MRI evaluation of distance between tonsillary fossa and internal carotid artery in children.

OBJECTIVES: The presence of the internal carotid artery (ICA) near tonsils can also cause severe bleeding during a tonsillectomy. We investigated the relationship between tonsil width and volume; and superior, middle and inferior tonsil-ICA distances in 5-9 and 10-15 years of age children. METHODS: Cranial MRI images of 200 children between 5 and 15 years of age were evaluated retrospectively. There were 100 children in group 1 (5-9 years of age) and 100 children in group 2 (10-15 years of age). Palatine tonsil width and volume; and superior, middle and inferior tonsil-internal carotid artery (ICA) measurements were performed bilaterally. RESULTS: Our results showed that bilateral tonsil width and volume; and left superior, middle and inferior tonsil-ICA distance of 5-9 years of age group were lower than those of the 10-15 year-of age group (p < 0.05). The nearest distance between ICA and palatine tonsil is at the inferior tonsil-ICA distance side in both age groups. Especially mean inferior and middle tonsil-ICA distances were lower than 8 mm in 5-9 years of age group and lower than 9 mm in 10-15 years of age group. Minimum middle tonsil-ICA distances were 2.0-2.50 mm in smaller children and 2.0-3.50 mm in older children. Similarly, the minimum inferior tonsil-ICA distances were 2.00 mm in smaller children and 2.20-3.00 mm in older children. There were positive correlations between tonsil width, volume, and superior tonsil-ICA distance; and middle and inferior tonsil-ICA distances (p < 0.05). CONCLUSION: In younger children, lower tonsil width; and in all children, lower tonsil volume can be a warning sign in terms of lower tonsil superior-ICA distance. During tonsillectomies, working at the middle and inferior tonsillary fossa, maximum attention must be performed for the possibility of the ICA being very closer to the tonsil to avoid unwanted bleedings.

Análise morfométrica maxilar aplicada a osteotomia Le Fort I / Morphometric analysis of maxilla applied to Le Fort I osteotomy

Introdução: A osteotomia Le Fort I é uma técnica cirúrgica utilizada para a correção de deformidades dentofaciais e para que ocorra a mobilização da maxila é necessária a disjunção da sutura pterigomaxilar. Durante esse procedimento, complicações podem ocorrer, como hemorragia resultante da injúria da artéria maxilar interna ou de seus ramos terminais, na qual a artéria palatina descendente é mais comum de ser lesionada. Objetivo: O objetivo deste estudo foi contribuir para o estabelecimento de parâmetros cirúrgicos seguros para realizar osteotomia le fort I com disjunção pterigomaxilar, por meio da obtenção de medidas das regiões maxilar e pterigomaxilar. Material e métodos: Foram selecionados quarenta crânios secos dos sexos masculino e feminino do Departamento de Anatomia de uma instituição pública e realizadas as medidas pelo método de inspeção direta com o uso de um paquímetro digital Mitutoyo® e um compasso Staedtler®. Foram medidas a altura e espessura da junção pterigomaxilar (JPM), a distância da sutura pterigomaxilar até o pilar zigomático, a distância desde o ponto mais inferior da sutura pterigomaxilar até a fissura orbital inferior (FOI), a extensão da parede lateral da cavidade nasal até o canal palatino descendente e o comprimento do septo nasal, bilateralmente. Para análise estatística dos resultados, utilizou-se o teste t para amostras independentes, com nível de significância de 5%. Resultados: Observou-se que para o lado direito, as médias das respectivas medidas foram de 14,88mm, 9,17mm, 27,60mm, 34,47mm e 36,86; e o lado esquerdo, as médias foram, respectivamente, 15,18mm, 9,08mm, 26,50mm, 34,70mm e 36,02mm. O valor médio do comprimento do septo nasal foi de 49,10mm. Conclusão: com base nos valores obtidos é possível estabelecer parâmetros operatórios para a osteotomia Le Fort I.

