A case of oculo-palato-skeketal myoclonus with its responsible lesion clearly delineated by magnetic resonance imaging (MRI)
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The brain lesions responsible for palatal myoclonus have been established in many patients by autopsies, although they are yet to be demonstrated with radiological methods including X-ray CT. We report here a case of oculo-palato-skeletal myoclonus whose causative lesion was clearly delineated by MRI.<BR>A 61-year-old man had been well until 60, when he suddenly lost consciousness followed by right hemiparesis. X-ray CT revealed a small bleeding in the tegmentum of the pons. He recovered from hemiparesis almost completely in several months. In January 1985, a year after the stroke, however, he developed abnormal involuntary movements (AIM) of the right upper and lower extremities, which gradually increased in severity. In April 1985, he was admitted to our hospital because of AIM and gait disturbance.<BR>General physical examination was unremarkable with normal mentality and blood pressure 140/80 mmHg. On neurologic examination, the most outstanding finding was spontaneously and synchronously occurring rhythmic movements involving eyeballs and soft palates at a rate of about 2 Hz, more marked on the right. Furthermore, AIM of the right upper and lower limbs were also obvious in synchrony with rhythmic ocular and palatal movements. These AIM of the limbs were more prominent in the proximal portions and augmented with voluntary motions. They persisted while he was wakeful, disappearing in sleep. There were pyramidal tract signs, hemiataxia and hemisensory disturbance on the right as well as truncal ataxia.<BR>X-ray CT of the brain failed to demonstrate the lesion, while MRI showed a low intensity lesion in the tegmentum of the mid- and upper pons, which extended on both sides, more dominant on the right, probably involving the right central tegmental tract; the lesion well accepted as responsible for palatal myoclonus occurring ipsilaterally.<BR>Our case whose brain lesion causative of oculo-palato-skeletal myoclonus was successfully delineated by MRI may be very valuable, because to our knowledge there have been no reports to identify its responsible lesion roentogenologically.
- 一般社団法人 日本脳卒中学会の論文
一般社団法人 日本脳卒中学会 | 論文
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