Local injections ofbotulinum toxinhave been used with success for treatment of strabismus' and blepharospasm. This approach has been extended to different types of focal and segmental dystonia2 (torticollis,' oromandibular dystonia, laryngeal dystonia, writer's and musician's cramp4) and hemifacial spasm.2 We now report the successful treatment of bruxism with botulinum toxin injections.A 32 year old woman was admitted in a coma after a car accident. The right pupil was larger (3 mm) than the left (2 mm); there were roving eye movements with incomplete abduction of the right eye. Spontaneous extensor spasms of the right arm and leg were observed; the left plantar response was extensor.A CT scan showed an inhomogeneous hyperdensity in the left parietotemporal area, consistent with a brain contusion. The patient was intubated and ventilated but recovered slowly. After four months, some communication with the patient was possible and she obeyed verbal commands. However, at this stage the patient had developed bruxism consisting of jaw clenching and chewing movements. The teeth grinding was very loud and almost continuous, causing damage to the teeth and annoyance to nearby patients.Six months after the accident, 25 units, or 10 ng toxin-haemagglutinin complex of botulinum A toxin were injected into both the temporal and masseter muscles; no attempt was made to infiltrate the pterygoid muscles. After five days, we observed a marked reduction in the bruxism. There was no excessive weakness in the masticatory muscles so that feeding became possible. The favourable effect of the injections lasted for eight weeks. Two weeks later, a second injection of a total of 100 units (40 ng) of botulinum toxin was given. The results were similar and the effect persisted twelve weeks later.Bruxism consists of rhythmic teeth grinding during sleep. It occurs in the general population, with a prevalence of five to 210%.However, an association of bruxism with organic brain damage and altered states of consciousness has been documented.' The onset of bruxism is frequently linked to the return of sleep-wake cycles in comatose patients; damage to the teeth and related bony structures is one of the major complications of chronic bruxism. Treatment with a special dental prosthesis may be needed to prevent injury to the teeth or dental loss but could not be fitted in our patient due to lack of cooperation. Bruxism can now be added to the list of indications for botulinum toxin treatment.

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Fibromuscular dysplasia (FMD) is an arterial lesion of unknown origin which may sometimes affect intracranial arteries. In recent years a few rare cases, mostly involving younger people, have been described. The present case concerns a child of 8 years in whom the finding of hemiplegia led to a diagnosis of intracranial fibrodysplasia which was proven by arteriography and biopsy. This arterial lesion is described within the context of stroke in children.

A case of culture verified Candida parapsilosis lumbar spondylodiscitis, with infectious involvement of an aortic prosthetic graft, presented with a lumbar radicular pain syndrome. Only 33 Candida infections of the spine are described in the literature. Candida parapsilosis was cultured in three cases. Considering the poor general condition of the patient, a conservative treatment with bedrest, casting and amphotericin B, hydrocortisone and itraconazol was given. The patient died 28 months after onset from intercurrent pneumonia.

Prolonged contact with high voltage electricity can cause severe damage to the brain. Contact with the skull can produce heating of the brain and the cerebrospinal fluid, which may result in an explosion of the orbital roofs with downward displacement of the brain into both orbits.