Introduction: The Le Fort I osteotomy is a surgical technique used for correction of dentofacial deformities and dislocation of the pterygomaxillary suture for mobilization of maxilla. During this procedure, complications may happen, such as hemorrhage resulting from the injury of the internal maxillary artery or its terminal branches, in which the descending palatine artery is more common to be injured. Objective: The aim of this study was to contribute for establishment of safe surgical parameters to improve osteotomy with pterygomaxillary disjunction, through the measurement of the maxillary and pterygomaxillary regions. Material and Method: Forty dry skulls (male and female) of the Department of Anatomy of a public institution were selected and the measurements were made by the direct inspection method using a Mitutoyo® digital caliper and a Staedtler compass ®. The height and thickness of the pterygomaxillary junction, the distance from the pterygomaxillary suture to the zygomatic pillar, the distance from the lower point of the pterygomaxillary suture to the inferior orbital fissure, the extension of the lateral wall of the nasal cavity to the descending palatine canal, and the length of the nasal septum, bilaterally, were measured. For the statistical analysis of the results, the t-test was used for independent samples, with a significance level of 5%. Results: We found that on the right side, the averages of the respective measurements were 14.88mm, 9.17mm, 27.60mm, 34.47mm and 36.86; and on the left side, the averages were, respectively, 15.18mm, 9.08mm, 26.50mm, 34.70mm and 36.02mm. The mean value of nasal septum length was 49.10 mm. Conclusion: Based on the values obtained it is possible to establish operative parameters for the Le Fort I osteotomy.

Microvascular anatomy of olfactory and accessory olfactory (vomeronasal) organs in adult Xenopus laevis: scanning electron microscopy of vascular corrosion casts / Anatomía microvascular de órganos olfatorios y accesorios (vomeronasal) en adultos Xenopus laevis: microscopía electrónica de barrido de moldes de corrosión vascular

Microvascular anatomy and histomorphology of olfactory and vomeronasal organs in adult Xenopus laevis Daudin were studied by scanning electron microscopy of vascular corrosion casts and paraplast embedded stained serial tissue sections. Results show that the arterial supply is bilaterally by terminal arterioles of the medial branch of the nasal artery and by the palatal artery. Arterioles give rise to a capillary meshwork characteristic for respiratory surfaces in principal chambers and in dorsal and caudal areas of middle chambers. Anterior and inferior areas of the middle chambers own a distinctly different capillary network with conspicuous short capillary loops. Loops have a dilated tip and extend in acute angles towards the chamber lumen. The vomeronasal organ (VNO) locates beneath the olfactory organ. It has a medial to lateral extension and attaches with its caudal circumference to the medial nasal glands. Its capillary bed displays rectangular meshes which preferentially orientate along the long axis of the VNO. Locally, capillaries form short hairpin-like or strongly twisted loops with dilated tips which point towards the lumen of the VNO. These capillaries slow-down blood velocity and may lead to an increased exchange of oxygen, nutrients and water-borne odorants in the middle chambers and of pheromones in the VNO. In the latter vascular structures are present which might serve as a vascular pump.

Se estudiaron la anatomía microvascular e histomorfología de los órganos olfatorios y vomeronasales de Xenopus laevis Daudin adultos, mediante microscopía electrónica de barrido de moldes de corrosión vascular y secciones de tejido seriadas, teñidas e incluídas en paraplast. Los resultados muestran que el suministro arterial es bilateral por arteriolas terminales de la rama medial de la arteria nasal y por la arteria palatina. Las arteriolas dan lugar a un lecho capilar característico de las superficies respiratorias en las cámaras principales y en las áreas dorsal y caudal de las cámaras intermedias. Las áreas anterior e inferior de las cámaras centrales poseen una red capilar significativamente diferente con llamativos bucles capilares cortos. Los bucles tienen una punta dilatada y se extienden en ángulos agudos hacia la luz de la cámara. El órgano vomeronasal (VNO) se ubica debajo del órgano olfatorio. Se extiende de medial a lateral y se une con su circunferencia caudal a las glándulas nasales mediales. El lecho capilar muestra mallas rectangulares que se orientan preferentemente a lo largo del eje longitudinal del VNO. Localmente, los capilares forman bucles cortos en forma de horquilla o fuertemente retorcidos con puntas dilatadas que apuntan hacia la luz del VNO. Estos capilares ralentizan la velocidad de la sangre y pueden conducir a un mayor intercambio de oxígeno, nutrientes y odorizantes, a base de agua en las cámaras intermedias y de feromonas, en el VNO. En este último, están presentes estructuras vasculares que podrían servir como una bomba vascular.

