Primary lingual dystonia is a rare condition, especially when it is only induced by speaking. Trihexyphenidyl failed to improve the symptoms. Several case series have demonstrated the effectiveness of botulinum toxin injection for the management of focal lingual movement disorders. Only 1 case of botulinum toxin injection for primary lingual dystonia induced by speaking has been reported, but this treatment has limited effectiveness. Our patient was treated with botulinum toxin using a superficial approach for injection into the tongue with continuing excellent results. Lingual botulinum toxin injection is a fairly simple, safe and viable treatment option for lingual dystonia induced by speaking.

Partial fascicular oculomotor palsy, the combination of bilateral midriasis with loss of vertical gaze movements, is rarely a consequence of midbrain infarction. We describe a patient with acute ischemic infarcts involving both upper most part of the midbrain, presenting with marked vertical gaze palsy and mydriasis bilaterally as the only neurological abnormality. These features are suggestive of partial fascicular oculomotor palsies involving the pupil, inferior rectus(IR), superior rectus(SR), inferior oblique(IO) muscles and sparing medial rectus(ML), levator palpebrae(LP) muscles. These neuro-ophthalmological and radiological findings in our case support the model that the fibers to medial rectus and levator palpebrae muscles might be located in the more caudal portion of the oculomotor fascicles.

No abstract