No abstract

Trigeminal neuralgia (TN) is a neurologic disorder characterized by relapsing and lancinating pain in one or more trigeminal nerve distribution unilaterally that lasts for a few seconds to 2 minutes. 1 The clinical features and history-taking are very important when diagnosing TN. 2The clinical criteria of the International Headache Society for a TN diagnosis are (1) occurring in one or more divisions of the trigeminal nerve, with no radiation beyond the trigeminal distribution and (2) pain with at least three of the following four characteristics: (a) recurring in paroxysmal attacks lasting from a fraction of a second to 2 minutes; (b) severe intensity; (c) electric-shock-like, shooting, stabbing, or sharp in quality; and (d) precipitated by innocuous stimuli to the affected side of the face. 3 However, clinical findings cannot be used to precisely distinguish idiopathic TN from symptomatic TN, 2 and hence magnetic resonance imaging (MRI) of the brain should be performed to evaluate other causes including multiple sclerosis or tumors. 1,2We report the case of a patient who was diagnosed with recurrent trigeminal neuritis of the maxillary branch confirmed by MRI. Trigeminal neuralgia (TN) is generally characterized by lancinating, unilateral, paroxysmal pain occurring in the distribution of the fifth cranial nerve. TN is diagnosed clinically based on the typical patient history, negative findings in a neurologic examination, and the response to medication. Idiopathic TN is the most common type, but TN can result from vascular malformation, compression, trauma, neoplasm, multiple sclerosis, or inflammation. We report a TN case diagnosed as recurrent trigeminal neuritis of the maxillary branch confirmed by magnetic resonance imaging.

Flail arm syndrome (FAS) has a similar clinical course 1 and pathological findings as amyotrophic lateral sclerosis (ALS). 2 It is important to distinguish the two diseases because FAS patients have significantly better survival rates compared with other typical ALS variants. 1,3 We report a FAS patient confirmed by clinical and electrophysiological findings based on review of literatures. We show the findings of polysomnography (PSG) in patient with FAS. We suggest that several issues related to the diagnostic process needed to be addressed. CASEA 50-year-old male presented with slowly progressive weakness and muscle wasting in his arms about two years ago. At the time of the first manifestation, weakness was noted in the right proximal arm accompanied by atrophy and identical symptoms occurred in the left arm after a one year.He had no remarkable medical history except for hypertension and there was no related family history. In neurological examination, bilateral weakness of the arms was scored as Medical Research Council grade I proximally and grade III in the distal muscles symmetrically, combined with muscle atrophy in the upper limb girdles. Both acromion processes of the scapular bone protruded beneath the skin. Both of his arms, forearms and hands were pronated. Fasciculation were absent in his all limbs and tongue. Sensory examination was normal Flail arm syndrome (FAS), known as one of the atypical amyotrophic lateral sclerosis (ALS) variants, has a similar clinical course and pathologic findings as ALS. Therefore it is difficult to differentiate between ALS and FAS at a glance. There are few reports involving individual analysis of FAS patients to date. The findings of polysomnography (PSG) in patient with FAS are not well known. We report a male FAS patient with review of literatures and several issues related to the diagnostic process.