Wernekink commissure syndrome with palatal myoclonus at onset: a case report and review of the literature.

BACKGROUND: Wernekink commissure syndrome causes a peculiar combination of internuclear ophthalmoplegia, dysarthria, and delayed-onset palatal myoclonus. Palatal myoclonus is thought to be secondary to delayed hypertrophic degeneration of the bilateral inferior olivary nuclei secondary to involvement of bilateral dentatoolivary tract. We describe a case of a patient with early-onset palatal myoclonus. CASE PRESENTATION: A 53-year-old Caucasian man with several vascular risk factors presented to our emergency room with slurred speech, double vision, difficulty with swallowing and walking, and rhythmic contractions of the soft palate. Brain magnetic resonance imaging showed an acute infarct of the right caudal midbrain and an old infarct of the right medulla. We hypothesize that the cause of early palatal myoclonus in our patient was a two-hit mechanism with degeneration of the right olivary nucleus resulting from prior right medullary lacunar stroke with the new infarct affecting the dentato-rubro-olivary tract on the left side, causing bilateral dysfunction initiating palatal myoclonus. CONCLUSIONS: Wernekink commissure syndrome with palatal myoclonus at onset suggests the presence of a prior ischemic insult in the medulla. Careful examination is important to identification of this presentation.

Prevalence of soft tissue calcifications in the maxillofacial region detected by cone beam CT.

OBJECTIVE: To determine the prevalence of soft tissue calcifications in cone beam computed tomography (CBCT) scans with different fields of view (FOV) and to assess its relation with the clinical relevance of the CBCT findings. MATERIAL AND METHODS: One thousand CBCT scans were grouped according to FOV's size and region scanned (MX-FOV, maxilla; MD-FOV, mandible; and MM-FOV, maxilla/mandible) and evaluated for the presence of soft tissue calcifications. Laterality and length of the elongated styloid processes (ESP) were also assessed. RESULTS: Eight hundred and eighty-two soft tissue calcifications were detected in 626 (62.6%) patients. MM-FOV presented the highest prevalence (76.8%), followed by MD-FOV (60.6%) and MX-FOV (57.2%). ESP and tonsillolith were the most frequent calcifications. Calcifications requiring treatment or not and those in need of follow-up accounted for 6.9%, 92.7%, and 0.3% of cases, respectively. There was no association between calcifications and subjects' gender or age (p > .05). Most cases of ESP occurred bilaterally and were longer in males (p < .05). CONCLUSIONS: There is a high prevalence of soft tissue calcifications in CBCT, and ESP and tonsilloliths are the most common types in all evaluated FOVs. While most cases do not require treatment, we emphasize the importance of detailed CBCT assessment for its diagnosis.

Aplicaciones del colgajo sural medial en cirugía reconstructiva de cavidad oral y orofaringe / Applications of medial sural artery perforator flap in oral cavity and oropharynx reconstruction

