A rare catastrophic cause of muffled voice

@#A 60-year-old diabetic lady presented with a four-day history of sore throat and fever, followed by dysphagia, odynophagia and voice change. It started with a low-grade fever with no chills or rigor, no night sweats and no loss of weight or appetite. There was no other positive history.

Lipoma of vallecula-a case report.

Lipomas of the larynx, oropharynx and hypopharynx are rare, accounting for approximately 1% of benign laryngeal neoplasms. We present a rare case of a simple lipoma arising from the right vallecula. A 55-year-old male presented with worsening dysphagia for 1 week. CT scan revealed a lesion of fat attenuation in the right vallecula. The patient underwent surgical excision and recovered uneventfully. To our knowledge, there are only two cases of vallecular lipoma that have been reported and they are both of spindle cell subtype and located on the left side. This is the first reported case of a simple lipoma arising from the right vallecula and causing obstructive symptoms. CT scan or MRI is essential in confirming the diagnosis and assessing the extent, thus allowing prompt excision, especially when the patient is symptomatic.

Extracranial Carotid Aneurysm Secondary to Takayasu Arteritis (TA): A Rare Complication

Extracranial aneurysms are a rare presentation accounting for only less than 5% of all peripheral artery aneurysms. The left common carotid artery aneurysm is considered even rarer. We present a case of a 46-year-old gentleman who presented to casualty unit with a neck mass, stridor and acute respiratory distress. Prior to this admission patient was being investigated for Takayasu arteritis (TA). Patient was subsequently intubated due to respiratory compromise. A CT angiography of the thorax was done showed a proximal left common carotid artery aneurysm with contained leakage of aneurysm with severe compression of the trachea. Patient was subsequently transferred to the vascular team in National Heart Institute for further management.

MR Volumetry of Hippocampus in Normal Adult Malay of Age 50 Years Old and Above.

BACKGROUND: Hippocampal volume is affected by several psychiatric illnesses of old age, as well as by normal aging. It is important to have a normal data in a population to assist in diagnosis. The aim of this study is to determine hippocampal volume in normal Malay people aged 50 years old and older. METHODS: This was a cross-sectional study of the normal Malay population aged 50 to 77 years. We included 43 participants, representing 19 men and 24 women. Magnetic resonance imaging (MRI) was performed using a GE Signa Horizon LX 1.0 Tesla. Oblique coronal images of temporal lobes were obtained and hippocampal volumetry was done manually and normalised with intracranial volume. RESULTS: Mean right and left hippocampal volumes (HCVs) were 3.43 cm³ (SD 0.32) and 3.26 cm³ (SD 0.34), with a significant difference between them (P < 0.001). Total mean HCVs exhibited no significant difference between men and women (P = 0.234). The means of the normalised right and left HCVs were 3.42 cm³ (SD 0.31) and 3.26 cm³ (SD 0.32). CONCLUSION: The mean right and left hippocampal volumes were significantly different in this study. Men had slightly larger mean HCVs but the difference was not statistically significant. It was found that normalisation further reduces the mean volume difference between the genders.

Normalised MRI Volumetry of the Hippocampus among Normal Malay Children and Adolescents.

BACKGROUND: Magnetic resonance imaging (MRI) is a noninvasive method for determining brain morphology and volumetry. Hippocampal volume changes are observed in conjunction with several diseases. This study aimed to determine the normalised volume of the hippocampus in normal Malay children and adolescents. METHODS: This was a cross-sectional study performed from January 2009 to June 2010. Brain and temporal lobe MRI was performed for 81 healthy normal Malay individuals aged 7-18 years. Manual volumetry was performed. The hippocampal volumes were normalised with the total intracranial volume. RESULTS: The original right, left, and total hippocampal volumes (mean and standard deviation) were 3.05 (0.48) cm(3), 2.89 (0.44) cm(3), and 5.94 (0.90) cm(3), respectively. Normalised hippocampal volumes for the right, left, and total volume were 3.05 (0.41) cm(3), 2.89 (0.41) cm(3), and 5.94 (0.79) cm(3), respectively. Pearson's correlation coefficient for the right and left hippocampal volumes with intracranial volume were 0.514 and 0.413, respectively (P < 0.001). Both the original and normalised hippocampal volumes of the right hippocampus were significantly larger than those of the left (P < 0.001). CONCLUSION: This is a data set for the local Malay paediatric population. There was no significant difference between the actual and normalised values of hippocampal volume in our study.

Hippocampal MR Volumetric Studies in Paediatric Patients with Epilepsy and Normal Controls.

The aim of this study was to determine and compare the hippocampal volume in children with epilepsy and in children in a control group and to compare the mean of right and left hippocampal volume in control subjects. This study was carried out at University Sains Malaysia (USM) from January 2008 to June 2009. This is a cross sectional study of 40 children with epilepsy and 40 children in a control volunteer group. Serial MRI of brain and temporal lobe were performed using a Signa Horizon LX 1.0 Tesla system. Oblique coronal sections perpendicular to the axis of temporal lobe were done with 4 mm slice thickness and 1 mm gap. T1, T2, FLAIR and SPGR series were done. The whole hippocampal volume was measured. Volumetry was done manually by using Osirix workstation (v 3.5.1-64 bit). All slices were measured three times and the average volume was taken. Data were analyzed by paired t test and independent t test for univariate data. The mean hippocampal volume in the control group was 2.81 cm(3) (SD=0.38) and 2.65 cm(3) (SD=0.41) for right and left hippocampus respectively. The mean hippocampal volume in epilepsy patients was 2.47 cm(3) (SD=0.52) and 2.39 cm(3) (SD=0.44) for right and left respectively. The hippocampal volume in epileptic children was significantly smaller than normal control children in average volume (p=0.001) and both right (p=0.002) and left (p=0.007) individually. In the control group, the right hippocampus volume was much greater than the left (p<0.001). The data of this study provide a useful reference for the study of hippocampal volume in the Malay paediatric population. It is useful in doubtful cases to determine which side is affected and also serves as part of the study to establish the whole age-related hippocampal growth.