterior approach followed by spinal reconstruction.

Nodular fasciitis is a reactive proliferation of fibroblasts/myofibroblasts characterized by a rapidly growing non-tender subcutaneous mass and subsequently self-limited course. It is commonly found on the upper extremities, face, and shoulder, although it may occur in any superficial location. Its etiology is largely unknown, but associations have been made with local trauma, infection and inflammation. We report a case of an intraneural and intramuscular nodular fasciitis presenting in the obturator nerve and gracilis muscle, respectively. To our knowledge, this is the second reported case of this disease presenting in a nerve of the lower extremity, as well as the first reported case of it presenting within muscle and nerve simultaneously.

Sickle cell disease is a hemoglobinopathy occurring due to replacement of valine for glutamic acid at the sixth position of the beta globin chain. The altered hemoglobin structure makes it prone for polymerization during hypoxic and infective stress. Polymerization of the hemoglobin molecule leads to sickling of the red blood cells in the vessels causing thrombosisvasoocclusive crises. Although abdomen and extremities are more often involved, silent cerebral infarcts and stroke can occur in up to 25-29% of patients and is the major cause of morbidity and mortality.

Primary coccidioidal infection caused by inhalation of spores growing several inches below the surface of desert soil in the San Joaquim valley in southern Arizona and central California is well documented in the literature. Most infections resolve quickly with minimal symptoms, although some individuals develop a subacute process called “Valley Fever”, which is characterized by shortness of breath, chest pain, cough and fevers lasting from weeks to months. Skin manifestations, including erythema nodosum and erythema multiforme may also be present and generally resolve with resolution of the respiratory tract illness. A recent retrospective study found that 6003 adult and 332 pediatric patients were hospitalized with endemic mycosis in 2002, but the overall incidence has been estimated at about 150,000 infections per year. We report a unusual case of recurrent stroke temporally associated with a CNS Coccidiomycosis infection in a traveler to a region where the fungus is endemic.