Objetivos. Presentar nuestra serie clínica de colgajos de perforantes basados en la arteria sural medial revisando las indicaciones, las características del colgajo y las complicaciones asociadas. Material y métodos. Análisis retrospectivo de 25 pacientes con defectos de cavidad oral y orofaringe reconstruidos con colgajo sural medial desde 2010 hasta 2013 en el Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario 12 de Octubre de Madrid. Resultados. El rango de edad fue de los 18 a los 82 años, siendo la edad media de 56,6 años. En cuanto a la distribución por sexos 14 eran varones y 11 mujeres. De los 25 colgajos realizados 15 fueron del miembro inferior izquierdo y 10 del derecho. La longitud media del pedículo fue de 11,21cm (7-16cm). En 8 casos presentaban 2 perforantes. No se evidenció ninguna perforante a menos de 8cm del pliegue poplíteo. El tamaño de la isla cutánea varió según las necesidades del defecto, entre 4 y 12cm de largo y de 2,5 a 6cm de ancho, con una media de 9,63×4,94cm. El cierre de la zona donante fue directo, sin precisar en ningún caso injerto dermoepidérmico. Dos colgajos presentaron necrosis total del mismo. Dos pacientes presentaron celulitis y dehiscencia parcial de la herida quirúrgica en miembro inferior, que evolucionó favorablemente con tratamiento antibiótico y curas locales. Conclusiones. El colgajo de perforantes de la arteria sural medial es una excelente opción en la reconstrucción de defectos de la cavidad oral y la orofaringe, proporcionándonos una adecuada adaptabilidad a la zona receptora y una mínima morbilidad de la zona donante (AU)

Objective. To present a clinical series of medial sural artery perforator flaps, including a review of its applications, characteristics, and related complications. Material and methods. A retrospective study was conducted on 25 patients who underwent oral cavity and oropharynx reconstruction with medial sural artery perforator flap from 2010 to 2013 in the Oral and Maxillofacial Surgery Department of the 12 de Octubre University Hospital (Madrid, Spain). Results. The ages ranged from 18 to 82 years (mean 56.6), with 14 males and 11 females. Of the 25 harvested flaps, 15 were from the left lower limb and 10 from the right. The mean pedicle length was 11.21cm (7-16cm). There were 2 perforations in 8 cases, but with no evidence of perforations less than 8cm away from the popliteal crease. The size of the skin paddle varied according to the defect, from 4 to 12cm long and 2.5 to 6cm wide, with a mean of 9.63×4.94. Direct closure of the donor site was performed in all cases with no skin graft needed. Two flap failures were reported. Two patients had inflammation and partial dehiscence of the surgical wound in the lower limb, with good results after local and antibiotic treatment. Conclusions. The medial sural artery perforator flap is an excellent alternative in oral cavity and oropharynx reconstruction, providing great adaptability to the defect and minimal donor site morbidity (AU)

Aberrant Lower Extremity Arterial Anatomy in Microvascular Free Fibula Flap Candidates: Management Algorithm and Case Presentations.

An accurate and comprehensive understanding of lower extremity arterial anatomy is essential for the successful harvest and transfer of a free fibula osteoseptocutaneous flap (FFF). Minimum preoperative evaluation includes detailed history and physical including lower extremity pulse examination. Controversy exists regarding whether preoperative angiographic imaging should be performed for all patients. Elevation of an FFF necessitates division of the peroneal artery in the proximal lower leg and eradicates its downstream flow. For patients in whom the peroneal artery comprises the dominant arterial supply to the foot, FFF elevation is contraindicated. Detailed preoperative knowledge of patient-specific lower extremity arterial anatomy can help to avoid ischemia or limb loss resulting from FFF harvest. If preoperative angiographic imaging is omitted, careful attention must be paid to intraoperative anatomy. Should pedal perfusion rely on the peroneal artery, reconstructive options other than an FFF must be pursued. Given the complexity of surgical decision making, the authors propose an algorithm to guide the surgeon from the preoperative evaluation of the potential free fibula flap patient to the final execution of the surgical plan. The authors also provide 3 clinical patients in whom aberrant lower extremity anatomy was encountered and describe each patient's surgical course.

Bilateral tonsilloliths and calcified carotid atheromas: case report and literature review.

