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.

Idiopathic laryngeal spasm (ILS) is an uncommon disorder characterised by brief episodes of stridor, occurring at any time. Subsequent outpatient ENT examination is normal. These episodes cause considerable anxiety for both patient and physician. Little is known about the initiating event(s) in this condition or the long-term outcome. Using a combination of telephone and postal questionnaires with case note review, we have reviewed a cohort of 21 patients with this diagnosis managed by the senior author over the last 15 years. None of the 19 patients who responded were worse; 13 (68%) described improvement or complete resolution of symptoms. ILS is difficult to classify in the spectrum of vocal cord disorders, but appears distinct to those previously described. The condition responds well to a conservative management approach of reassurance and counselling.

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Background: Pleomorphic salivary adenomas (PSA) are the commonest salivary tumor and are benign neoplasms that affect mostly the parotid glands. PSA's can however affect the minor salivary glands, typically around the palate. The treatment of choice for minor gland PSA's is via complete surgical excision and close monitoring to exclude recurrences. Case Report: We describe here a rare case of a minor salivary gland pleomorphic adenoma arising from the glosso-tonsillar sulcus in a 41-year-old patient. The presented tumor was treated with full surgical excision and was followed-up with regular MRI scans to rule out recurrences. Conclusion: PSA's of the minor salivary glands are uncommon and should be treated with a high level of suspicion due to a high malignant potential.

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.

As a recognised cause of acute stroke, particularly in younger patients, spontaneous carotid artery dissection is an important diagnosis to consider. Although advances in interventional radiology are improving diagnosis, it is still considered an underrecognised phenomenon [1]. It is estimated to account for around 2.5% of all strokes, but this figure is much higher for younger patients [2]. However, the clinical presentation can be varied, subtle and often challenging to make, with multiple different presentations described. Unilateral cranial nerve palsies, particularly of the lower cranial nerves, are a recognised sign in up to 12% of cervical artery dissections [1], and it is therefore vital to be able to recognise them. We present a case of a man referred to a head and neck cancer clinic with unilateral lower cranial neuropathies and neck pain who was subsequently found to have an internal carotid artery dissection.