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首页> 外文期刊>Journal of clinical neuroscience: official journal of the Neurosurgical Society of Australasia >Oculopalatal tremor, facial myokymia and truncal ataxia in a patient with neurosarcoidosis
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Oculopalatal tremor, facial myokymia and truncal ataxia in a patient with neurosarcoidosis

机译：神经结节病患者的眼睑震颤，面部肌强直和共济失调

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Symptomatic palatal tremor (SPT) is the result of a structural lesion, in the form of stroke, trauma or demyelinating disease. SPT is due to contractions of the levator veli palatini and can be accompanied by simultaneous movements of the facial and ocular muscles. Facial myokymia (FM) is a persistent quivering of the facial muscles. FM is usually encountered with conditions involving the pontine tegmentum. We report, to our knowledge, the first patient with neurosarcoidosis with simultaneous SPT and FM. A 49-year-old African American woman, with non-caseating granulomas in a paratracheal lymph node biopsy, presented with progressive gait disturbances for the last 3 years. Neurological examination revealed ataxic speech, bilateral rotatory nystagmus, myokymia of the chin and perioral muscles, palatal tremor without ear click and marked truncal ataxia. MRI demonstrated a lesion involving the facial nucleus and the right middle cerebellar peduncle. Based on exclusion of alternative etiologies, a diagnosis of neurosarcoidosis was made and the patient was started on methotrexate for 9 months, with minimal improvement. She was then switched to intravenous infliximab without major adverse events. The patient's speech and gait ataxia improved and follow up MRI demonstrated resolution of the enhancing lesions. To our knowledge, this is the first reported case of the combination of palatal tremor and FM due to neurosarcoidosis. Methotrexate may fail to produce clinical or radiographic response in up to 39% of patients. Tumor necrosis factor-a inhibitors, such as infliximab, should be considered in refractory cases. (C) 2014 Elsevier Ltd. All rights reserved.
机译：有症状的lat性震颤（SPT）是中风，外伤或脱髓鞘疾病形式的结构性病变的结果。 SPT是由于提肌veli palatini的收缩引起的，可伴有面部和眼部肌肉的同时运动。面部肌强直症（FM）是面部肌肉的持续颤动。 FM通常在涉及桥脑被盖的情况下遇到。据我们所知，我们报告了首例同时伴有SPT和FM的神经结节病患者。一名49岁的非洲裔美国妇女在气管旁淋巴结活检中出现非干酪性肉芽肿，在过去3年中出现了进行性步态障碍。神经系统检查发现共济失调言语，双侧旋转性眼球震颤，下巴和口周肌肌强直，pa上震颤，无耳鸣和明显的躯干共济失调。 MRI显示病变累及面部核和右小脑中轴。基于其他病因的排除，对神经结节病进行了诊断，患者开始接受甲氨蝶呤治疗9个月，但病情仅有最小改善。然后，她改用静脉注射英夫利昔单抗，无重大不良事件。患者的言语和步态共济失调得到改善，MRI随访显示病灶增强。据我们所知，这是因神经结节病导致reported震颤和FM结合的首例报道病例。甲氨蝶呤可能无法在多达39％的患者中产生临床或影像学反应。难治性病例应考虑使用肿瘤坏死因子-α抑制剂，如英夫利昔单抗。 （C）2014 Elsevier Ltd.保留所有权利。

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