Tonsilloliths and calcified carotid atheromas are dystrophic calcifications that can be identified in routine oral radiographs. This case report is the first description in the English literature of the simultaneous occurrence of bilateral tonsilloliths and calcified carotid atheromas. Panoramic oral radiographs from a 62-year-old woman presented bilateral radiopaque images of the left and right ramus of the mandible; multiple and well-defined radiopacities below the left angle of the mandible, next to the C3-C4 cervical vertebrae; and a single radiopacity on the right side between the hyoid bone and the mandible base. Computed tomography confirmed the exact location of the calcifications in the oropharyngeal and carotid spaces. A diagnosis of bilateral tonsilloliths and calcified carotid atheromas was reached. Doppler ultrasound indicated a degree of stenosis of ± 20% within the right and left carotids. The patient was referred to a vascular surgeon to evaluate the calcified carotid atheromas. Follow-up of the tonsilloliths was also performed.

A Case of Arteriovenous Malformation Presenting as Wallenberg Syndrome / 대한이비인후과학회지

Lateral medullary syndrome, also known as Wallenberg syndrome, is characterized by sensory deficits affecting the trunk and extremities on the opposite side of the lesion, and the face and cranial nerves on the same side of the lesion. Other clinical symptoms and findings are dysphagia, slurred speech, ataxia, facial pain, vertigo with nystagmus, Horner's syndrome, diplopia, and possibly palatal myoclonus. The cause of this syndrome is usually occlusion of the posterior inferior cerebellar artery or vertebrobasillar artery. We observed a case of Wallenberg syndrome occuring secondary to the cavernous malformation and initially presenting as unilateral vocal cord palsy. The centrally-medicated vocal cord palsy is a rare cause of hoarseness, but should be considered in cases where no other local cause can be found.

Top of the basilar artery embolic stroke and neonatal myoclonus.

Cerebellar stroke has been virtually unreported in the living newborn infant. A term newborn male weighing 3380g at birth suffered myoclonic seizures within 24 hours of birth by spontaneous vaginal delivery. Apgar scores were 3 and 4 at 1 and 5 minutes. Myoclonus persisted for 9 days, responding poorly to step-up anticonvulsant treatment including lidocaine, midazolam, and clonazepam. Imaging documented arterial ischaemic stroke within the left posterior cerebral and both superior cerebellar arteries, compatible with top of the basilar artery stroke. There was no electrographic correlate for the seizures. Disturbed oscillation within the dentato-rubro-olivary circuitry was the likely mechanism. The probable cause was embolism from an in-utero-onset inferior caval vein thrombosis. At 22 months the child was sitting unsupported. Scores on the Bayley Scales of Infant Development II were equivalent to those of a 12-month/year-old. He showed ataxic motor behaviour. Embolism can cause neonatal top of the basilar artery stroke, which may present with myoclonus due to cerebellar injury.

Retalho de abbé na queiloplastia secundária do paciente fissurado bilateral

Objetivo: Avaliar a possibilidade de uso do retalho de Abbé na queiloplastia secundária do paciente fissurado bilateral. Método: Foram avaliados 10 pacientes com seqüela de fissura lábio-palatina bilateral, de janeiro 2001 a janeiro 2007, com queixas diversas quanto ao encurtamento do pró-labio, sulco gengivo-labial curto, hipertrofia cicatricial, dificuldade para uso de aparelho ortodôntico, alteração da coluna filtral e do arco do cupido. Os pacientes apresentavam seguimento mínimo de 3 meses, sendo avaliados quanto a sexo, idade, tempo de autonomização do retalho, complicações, número de intervenções, comprimento e largura do retalho. A qualidade dos resultados foi avaliada conforme a presença ou não de complicações. Técnica cirúrgica: Marcação linha média do lábio inferior com limitação eqüilateral para largura de filtro de 8-10 mm e comprimento variável, relacionando com o defeito individual, tanto em "V", "W" ou "Lambda". Retalho baseado no pedículo vascular da artéria labial inferior, ramo da artéria facial, que se mostra constante, e um retalho composto (pele, musculatura e mucosa). A liberação do pedículo vascular é realizada após a autonomização do retalho entre 10-21 dias. Resultados: Foram realizados 10 retalhos de Abbé, em 9 pacientes do sexo masculino e 1 do feminino, sendo necessárias 28 cirurgias para correção final dos lábios, média de 2,8 procedimentos por paciente, todos com resultados secundária do lábio em pacientes fissurados bilaterais selecionados com bons resultados e poucas complicações.

