Adult Spinal Primary Leptomeningeal Medulloblastoma Presenting as Pseudotumour Cerebri Syndrome.

A previously well 34-year-old man presented with severe pseudotumour cerebri. Imaging showed that he had a cauda equina tumour which proved to be a medulloblastoma. There was no tumour mass in the posterior fossa so we assume that this was a primary leptomeningeal medulloblastoma. In patients with somewhat atypical pseudotumour, spinal imaging should always be considered.

The effect of supervised exercises on static and dynamic balance in Parkinson's disease patients.

BACKGROUND/AIM: The aim of the this study was to examine the effects of supervised exercises on measures of static and dynamic balance Parkinson's disease (PD) patients. MATERIAL AND METHODS: The study used a before-after study design. Seventeen PD patients with mild and moderate levels of disability were enrolled in the study. Patients followed an exercise program under a physiotherapist's supervision one day a week for 12 weeks. The standard Balance Master protocol was used before and after exercise to assess static and dynamic balance. RESULTS: A statistically significant difference was observed in the unilateral balance test, one of the static balance assessments performed while standing on the left or right leg with eyes closed (p < 0.05). With respect to dynamic balance, a statistically significant difference in the maximum excursion of limits of stability (LOS), one of the balance tests used in the supervised exercise programs for patient with Parkinson's disease, between measurements taken before and after exercises was also detected (p < 0.05). CONCLUSIONS: The change of LOS revealed that dynamic balance improved due to the exercises. Thus, our supervised exercise program provided improvement in dynamic balance of PD patients.

Is it always necessary to apply botulinum toxin into the lower facial muscles in hemifacial spasm?: a randomized, single-blind, crossover trial.

BACKGROUND: Botulinum toxin (BTX) injections are accepted as safe and efficacious in the treatment of hemifacial spasm (HFS), but it is still debated whether BTX treatment of lower facial muscles should be performed or not. OBJECTIVE: The study aims to evaluate the necessity of BTX administration into lower facial muscles in patients with HFS. METHODS: A randomized, single-blind, crossover, clinical trial was conducted. Twenty-three HFS patients were randomly allocated to two different application methods. The patients were administered BTX type A into both the orbicularis oculi and perioral muscles in the first method and BTX type A into the orbicularis oculi but placebo into the perioral muscles in the second method. Subjects were crossed over to the alternate method when they needed BTX injection with a minimum of 3 months' duration. All the patients underwent both methods with no change in the total dose of BTX. RESULTS: All the patients benefited from BTX treatment regardless of the methods. However, in the patients with severe lower facial muscle involvement, the application of BTX into both orbicularis oculi and lower facial muscles led to better results. CONCLUSION: Our data suggest that BTX application to lower facial muscles might not be necessary in patients with mild lower facial involvement.