An unusual presentation of vertigo: is head titubation the key to diagnosis?

Objective. Discuss complex interplay of pathophysiological effects of cerebellar space occupying lesions on the vestibular pathway. Discuss challenges of diagnosis and referral along with differential and final diagnosis of unusual presentation. Case Report. We describe the case of a patient with vertiginous symptoms complicated by neurological features, namely, head titubation and tremor. The patient also had signs of oscillopsia and possible impairment of the vestibulo-ocular reflex. The resulting symptom and sign complex made for a difficult diagnosis, as the interplay of the pathophysiology of these signs, were unusual. Conclusion. The discussion has revealed that the cerebellar lesions themselves may have simultaneously caused head tremor and an inability for the vestibulo-ocular reflex to compensate, resulting in vertigo. However, whether the vertigo was a result of an oscillopsia, nystagmus, or central cause, the referral route should initially be via a general physician to rule out such a life threatening cause as a tumour.

Air rifle pellet injury to the middle ear, a very rare occurence.

INTRODUCTION: Air rifle pellet injuries are relatively common. These injuries often involve the brain, eyes chest or abdomen. It is rare for ENT surgeons to be involved in the care of these patients. CASE REPORT: We present the case of a 38 year old man with a history of an air rifle pellet injury to the left ear. Presenting symptoms included bleeding per ear, otoalgia, hearing loss and tinnitus. Imaging and surgical exploration demonstrated a metallic pellet in the left petrous temporal bone, within the middle ear and a fracture of the anterior wall of the external auditory meatus with associated tiny metallic fragments. A further surgical exploration was required to remove a bony sequestrum of the anterior canal wall. CONCLUSION: The onset of pain and discharge a few months after the injury may imply the formation of a delayed sequestrum. The possibility of an implantation cholesteatoma should also be considered.

Rhabdomyosarcoma of the adult nasopharynx.

Rhabdomyosarcoma of the adult head and neck is rare, particularly beyond 40 years of age. In this region, the nasopharynx is an unusual site. Most nasopharyngeal rhabdomyosarcomas are of an alveolar variety. We report a case of embryonal or spindle cell rhabdomyosarcoma in the nasopharynx of a 47-year-old man. The histology of this tumour revealed clear cells that have not been described in embryonal rhabdomyosarcomas occurring in the head and neck. The pathology is discussed and current literature reviewed.