Palatal myoclonus secondary to vertebral artery compression of the inferior olive.

A 47-year-old male with a 5-year history of palatal myoclonus was found on magnetic resonance imaging (MRI) examination to have an ectatic dominant left vertebral artery that compressed the left inferior olive. Microvascular decompression effectively eliminated his symptoms. This case and a similar case presented here with an ectatic vertebral-basilar system illustrate the value of standard MRI in conjunction with magnetic resonance angiography (MRA) in evaluating palatal myoclonus, and they suggest a potential role for decompressive surgery when persistent, highly symptomatic inferior olivary ischemia or compression occurs.

Palatal myoclonus--a case report.

Palatal myoclonus is usually due to a brainstem or cerebellar lesion disrupting the dentato-rubro-olivary pathway. Rarely it may be caused by a cortical lesion. The precipitating factor in 70% of all cases is an infarct. We describe an unusual case of a patient with palatal myoclonus who had an old ipsilateral cerebellar infarct and a new contralateral subcortical (corona radiata) infarct. We postulate that the new infarct caused disinhibition of the old cerebellar infarct, resulting in palatal myoclonus. Magnetic resonance imaging (MRI) of the brain did not show any hypertrophy of the inferior olivary nucleus. Her myoclonus proved refractory to clonazepam, valproate and phenytoin.

Bulbar myoclonus without palatal myoclonus. A hypothesis on pathophysiology.

A 40-year-old woman with myoclonic contractions bilaterally in the infrahyoid neck muscles, especially in the left cricothyroid muscle, was presented and successfully treated with botulinum toxin injections. The patient had a wide, aberrant vessel curving into the left dorsolateral reticular formation of the medulla oblongata. Based on our observations, we propose that symptomatic bulbar and palatal myoclonus is caused by pathology in the dorsolateral reticular formation, and not by inferior olivary dysfunction as is currently thought.

Nuevo diseño de abordaje geometrico tridimensional de implantes oseintegrados: incisión medial y levantamiento vestibular / New description of tridimensional geometric boarding of osseointegrated implants: medial incisive and vestibular elevation

Se presenta un nuevo diseño de incisión de tejidos blandos para abordar el hueso alveolar en la colocación de implantes oseointegrados. La incisión en la zona posterior es medial a la apófisis alveolar con dos ángulos de 60- por encima de la cresta alveolar hacia vestibular. Quedando una amplia base de pedículo y se realiza una mínima separación del musculo buccionador. Esta incision respeta la encía adherente (2mms) de dientes adyacentes, la arteria palatina anterior y el tejido sub-lingual. En la zona anterior es similar cuidando de no seccionar el nasopalatino y en el inferior, no llevarla hasta el tejido laxo del área sub-lingual. Este diseño permite una perfecta visualización del área a implantar, comoda separación, eliminación del separador medial, la cicatrización es medial a los implantes lo cual disminuye la inflación facial por la limitada separación del buccinador. Se analizan 20 pacientes, 10 con implantes individuales y 10 edéntulos parciales posteriores, la cicatrización fue por primera intención con minimas dificultades relacionadas a la incisión

[Unilateral palatal myoclonus with peculiar ocular movements--neurotological studies and MRI].

