A 74-year-old male presenting with headache, high fever, and mental malaise was diagnosed with intracranial infection based on magnetic resonance imaging. The patient initially responded poorly to broad-spectrum antibiotic therapy. A multidisciplinary team review of imaging and dedicated sinus computed tomography results revealed pansinusitis and a right sphenoid bone wall defect, confirming a sinogenic origin. Functional endoscopic sinus surgery was performed followed by systemic antibiotics therapy and intrathecal injection, and the infection was eventually controlled. For intracranial infections with poor initial response, sinogenic sources should be investigated even in the absence of nasal symptoms. Meningeal irritation signs are often absent in older patients; the triad of headache, fever, and mental malaise warrants particular clinical attention. Source control and sustained anti-infective therapy under multidisciplinary collaboration are the key to successful treatment.
Cervical emphysema after dental treatment is a rare complication, which could result in deep neck infections, pneumothorax, air embolisms or even sepsis. Early diagnosis is a key factor in its successful management. The authors present two case reports of patients with massive cervicothoracic emphysema after dental treatment. Both patients were admitted to the ENT ward for observation; a CT scan eliminated serious complications and prophylactic antibiotic treatment was administered. The patients did not develop any further complications; the emphysema withdrew within days and both patients were discharged in less than 7 days. Cervicothoracic emphysema after dental treatment is uncommon but is a potentially fatal complication. An early and correct diagnosis is crucial. In most cases, a conservative approach is sufficient. More severe cases with the involvement of the deep neck spaces and thorax may require a more intensive approach.
Myxoid/round cell liposarcoma (MRCLS), a high-grade subtype of myxoid liposarcoma (MLS), accounts for 20–25% of liposarcomas (LSs). While pulmonary metastases predominate, orbital involvement is exceedingly rare and clinically challenging. A 37-year-old male presented with a three-week history of right-sided exophthalmos and diplopia. His medical history was notable for MRCLS of the right thigh, treated with surgery, radiotherapy, and doxorubicin-based chemotherapy. Imaging demonstrated a right orbital mass, confirmed histologically as metastatic MRCLS. Rapid progression led to vision loss and severe pain. Additional metastases were identified in the presacral region and left pleura. Palliative ifosfamide failed to control orbital growth; orbital exenteration provided pain relief and cosmetic improvement. MRCLS may metastasize to the orbit within two years and exhibit aggressive behaviour. Clinicians should consider atypical metastatic spread in patients with a history of soft-tissue sarcoma presenting with orbital symptoms.
Paraglottic space schwannoma is a rare benign laryngeal tumor, and surgery of large lesions remains clinically challenging. We present a 59-year-old male with 10-year hoarseness diagnosed with left paraglottic space schwannoma (3.7 cm) and systematically review relevant literature to analyze its characteristics, diagnostic methods and surgical strategies. The patient underwent direct laryngoscopy with combined CO2 laser and microlaryngoscopic techniques. We summarize his clinical features, surgical process, pathological results and postoperative recovery. No local recurrence or residual lesion was observed during follow-up. Therefore, the transoral laser microsurgery is an effective, minimally invasive surgical option for large paraglottic space schwannomas (>3 cm), achieving complete excision with minimal trauma, less bleeding, rapid recovery and no cervical scarring.
Skull vibration-induced nystagmus (SVIN) normally begins and ends abruptly, without post-stimulatory reversal, because the 100 Hz stimulus drives irregular afferents through the direct pathway and largely bypasses the velocity storage integrator. An 83-year-old woman with chronic gait instability, dizziness and no resting nystagmus underwent skull vibration-induced nystagmus testing, which produced high-intensity right-beating nystagmus (73°/s) that reversed to left-beating nystagmus (10°/s) for 6–8 s after stimulus cessation; the same pattern recurred at 3-month follow-up. Imaging showed a left vestibular schwannoma with floccular compression and diffuse parenchymal retraction, and temporal bone photon-counting-detector CT excluded semicircular canal dehiscence; testing indicated predominantly left hypofunction. We interpret the reversal, hypothetically, as a stimulus-facilitated, rebound-like central phenomenon—arising from the fixed left vestibular-tone asymmetry and the unusually intense vibratory drive on a permissive central substrate—and emphasize extending observation beyond the per-stimulatory period, where such post-stimulatory signs may reveal coexisting peripheral and central vestibular dysfunction.
