Morgagni-Stewart-Morel Syndrome Presenting as Acute Neurological and Respiratory Distress.

Background: Morgagni-Stewart-Morel syndrome (MSMS) is an uncommon disorder characterized by internal frontal hyperostosis, obesity, neuropsychiatric symptoms, and often associated endocrine abnormalities, notably hypothyroidism. Acute presentations are rare and can pose diagnostic challenges, especially in the prehospital setting. We describe a rare acute presentation of Morgagni-Stewart-Morel syndrome (MSM) involving neurological deterioration and respiratory failure, highlight the importance of early recognition and multidisciplinary management in improving outcomes. Case presentation: A 62-year-old woman presented with sudden-onset severe neurological impairment accompanied by acute respiratory distress, initially identified by prehospital emergency medical services. Prompt airway management, including endotracheal intubation and mechanical ventilation, enabled stabilization and urgent transfer to hospital care. Neuroimaging revealed characteristic internal frontal bone thickening, confirming the diagnosis of MSMS. A multidisciplinary approach targeting the neurological, endocrine, and respiratory components led to progressive clinical improvement and a favourable recovery. Conclusion: This case underscores the critical importance of early recognition of MSMS in acute, life-threatening presentations. Awareness of this rare syndrome among prehospital and emergency clinicians can facilitate timely intervention and improve patient outcomes. LEARNING POINTS: Morgagni-Stewart-Morel syndrome can exceptionally present with acute neurological and respiratory compromise, not just chronic neuropsychiatric symptoms. The presence of internal frontal hyperostosis, even if incidental, should prompt evaluation for underlying endocrine and neurological dysfunction.Timely airway management and correction of hormonal imbalances are essential to survival and recovery.Multidisciplinary collaboration is crucial in managing complex cases of Morgagni-Stewart-Morel syndrome, especially in acute settings where diagnosis is challenging.