Apraxia of Eyelid Closing and Unilateral Meige's Syndrome Complicating Left Middle Cerebral Artery Infarction

Apraxia of eyelid closure is an uncommon condition characterized by difficulties in voluntary eye closing with preserved normal blinking. Meige's syndrome is a disorder of adults, and is characterized by prolonged symmetric dystonic contraction of the orofacial muscles and blepharospasm. We report a case of apraxia of eyelid closure on the right eye with Meige's syndrome on the left eye complicating a left middle cerebral artery territory infarction.

A Case of Progressive Ataxia and Palatal Tremor

Progressive ataxia and palatal tremor (PAPT) is a subgroup of symptomatic palatal tremors which is characterized by palatal tremor and idiopathic progressive cerebellar ataxia. Here, we report a 59 year-old-male who presented with a 5 months history of progressive cerebellar ataxia, and was discovered to have both a symptomatic palatal tremor and torsional nystagmus. Various studies searching for the cause of the ataxia and the palatal tremor all came out negative, thus defining this patient as a PAPT.

Correlation of Midbrain Diameter and Gait Disturbance in Patients with Idiopathic Normal Pressure Hydrocephalus

BACKGROUND: While gait disturbance is an important feature of idiopathic normal pressure hydrocephalus (NPH), there are only tentative theories explaining its pathophysiology. The mesencephalic locomotor region has been suggested as the anatomical substrate for the development of hypokinetic gait. We evaluated the correlation between gait disturbance and midbrain diameter to investigate the role of mesencephalic locomotor region in development of NPH gait. METHODS: We enrolled 21 patients with NPH and 20 age-matched control subjects. Maximal diameter of midbrain and pons and the width of lateral and third ventricle were measured at midsagittal T1-weighted MRI and axial T2-weighted MRI, respectively. Gait disturbance, cognitive dysfunction, and incontinence were semi quantified. RESULTS: Maximal midbrain diameter was significantly smaller in NPH group, as compared to the controls (14.8 +/- 0.9 vs. 17.1 +/- 0.7 mm, p<0.001). There was an inverse correlation between the midbrain diameter and the ventricular width (r=-0.562, p=0.008 in third ventricle and r=-0.510, p=0.018 in lateral ventricle). Severity of gait disturbance were negatively correlated with midbrain diameter (r=-0.598, p=0.004), but degree of cognitive dysfunction and incontinence showed no significant correlation with brainstem diameter nor ventricular width. CONCLUSIONS: This study suggests that midbrain atrophy is significantly associated with gait disturbance in NPH. Furthermore, this study implies the possible role of midbrain structures including mesencephalic locomotor region in the genesis of NPH gait.

Clinical and EMG Characteristics of Pretarsal Motor Persistence

Pretarsal motor persistence (PMP), a subtype of apraxia of the eyelid opening, is characterized by the inability to open the eyelids at will due to persistent activity of orbicularis oculi muscles following voluntary closure. Here, we describe clinical characteristic and the synchronous EMG recording from the levator palpebrae and orbicularis oculi muscles of PMP in patient with essential blepharospasm, idiopathic Parkinson's disease, and progressive supranuclear palsy.

Two Cases of ReVersible Parkinsonism after V-P Shunt Operation of Obstructive Hydrocephalus due to SAH

Parkinsonism associated with obstructive hydrocephalus due to idiopathic aqueductal stenosis or after shunt revision has been occasionally reported in the literature. Their Levodopa effectiveness and good prognosis has also been reported. However, the etiology and pathophysiology has not been well elucidated. We herein report two cases of parkinsonism associated obstructive hydrocephalus due to SAH. Interestingly, in both cases, parkinsonism occurred after a V-P Shunt and not after obstructive hydrocephalus.