We examined the effects of lexical competition and word frequency on spoken word recognition and production in healthy aging. Older (n = 16) and younger adults (n = 21) heard and repeated meaningful English sentences presented in the presence of multitalker babble at two signal-to-noise ratios, +10 and -3 dB. Each sentence contained three keywords of high or low word frequency and phonological neighborhood density (ND). Both participant groups responded less accurately to high- than low-ND stimuli; response latencies (from stimulus offset to response onset) were longer for high- than low-ND sentences, whereas response durations-time from response onset to response offset-were longer for low- than high-ND stimuli. ND effects were strongest for older adults in the most difficult conditions, and ND effects in accuracy were related to inhibitory function. The results suggest that the sentence repetition task described here taps the effects of lexical competition in both perception and production and that these effects are similar across the life span, but that accuracy in the lexical discrimination process is affected by declining inhibitory function in older adults.

Subjects with spontaneous CSF leaks had postclamping average ICP identical to controls with IIH and papilledema. Such evidence suggests that a CSF leak in this patient population provides sufficient pressure diversion to avoid the development of papilledema.

Objectives: Spontaneous cerebrospinal fluid (CSF) leaks typically present in patients with undiagnosed idiopathic intracranial hypertension (IIH) secondary to pressure erosion of the skull base. Despite elevated intracranial pressure (ICP) on lumbar puncture or ventriculostomy, patients with spontaneous CSF leaks rarely complain of visual disturbances. The objective of this study is to correlate the presence of preoperative papilledema with opening ICP in patients undergoing endoscopic repair of spontaneous CSF leaks. Methods: Prospective evaluation of patients with spontaneous CSF leaks was performed over a 1-year period (December 2012 to December 2013). Fundoscopic examination for papilledema was completed preoperatively and CSF pressure was measured by lumbar puncture or ventriculostomy intraoperatively. Data regarding demographics, nature of presentation, and body mass index (BMI) were also recorded and compared to a control cohort of IIH patients with papilledema. Results: Sixteen patients (avg. age 52 years) were evaluated. Obesity was present in 94% of individuals (avg. BMI 43.5; range, 27-65). Papilledema was absent preoperatively in all subjects. Opening pressures via lumbar puncture/ventriculostomy were 27 ± 7.7 cmH20. Following 6 hours of clamping, measurements significantly increased to 36 ± 9.7 cmH20 ( P < .001). IIH controls (avg. age 33 years, avg. BMI 36.7, 22-52) exhibited average ICP (36 ± 10.5) identical to post-clamp measurements in the spontaneous CSF leak cohort. Conclusions: Subjects with spontaneous CSF leaks had post-clamping average ICP identical to controls with IIH and papilledema. Such evidence suggests that a CSF leak in this patient population provides sufficient pressure diversion to avoid the development of papilledema.

Patients with spontaneous CSF leaks have evidence of enlarged Meckel's caves. Evaluation of Meckel's cave dimensions should be included in preoperative imaging assessment as an additional indicator of chronically elevated intracranial pressure.

A 14-year-old girl with no significant medical history presented at Emergency Department with sore throat and odynophagia after one episode of nonviolent coughing. She denied any respiratory distress, voice change, foreign body ingestion, retching, substance abuse, dental procedures, or trauma. She was afebrile with normal oxygen saturation and physical examination including the head and neck was unremarkable with the exception of bilateral neck crepitus without tenderness on palpation. Fiberoptic laryngoscopy revealed a patent laryngeal airway with normal vocal fold movement. Lateral neck X-ray demonstrated a linear air-column in the retropharyngeal space and computed tomography confirmed emphysema involving the retropharyngeal space and mediastinum with no evidence of fluid collection or abscess formation. Spontaneous retropharyngeal and mediastinal emphysema are clinical entities where free air is present within the confines of retropharyngeal space and mediastinum without obvious cause. It is benign and self-limited in nature and allows for conservative management. This case is presented with a review of literature.