Vernet Syndrome by Varicella-Zoster Virus

Vernet syndrome involves the IX, X, and XI cranial nerves and is most often attributable to malignancy, aneurysm or skull base fracture. Although there have been several reports on Vernet's syndrome caused by fracture and inflammation, cases related to varicella-zoster virus are rare and have not yet been reported in South Korea. A 32-year-old man, who complained of left ear pain, hoarse voice and swallowing difficulty for 5 days, presented at the emergency room. He showed vesicular skin lesions on the left auricle. On neurologic examination, his uvula was deviated to the right side, and weakness was detected in his left shoulder. Left vocal cord palsy was noted on laryngoscopy. Antibody levels to varicella-zoster virus were elevated in the serum. Electrodiagnostic studies showed findings compatible with left spinal accessory neuropathy. Based on these findings, he was diagnosed with Vernet syndrome, involving left cranial nerves, attributable to varicella-zoster virus.

Proposal for Early Diagnosis of Congenital Muscular Torticollis: Case-based Approach: Report of two cases

Congenital muscular torticollis (CMT) is called 'pseudotumor of infancy' because it is commonly discovered and diagnosed within 14~28 days after birth as a sternomastoid tumor. We report two cases of CMT which presented as head tilt without any palpable neck mass immediately after birth but later developed into sternomastoid tumors. Serial ultrasonography confirmed increased echogenicities of the sternocleidomastoid muscles. We think that these findings are prodromal signs of sternomastoid tumors. Close physical examination by a neonatologist is crucial for an early diagnosis of CMT. Neonates with head tilt and increased ecogenicity of the sternocleidomastoid muscle on ultrasonography should be carefully followed up to see whether neck mass develops later. The authors suggest that CMT is not a static entity but rather one that progress to mass alteration after birth.

Verification of the Dystonic Muscles Using 18F-Fluorodeoxyglucose Positron Emission Tomography in a Patient with Cervical Dystonia: A case report

Treatment of choice for cervical dystonia is botulinum toxin (BTX) injection and surgical interventions can be tried in refractory cases. Success of BTX injection depends on precise muscle selection and adequate dosage of BTX. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) can evaluate the metabolism of the superficial and deep cervical muscles with high resolution and may be useful for identifying dystonic muscles in CD. We report a satisfactory result of BTX injection using 18F-FDG PET/CT for identification of dystonic muscles in a patient with cervical dystonia who previously failed to respond to botulinum toxin injection and denervation operation.

Effect of Botulinum Toxin A for Upper Limb Function in Post Stroke Spastic Hemiplegia

OBJECTIVE: Botulinum Toxin A (BoNT-A) is one of the therapeutic methods for the spastic decrement of the upper limb which appears from the patient after stroke. Decrement of stiffness is announced from many studies, but the effect of functional improvement was few examined closely so far clearly. The purpose of this study is to evaluate the effects of BoNT-A for the improvement of upper limb function in post stroke spastic hemiplegia. METHOD: Eleven chronic stroke patients (mean age 44.4 years) were included and injected BoNT-A (Dysport®, Ipsen, UK) according to degree of stiffness of each individual. Motor assessment scale, Box and Block test, Peg board test, Ashworth Scale, manual muscle test, Visual analogue scale, and subject satisfaction were applied at the baseline, and 1 week, 1, 2 and 3 months after interventions. All subjects were also submitted to ongoing rehabilitation therapy. RESULTS: Motor assessment scale results were statistically significant improvements at 1, 2 and 3 months after intervention (p<0.05). Also, statistically significant decreases in muscle tone as determined by the Ashworth scale were found at 1 week, 1, 2 and 3 months after injections (p<0.05). CONCLUSION: Botulinum Toxin A could derive the functional improvements as well as the tone reduction of upper limb in post stroke spastic hemiplegia.