A Presumed Case of Multiple Sclerosis at 4-year-old Age

A child, aged 4-year-old girl was admitted to our hospital because of impaired vision and right hemiparesis. Brain MRI showed a lesion in the left parietal white matter, and visual evoked potentials and brainstem evoked potentials gave abnormal findings showing lesions also of the optic nerves and brainstem. Her symptoms were resolved with steroid therapy. Afterwards, she had 3 episodes of spastic paraparesis, cerebellar syndrome, downbeat nystagmus, and clinical seizures for a year. With a history of remissions and exacerbations and brain MRls that revealed new scattered lesions each time, the diagnosis of multiple sclerosis was able to be made. This is the one of the youngest of known patients with MS, yet described, in Korea, whose first attack occurred at 4 years old of age.

Pure Motor quadriplegia in Bilateral Medial Medullary Syndrome

Medullary pyramid is the one place where corticospinal fibers are isolated as the pyramidal tract, and the result of such lesions has been a flaccid hemiplegia. Medial medullary syndrome may occur bilaterally, resulting in flaccid quadriplegia with facial sparing, bilateral lower motor neuron signs of the tongue, and complete loss of position and vibratory sensation affecting all for extremities. Occasionally, only the pyramid is damaged, resulting in a pure motor quadriplegia without other medullary signs. We report a 78-year-old man who suddenly developed flaccid quadriplegia without any other medullary signs. Brain MRI showed bilateral medial medullary infarctions that was probably due to anterior spinal artery occlusion.

2 Cases of Pathologically Proven Cephalic Fibromuscular Dysplasia

Fibromuscular dysplasia (FMD) is a segmental nonatheromatous and noninflammatory angiopathy of unknown cause. Despite the unknown origin Of FMD, it has been recognized in the extracranial internal cartid, vertebral, and intracranial arteries. Usually the diagonsis of FMD has been done by angiographic findings, and pathologically proven cases are very rare. We report 2 patients who had suffered from hemicranial pain and ipsilateral ama-urosis figax, and whose initial laboratory evaluations revealed high ESR. The biopsy was done in the temporal artery under the impression of the temporal arteritis, which showed the findings of the fibromuscular dysplasia.

A Case of Collet-Sicard Syndrome Resulting from Jugular Vein Thrombosis

Collet-Sicard syndrome is one of the syndromes of the multiple lower cranial nerve palsies, characterized by unilateral paralysis of 9th through 12th cranial nerves. The present report describes a 34-year-old woman who had hoarseness, dysarthria, and loss of taste developed after febrile illness. Brain MRI, both T1WI and T2WI, showed high signal intensity in the left jugular foramen. Gd-GTPA contrast injection revealed thickening and enhancement of the left tentorium. Angiography disclosed nonvisualization of the left transverse and sigmoid sinus, and reconstruction of the left internal and external jugular vein by collaterals from the angular, facial, and posterior fossa veins. The patient improved spontaneously two months later. This is the first report of Collet-Sicard syndrome resulting from jugular vein thrombosis.