This is the first report of unilateral palatal myoclonus with which two different ocular movements were synchronized. A 55-year-old woman was admitted to our hospital due to intubation and dysarthria of sudden onset after three similar attacks for these four years. On admission right ptosis, hypalgesia in the right face, right facial nerve palsy, dysarthria, bilaterally increased deep tendon reflexes and trunkal ataxia were noted. Continuous repetitive contractions at 110/min frequencies were observed in the left soft palate, pharynx and larynx. On electronystagmography and electro-magnetic search coil system (Skala system), two different ocular movements, i.e., rotary oscillation with torsion and nystagmus to the right, successively alternated each other at random during eyelids closure. They were synchronized with palatal myoclonus. True nystagmus synchronized with palatal myoclonus has not been reported. When she calculated, rotary oscillation disappeared. In sleep polygraphy, rotary oscillation reduced in amplitude in stage 1 and disappeared in stages 2, 3, 4 and REM. On the other hand, the nystagmus reduced in amplitude in stage 1 and 2 and disappeared in stages 3, 4 and REM. The direction of nystagmus was converted to the left in stages 1 and 2. Similarly, in a drowsy state induced by intravenous injection of 7 mg diazepam, the direction of the nystagmus was converted to the left. On brain magnetic resonance imaging (MRI) right inferior olive was identified as a well circumscribed, enlarged increased signal area on T2-weighted and proton density-weighted images in addition to the lesions of infarcts in left corona radiata, posterior limb of right internal capsule and tegmentum pontis.(ABSTRACT TRUNCATED AT 250 WORDS)

[Soft palate myoclonus and opsoclonus in disorders of cerebrovascular circulation in the vertebrobasilar system]. / Miokloniia miagkogo neba i opsoklonus pri narusheniiakh mozgovogo krovoobrashcheniia v vertebra'lno-baziliarnoi sisteme.

In 4 patients with residual cerebral circulation disorders in the vertebrobasilar vascular bed, the myoclonus of soft palate, pharynx, larynx, tongue (in 2 cases comprising opsoclonus) developed among other signs of brainstem or cerebellar lesions. Myoclonic hyperkinesia emerged after 1.5 to 4 months of the disease, not in its acute period, and was not related to second stroke. With focal neurological signs analyzed, the syndrome of the soft palate myoclonus++ plus opsoclonus appeared in connection with the lesions of upper cerebellar crus where dento olivary++ pathway and the fibers connecting the cerebellar flocculus with oculomotor nuclei run. Soft palate myoclonus++ without opsoclonus emerges with lesions of cerebellar dental nucleus and central pathway of the brainstem tegmentum.

Hypertrophy of the inferior olivary nucleus. A clinico-pathological observation.

The clinico-pathological findings in a 61-year-old man, who suffered from branchial and skeletal myoclonus, appearing six months after a brainstem infarction are reported. Of all the drugs which are usually thought to be effective in the treatment of myoclonus, only valproic acid brought some relief. The necropsy revealed bilateral hypertrophy of the olives, together with bilateral pontine tegmental and rubral infarctions, without involvement of the olivary pathway.

[So-called laryngeal nystagmus. Progressive myoclonus as a symptom of a cerebellar and brain stem infarct]. / Der sogenannte Kehlkopfnystagmus. Progrediente Myoklonien als Symptom eines Kleinhirn- und Hirnstamminfarktes.

The present article describes a patient with ischemia in the vascular territory of the posterior inferior cerebellar artery, who developed in addition to other typical signs of the dorsolateral medulla oblongata, myoclonic movements of the ipsilateral vocal cord. Within a period of one year, the myoclonic movement progressed, leading to bilateral involvement of the velo-pharyngeal muscles. The essential neuropathological lesion is considered to be an impairment of the dentato-olivary System. In this respect there is a close relationship to other types of rhythmical myoclonus due to lesions of the brain-stem and cerebellum.

[Vocal cord myoclonus. A case report on the posterior inferior cerebellar artery syndrome]. / Stimmbandmyoklonus. Ein kasuistischer Beitrag zum Syndrom der Arteria cerebelli inferior posterior.

The present article describes a patient with ischemia in the vascular territory of the posterior inferior cerebellar artery, who developed, in addition to other typical signs of the dorsolateral medulla oblongata, myoclonic movements of the ipsilateral vocal cord. The essential neuropathological lesion is considered to be an impairment of the dentato-olivary system. In this respect there is a close relationship to other types of rhythmical myoclonus due to lesions of the brain-stem and cerebellum.