Sulcal arteries perfuse the anterior two-thirds of the spinal cord, and spinal cord infarction as a result of sulcal artery occlusion is rare. Most reported cases are associated with vertebral artery dissection, and commonly involve the cervical spinal cord. A 74-year-old man presented with sudden onset weakness and numbness after a brief bout of abdominal pain. Further investigations concluded that this was sulcal artery syndrome. We report a case of sulcal artery syndrome affecting the thoracic spinal cord presenting as Brown–Sequard syndrome. Sulcal artery syndrome usually has good prognoses, unlike anterior spinal artery infarction.

An otherwise healthy woman inherlate20spresentedwitha1-week history of almost continuous bilateral ear twitching. Onset was spontaneous. There was no previous exposure to neuroleptics nor history of neuropsychiatric disorders. The ear movements were not within voluntary control nor distractible under cognitive load. These movements caused significant distress including poor sleep and headaches.Shedeniedfeelingstressedoranxious.Themovementsstopped during sleep. She denied any tinnitus.Examination revealed semirhythmic, asymmetrical movement of bilateral ears and the frontalis muscle. The character of muscle movement was observed on ultrasonography. Muscle contraction and shortening generally began as quick and jerky movements, and the degree of contraction ranged from complete to partial. Muscle relaxation and lengthening occurredatvariablespeed,fromquickandjerky to slow and sinuous. Neurologic examination results were otherwise normal with no tremors or dyskinesias in thelimbs.TheVideodemonstratestheclinicalpresentationandmuscle movements visualized under ultrasonography examination.Full blood cell count and inflammatory markers were within normal limits. Electrolyte levels including calcium, magnesium, and phosphate were normal. Magnetic resonance imaging results of the brain were normal.The patient was diagnosed as having auricular dyskinesia with no obvious precipitating factor and started taking baclofen, 10 mg, 3 times adaywithnoimprovement.Thiswaschangedtoclonazepam,0.25mg, 3 times a day. She was able to sleep better with clonazepam, but it had no effect on the frequency or intensity of the twitching.The patient was offered a trial of botulinum toxin injection in view of her poor response to oral medications. Ultrasonography (Aixplorer Mach 30 with a high-frequency linear transducer SLH20-6 using musculoskeletal preset [resolution mode; depth, 1 cm] with focus set at the structure of interest) was used for muscle examination. Bilateral auricularis superior and posterior muscles were injected with 10 units of onabotulinum toxin type A. A further 10 units were injected into the frontal bellies of the occipitofrontalis muscle bilaterally in the area with the most active muscle movements seen under ultrasonography. The Figure shows a pictorial representation of the muscles. At follow-up 2 weeks later, all spontaneous movements had ceased. She did not experience any adverse events apart from worsening of the existing headache for a few days.

Background: The ambulatory outcomes in traumatic conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are important yet under-described. Objective: This review aimed to determine the ambulatory outcomes of patients with traumatic CMS and CES, and to identify the clinical factors affecting these outcomes. Methods: PubMed, EMBASE, CINAHL, and Cochrane databases were searched from database inception to August 2021. The searches were limited to articles in English language, human studies, and adult populations. Abstracts, letters, commentaries, editorials, conference posters, case series, case reports, and pilot studies were excluded. Two independent reviewers screened the studies, extracted relevant data regarding the ambulatory outcomes, and evaluated the risk of bias using the Joanna Briggs Institute critical appraisal checklist. If consensus could not be reached, a third reviewer arbitrated. Results: Three articles with a total of 993 participants were analysed. The risk of bias was moderate in two studies and low in one study. The descriptions of ambulatory outcomes were heterogeneous. 111 out of 214 (52%) of the patients with traumatic CES achieved independent walking after rehabilitation. Data regarding walking ability in patients with traumatic CMS were lacking. Improvements in lower limb strength and functional mobility were similar in patients with traumatic CES and those with traumatic CMS. Early rehabilitation, less severe injuries, and lower neurological injury levels are associated with more favourable ambulatory outcomes. In view of the heterogeneity of ambulatory outcomes in the included studies, meta-analysis was not conducted. Conclusions: The ambulatory outcomes of patients with traumatic CMS and CES were heterogeneous with more data available for CES. There is no evidence to suggest that traumatic CMS survivors have worsened motor and mobility prognoses than survivors with traumatic CES.

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