A 1-year-old Maine coon cat was presented with acute onset of central vestibular syndrome and recurrent generalized tonic-clonic seizures. Computed tomographic imaging of the head revealed a left-sided intracranial lesion consistent with an abscess, associated with bilateral otitis media/interna, with more severe involvement of the left tympanic bulla. Based on clinical and imaging findings, the cat underwent surgical intervention consisting of a left temporal burr-hole craniotomy for abscess drainage combined with a unilateral ventral bulla osteotomy. Purulent material was collected during surgery and submitted for bacterial culture, which yielded Staphylococcus aureus sensitive to amoxicillin-clavulanic acid and metronidazole. Postoperative management included intravenous antimicrobial therapy followed by oral treatment after discharge. Transient vestibular dysfunction and Horner's syndrome were observed after surgery and resolved completely within 3 mo. At a long-term follow-up, the cat was neurologically normal. This case highlights the successful surgical management of an otogenic intracranial abscess in a cat and supports unilateral surgical treatment guided by clinical and imaging findings. Key clinical message: Intracranial abscesses secondary to otogenic infection should be considered in cats that have central vestibular clinical signs and seizures. A combined surgical approach using burr-hole craniotomy and ventral bulla osteotomy, guided by imaging findings, can result in favorable clinical outcomes.

Horner syndrome is a well-recognized manifestation of sympathetic pathway disruption in lung cancer, particularly in apical lesions; however, its reversibility after treatment varies and remains difficult to predict. We report two cases of lung cancer-associated Horner syndrome that showed contrasting neurological outcomes following radiotherapy. In the first case, contrast-enhanced computed tomography (CT) demonstrated an apical lung tumor with a close anatomical relationship to adjacent neurovascular structures, and Horner syndrome failed to show sustained improvement after definitive radiotherapy. In the second case, contrast-enhanced CT revealed a supraclavicular lymph node metastasis without radiological evidence of direct neural invasion, and the neurological symptoms improved and remained stable after palliative radiotherapy. The differing post-treatment courses observed in these cases suggest that pre-treatment imaging findings, particularly the anatomical relationship between tumor lesions and surrounding neurovascular structures, may assist in prognostic estimation and patient counseling regarding the potential reversibility of Horner syndrome in patients with lung cancer.

Lateral medullary syndrome (LMS), or Wallenberg syndrome, typically arises from ischemia of the dorsolateral medulla and is characterized by crossed sensory deficits, ipsilateral cranial nerve involvement, cerebellar ataxia, and Horner's syndrome. We report a 66-year-old hypertensive female who presented with classical clinical features suggestive of LMS, including ipsilateral facial sensory loss, contralateral body sensory impairment, palatal weakness, ipsilateral Horner's syndrome, and cerebellar signs. However, diffusion-weighted magnetic resonance imaging revealed a predominantly paramedian pontine tegmental infarction with associated right cerebellar involvement, without evidence of medullary ischemia. This clinico-radiological dissociation can be explained by the involvement of shared neuroanatomical pathways, such as the spinothalamic tract, spinal trigeminal nucleus, and descending sympathetic fibers, which extend into the pontine tegmentum, thereby mimicking LMS. This case highlights the limitations of clinical localization in posterior circulation stroke and emphasizes the importance of neuroimaging in accurately identifying lesion sites when brainstem syndromes present with overlapping features.

Ancient schwannoma is a rare, slow-growing, benign peripheral nerve sheath tumor characterized by long-standing degenerative changes that may clinically, radiologically, and histopathologically mimic malignancy. These tumors commonly present as asymptomatic, gradually enlarging masses in the head and neck region, posing significant diagnostic challenges. We report a rare case of cervical ancient schwannoma in a 53-year-old male who presented with a painless swelling below the left ear of six-month duration. Radiological imaging suggested a necrotic cervical lymph node, and fine-needle aspiration cytology was inconclusive due to hypocellularity. Complete surgical excision was performed, and definitive histopathological examination confirmed the diagnosis of ancient schwannoma. Postoperatively, the patient developed Horner's syndrome, an expected but uncommon complication, which was managed conservatively. This case highlights the complex diagnostic challenges associated with ancient schwannomas, emphasizes the necessity of histopathological confirmation, and illustrates the importance of meticulous preoperative planning to anticipate potential neurological complications.

Post-styloid parapharyngeal space (PPS) tumors are rare and predominantly neurogenic. Because tumors arising from the vagus nerve or the cervical sympathetic chain are associated with distinct postoperative morbidities, accurate preoperative identification of the nerve of origin is clinically important for surgical planning and risk counseling. The primary endpoint was the accuracy of imaging-based nerve-of-origin prediction using vessel displacement patterns, compared with intraoperative confirmation.

Sympathetic arrhythmia represents a life-threatening complication following acute myocardial infarction (AMI), which is characterized by recurrent episodes of electrical dysrhythmias that are often refractory to antiarrhythmic medications and thereby necessitate repeated electrical cardioversion or defibrillation. This case series aims to evaluate the efficacy and safety of ultrasound-guided stellate ganglion block (SGB) as a rescue therapy for refractory ventricular arrhythmias and one case of rapid atrial flutter following AMI.

Physiologic [18] F-fluorodeoxyglucose (FDG) uptake in brown adipose tissue (BAT) is a recognized source of false-positive findings on positron emission tomography (PET) scans, typically presenting as symmetric, multifocal activity in fat-density tissue. We report a case of a 30-year-old woman with left-sided cervical swelling and unilateral, left-sided FDG uptake mimicking malignancy, but without corresponding computed tomography abnormalities. The patient's history included right-sided mediastinal ganglioneuroma resection in childhood, resulting in Horner syndrome. Hybrid PET/magnetic resonance (MR) imaging with image fusion definitively localized the FDG activity to left-sided BAT, confirming the tissue origin and linking the unilaterality to sympathetic denervation from prior right stellate ganglion disruption. This case illustrates that hybrid PET/MR can resolve diagnostic uncertainty in atypical BAT presentations and highlights the importance of recognizing altered BAT metabolism after sympathetic injury to avoid misinterpretation of PET findings.

The recombinant measles virus (MeV) is among those vaccine platform technologies, which are tested for the fast generation of effective vaccines against other pathogens, such as emerging virus diseases. Different live-attenuated vaccine strains have become available as backbones, with few differences. Here, we analyze how minor differences of recombinant Moraten (MVvac2) or Schwarz (MVSchw) constructs have an impact on the performance of respective derived Middle East respiratory syndrome (MERS) vaccine candidates. MVvac2 or MVSchw viruses, both encoding the Spike glycoprotein (S) of the MERS-coronavirus (MERS-CoV) in an additional transcription unit (ATU) between the hemagglutinin gene and the polymerase gene L cassette, were tested. Both robustly expressed the additional gene. However, approximately twofold to threefold higher amounts of S proteins were observed in cells infected by the MVSchw-MERS-S(H) virus, correlating with the same relative ratio of S mRNA found in these cells. Exchange of the short genomic 3' UTR ATU sequence in MVvac2 against the sequence in MVSchw enhanced gene expression by about the same factor and demonstrates causality. MeV-susceptible IFNAR-/--CD46Ge mice vaccinated with either candidate reveal that higher relative S antigen expression by MVSchw-MERS-S(H) tended toward induction of higher specific antibody titers, but lower numbers of S antigen-specific T cells. In subsequent challenge experiments, both candidates were effective. Thus, minor differences in the genetic composition of recombinant MeV's ATU may modulate the gene expression pattern of additionally encoded proteins that are reflected by changes in the respective immunogenicities, but which were not decisive for protection in the chosen disease model.