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A 37-year-old woman previously healthy presented with four days history of numbness at the mandibular division (V3) of the trigeminal nerve on the left side of her face. Physical exam revealed an alert, calm well-oriented patient and demonstrated that binocular vision was normal, bilateral pupils were of the same size, eyes were sensitive to light reflection and eyeballs moved freely in all directions. The fundoscopic exam was normal and facial sensation was also normal except for numbness and sensory loss at the mandibular division of the trigeminal nerve CN V on the left side of her face. The findings were solely unilateral. There was no nystagmus, no mouth deviation, and no sensorineural hearing problems. Otherwise, cranial nerve examination was normal. No cutaneous stigmata of neurofibromatosis type 1 were observed. She was diagnosed with trigeminal neuropathy and magnetic resonance imaging (MRI) of the brain was ordered.

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It is difficult to explain the origin of intracranial parenchymal schwannomas since it is known that brain parenchyma normally lacks the presence of schwann cells [3]. Several authors proposed myriad hypotheses, with the most accepted one suggesting that the origin of intraparenchymal schwannomas would be schwann cells around arteries in the intracranial perivascular nerve plexuses in the brain and the subarachnoid space [1,2,3,8]. Alternative theories involve the growing of neural crest cells trapped during embryogenesis [8], differentiation of pluripotential mesodermal pial cells [1,8,9] schwannosis, or aberrant schwan cells having neoplastic potential, and schwann cell migration through the trigeminal nerve [8]. Schwann cells were also reported in brain tissue in multiple sclerosis plaques or at the edge of old infarcts [9].

As an ongoing heat wave swamps the American South, states from Texas to Missouri and Tennessee have recorded temperatures 20 degrees above normal in the high 90s and low 100s. With weeks of extreme heat and humidity, the public health impacts and healthcare costs of our warming world have been on full display.

Badr describes the period between 749 and 974 as a push-and-pull between peace and political turmoil, while Medina continued to pay allegiance to the Abbasids. From 974 to 1151, the Sharifate of Medina was in a liaison with the Fatimids, even though the political stand between the two remained turbulent and did not exceed the normal allegiance. From 1151 onwards, Medina paid allegiance to the Zengids, and the Emir Nuruddin Zengi took care of the roads used by pilgrims and funded the fixing of the water sources and streets. When he visited Medina in 1162, he ordered the construction of a new wall that encompassed the new urban areas outside the old city wall. Zengi was succeeded by Saladin, founder of the Ayyubid dynasty, who supported Qasim ibn Muhanna, the Sharif of Medina, and greatly funded the growth of the city while slashing taxes paid by the pilgrims.[5] He also funded the Bedouins who lived on the routes used by pilgrims to protect them on their journeys. The later Abbasids also continued to fund the expenses of the city. While Medina was formally allied with the Abbasids during this period, they maintained closer relations with the Zengids and Ayyubids. The historic city formed an oval, surrounded by a strong wall, 30 to 40 ft (9.1 to 12.2 m) high, dating from this period, and was flanked with towers. Of its four gates, the Bab al-Salam ("The Gate of Peace"), was remarked for its beauty. Beyond the walls of the city, the west and south were suburbs consisting of low houses, yards, gardens and plantations.[5] 006ab0faaa