Cervical bronchogenic cysts are rare. We present two cases of neck swelling resulting from bronchogenic cyst. (1) An 8-month-old male child presented with a 3 ¥ 3 cm infrahyoid midline cystic neck swelling since birth. Surgical excision was performed. Histological examination demonstrated a cyst lining of mucinous respiratory-type epithelium. The features were consistent with benign bronchogenic cyst (Fig. 1). (2) A 5-year-old female child presented with 4 ¥ 3 cm midline cystic swelling in infrahyoid region. Surgical excision of swelling was performed. Histopathology of cyst lining revealed respiratory epithelium consistent with bronchogenic cyst. Bronchogenic cysts may be intrathoracic or extrathoracic. There are a little over 70 reported cases of extra thoracic bronchogenic cysts. The male to female ratio is 4:1. The primitive foregut is divided into ventral and dorsal structures by the laryngotracheal groove during the fifth week of gestation. Lung buds of the ventral component form by the seventh week, but fusion of the mesenchymal bars forming the anterior chest wall occurs only in the third gestational month. During this process of fusion, bronchial tissue may get separated beyond the confines of the chest wall and sternum. Local traction or compression on adjacent structures can cause symptoms of dyspnoea, cyanosis or dysphagia. A neck abscess can also occur if the cyst becomes infected. There is also a rare possibility of mucoepidermoid carcinoma occurring, which emphasizes the necessity of resection. Magnetic resonance imaging is the study of choice due to excellent soft-tissue details. Computed tomography is useful to confirm the presence of a fluid-density mass. The definitive treatment of paediatric cervical bronchogenic cysts is surgical excision. If complete surgical excision is performed, recurrence is unlikely. The possibility of a bronchogenic cyst should be considered in the differential diagnosis of neck masses.

We report the case of a 55-year-old man who presented with a left hemisphere stroke. The initial computed tomography scan demonstrated a cerebral infarct in association with a left middle cerebral artery occlusion. Carotid duplex ultrasound imaging revealed a surgical grade stenosis of the proximal left internal carotid artery; however, in view of the uncertain benefits of internal carotid endarterectomy in the face of ipsilateral middle cerebral artery occlusion, surgery was deferred. Subsequent surveillance by transcranial Doppler imaging and repeat computed tomography demonstrated spontaneous recanalization. The patient proceeded to carotid endarterectomy with no complications.

A patient presented to the emergency department having fallen backwards onto a wooden knitting needle which broke, leaving only a small entry wound. The top CT scan (fig 1A) showed a linear low attenuation track extending towards the left paravertebral region. …

A 49-year-old man presented with a 5-month history of poor balance and lower limb weakness. Examination revealed Medical Research Council 4/5-grade weakness in both legs, an absent left knee-jerk reflex and an up-going plantar reflex on the right. Joint position sense was impaired in both legs, as was fine touch sensation in his left ankle and he exhibited cerebellar signs of unsteady gait and poor coordination. There was no bladder or bowel involvement. The initial impression was of a posterior fossa lesion or a lesion in the cervical cord. A magnetic resonance (MR) examination of the brain was normal. MR of the spine showed no structural abnormality but diffuse, abnormally low, marrow signal intensity within the vertebral bodies was present, in keeping with loss or replacement of normal marrow fat. Blood investigations subsequently revealed a picture suggestive of pernicious anaemia. Significant blood results were as follows (with reference ranges in parentheses): Haemoglobin 125 g/l, mean cell volume 112 fl, serum vitamin B12 68 ng/l (211–900), serum folate 14Æ2 lg/l (2Æ4–20 lg/l) and ferritin 235Æ5 lg/l (12–300 lg/l). A blood film showed slight macrocytosis. Parietal cell and intrinsic factor antibodies were also positive. These findings confirmed the diagnosis of sub-acute combined degeneration of the cord secondary to pernicious anaemia. The patient was commenced on weekly intramuscular B12 supplementation. On normal T1-weighted MR images of the spine in an adult, the abundant fatty marrow results in a higher signal intensity in vertebral marrow than in the intervertebral discs (left image). In this case, the vertebral marrow was of slightly lower signal intensity than the intervertebral discs (right image). The underlying process of hypercellularity of the marrow with loss of fat cells results in the reduction in signal intensity on T1-weighted images. This imaging feature more commonly occurs in conditions such as leukaemia, lymphoma, multiple myeloma and metastatic disease. However, as shown in this case, non-neoplastic haematological disorders can produce this abnormality. In sub-acute combined degeneration of the cord, high resolution MR images of the spinal cord may reveal abnormal hyperintensity within the posterior aspect of the cervical cord on T2-weighted MR images, due to demyelination of the dorsal columns.

Bilateral intracavernous carotid artery aneurysms are rare and can present with different clinical findings. We report such a case presenting with progressive cranial nerve palsies due to gradual increase in the size of aneurysms. This case demonstrates the clinician's difficulty in diagnosis when isolated cranial nerve palsy is the sole presenting sign.