Varghese Thomas

Neurofibromatosis type 1 (NF1) with vocal cord palsy: baffling presentation of a benign tumour

A 33-year-old man presented with hoarseness of voice, cough and choking while eating for 1 weeks duration. His sister was diagnosed with neurofibromatosis but was asymptomatic. Two years previously he had paraparesis due to a dumb-bell neurofibroma of the posterior mediastinum with intraspinal extension, which was excised with full recovery, but the lesion recurred and a re-excision was performed with histopathological confirmation as neurofibroma. On examination the patient was conscious with stable vitals. Multiple, extensive neurofibromas were seen on the face (figure 1A) and plexiform lesions over the trunk with scars of previous surgical incisions of biopsy (figure 1B). He had left vocal cord paralysis, confirmed by indirect laryngoscopy. Chest radiograph anteroposterior view …

An unusual unilateral benign congenital anomaly of the pupil

A 50-year-old male manual labourer attended the outpatient department with history and clinical features of upper respiratory infection. He had studied up to the fifth grade. There was no history of visual symptoms. There was no significant family history of congenital ocular diseases. His vital signs, general and system examinations were normal. However, examination of his left eye showed a small eccentrically placed pupil with reduced papillary diameter (figure 1). The right pupil was of normal size and reaction (figure 2). The comparative images of both eyes are shown in (figure 3A, B, C). The extraocular movements were normal …

Condylus tertius and episodic vertigo: is there an association?

A 39-year-old man presented with acute attack vertigo and vomiting and painful restriction of neck mobility. He was suffering from episodic vertigo with no relief from medication. He had experienced similar episodes over the past 7 years. Initially, episodes of vertigo associated with vomiting occurred once per month but later increased in frequency to 2–3 times per week early in the morning. Daily vertigo/vomiting episodes over the previous 2 months had prevented him from going to work. There was no history of drug intake apart from cinnarazine hydrochloride and betahistine hydrochloride, which he stopped as they provided no relief. The vitals, ear, nose and throat examination and neurological examination were within normal limits. All the other causes …