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SUMMARY An unusual case of peripheral hypoglossal nerve palsy, caused by lateral position of the external carotid artery and an abnormally high carotid bifurcation is reported. Improvement followed ligation and cutting of the external carotid artery at its origin. Stroke Vol 15, No 4, 1984 VARIATIONS AND ANOMALIES are common at the bifurcation of the external and internal carotid arteries.1 Lateral position of the external carotid artery 2 " 6 formerly considered extremely rare, has recently been found to be more common.7 8 However, there are few reports, that this condition causes neurological signs.1 In this paper, a case of peripheral hypoglossal nerve palsy caused by lateral position of the external carotid artery and a carotid high bifurcation is presented.Case Report A 49-year-old man was admitted because of tongue deviation and dysarthria on December 8, 1980. At age 42, his blood pressure was found to be high and antihypertensive drugs were presented. He had felt throbbing pains in the occipital region beginning November 10, 1980, but these pains became intense from midday of November 21. At that time he visited a neurosurgical clinic, but no abnormalities could be found. On the morning of November 22, eating became difficult, and movement of the tongue was impeded, making speech inarticulate.Tongue deviation to the right and atrophy and fasciculation of the right lingual muscle were observed ( fig. 1). Tactile sensibility and taste sensation of the tongue were normal, and no abnormality of other cranial nerves was observed. There were no other abnormalities on neurological examination. Homer's sign was not presented and no bruit was heard in the neck. A diagnosis of peripheral hypoglossal nerve palsy with suspected hypoglossal neurinoma was made.A CT scan demonstrated no abnormality related to the right hypoglossal palsy. Right jugular venography revealed good filling by contrast medium and no abnormal findings. Tomography of the hypoglossal ca- nals, was normal. Bilateral carotid angiography and bilateral vertebral angiography were performed. No abnormalities were observed in the vertebral angiogram, except conspicuous elongation of the basilar artery. In the right carotid angiogram, marked lateral displacement of the right external carotid artery was noticed and the bifurcation of the external and internal carotid arteries was abnormally high (upper margin of the C 2 vertebra); there was conspicuous kinking and elongation of the external and internal carotid arteries and, in particular, prominent dilatation of the proximal portions of both arteries. In the lateral view of the angiogram, a loop-like elongation was observed 3.5 cm distal to the bifurcation ( fig. 2). In the left carotid angiogram, as in that of right side, the bifurcation was at a high level (center of C 2 vertebra) and elongation was conspicuous, but a lateral position of the external carotid artery was not seen.From this examination, the possibility of hypoglossal neurinoma was excluded and the following two mechanical processes wer...

An intramuscular injection (IMI) is an injection given directly into the central area of a specific muscle. Certain medicines need to be administered by the gluteal route for these to be effective. The aim of this study was to determine the influence of body mass index (BMI), subcutaneous fat, and muscular thickness of the dorsogluteal IMI site among healthy Japanese women. There were 39 healthy female subjects who volunteered and met the criteria. Their ages ranged from 40s to 60s (50.82 ± 6.04). With the data collected using the B-mode ultrasound images of the dorsogluteal site, it was found that the distance from the epidermis to the under-fascia (DEUF) of the gluteus maximus was dissimilar between the subject's right and left buttocks. It was found that the distance from the epidermis to the iliac bone (DEI) was significantly more on the right than on the left buttocks. In the case of an adult Japanese woman with a BMI of 21 or more, the DEUF of the gluteus medius was found to be about 30 mm, and the DEI was approximately 50 mm or more. Based on these findings, it is recommended that a needle length of 38 mm (1.5 inches) can be safely used to administer IMIs to the gluteus medius muscle to effectively and efficiently deliver medications through the IMI route.

Long Acting Injectable (LAI) medications for patients with schizophrenia is commonly administered to relieve their symptoms. Through shared decision-making and clinical evidence-based, psychiatrists should systematically offer LAIs to all patients requiring long-term antipsychotic treatment as a first-line treatment. Gluteal intramuscular (IM) injection requires accurate insertion of needles into the specific muscle area, often the outer upper quadrant of the buttocks, in order to achieve the required blood concentration. The purposes of this study were to compare the "Distance from the Epidermis to the Under-Fascia (DEUF)" and "Distance from the Epidermis to the Iliac Bone (DEB)" of the buttocks IM injection sites at the dorsogluteal and ventrogluteal sites among healthy Japanese volunteer subjects, and to identify the optimal insertion injection needle length. The DEUF and DEB at the gluteal regions were measured by ultrasonography. Welch's one-way analysis of variance was used to compare the DEUF and the DEB at the gluteal IM injection regions. There was no statistically significant difference observed between the right and left mean values of DEUF for Hochstetter and Clark's point at the ventrogluteal sites, and the Four and Three-way split or Double Cross point at the dorsogluteal sites. However in the DEB, the Hochstetter's point (P < 0.01) at ventrogluteal site on the right side, and Clark's point (P < 0.05) were significantly shorter than the Double Cross point at dorsogluteal sites (F = 4.38). The left buttocks S. Masuda et al. 204 Hochstetter's point was significantly shorter than the Double Cross point (F = 4.38, P < 0.01). These results, however, did not establish a statistically significant difference in the DEUF among injection sites. It was considered that the difference in the DEB depended on muscle volume and thickness in the gluteal injection sites.