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(Created page with "== Introduzione == Prima di entrare nel vivo della discussione riguardante la patologia della nostra paziente Mary Poppins quella che dai capitoli precedenti sembra di tipo neuromotriia ed in particolare un 'Spasmo emimasticatorio' dovremmo focalizzare alcuni punti selettivi che ci aiuteranno a comprendere l'importanza dello excursus dei capitoli precedenti per finire al determinante processo di decriptazione del segnale. Cominciamo con il dire che non è tanto comples...")
 
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== Introduzione ==
== Introduction ==
Prima di entrare nel vivo della discussione riguardante la patologia della nostra paziente Mary Poppins quella che dai capitoli precedenti sembra di tipo neuromotriia ed in particolare un 'Spasmo emimasticatorio' dovremmo focalizzare alcuni punti selettivi che ci aiuteranno a comprendere l'importanza dello excursus dei capitoli precedenti per finire al determinante processo di decriptazione del segnale.  
Before getting to the heart of the discussion regarding the pathology of our patient Mary Poppins, which from the previous chapters seems to be of a neuromotor type, in particular a 'Hemimasticatory Spasm', we should focus on some fundamental points that will help us to understand the importance of the ''excursus'' of the chapters and at the same time to better understand the essence of the decryption process of the neurological signal, already mentioned several times.  


Cominciamo con il dire che non è tanto complesso fare diagnosi di 'Spasmo emimasticatorio' ma lo è fare diagnosi differenziale tra 'Spasmo emifacciale ed ancor più capire la natura della malattia per indirizzare la terapia.
Let's start by saying that it is not so complex to make a diagnosis of 'Hemimasticatory Spasm', it is to make a differential diagnosis between Hemimasticatory and Hemifacial Spasm because it does not depend only on the nervous districts involved, but even more it is to understand the nature of the disease to address, subsequently, adequate therapy.


Dovremmo, innanzitutto, considerare i disturbi del movimento indotti possono essere definiti come movimenti involontari o anormali innescati da traumi ai nervi o alle radici craniche o periferici.<ref>Joseph Jankovic. [https://pubmed.ncbi.nlm.nih.gov/19555833/ Peripherally induced movement disorders]
We should, first of all, consider movement disorders which can be defined as involuntary or abnormal movements triggered by trauma to the nerves or cranial or peripheral roots.<ref>{{cita libro
| autore = Jankovic J
| titolo = Peripherally induced movement disorders
| url = https://pubmed.ncbi.nlm.nih.gov/19555833/
| volume =
| opera = Neurol Clin
| anno = 2009
| editore =
| città =
| ISBN =
| DOI = 10.1016/j.ncl.2009.04.005
| PMID = 19555833
| PMCID =
| oaf = <!-- qualsiasi valore -->
| LCCN =
| OCLC =
}}</ref> From this it is contextual to consider involuntary movements including spasms also pathologies of the Central Nervous System as well as the peripheral one. In a study by Seung Hwan Lee et al.<ref>{{cita libro
| autore = Lee SH
| autore2 = Rhee BA
| autore3 = Choi SK
| autore4 = Koh JS
| autore5 = Lim YJ
| titolo = Cerebellopontine angle tumors causing hemifacial spasm: types, incidence, and mechanism in nine reported cases and literature review
| url = https://pubmed.ncbi.nlm.nih.gov/20845049/
| volume =
| opera = Acta Neurochir (Wien)
| anno = 2010
| editore =
| città =
| ISBN =
| DOI = 10.1007/s00701-010-0796-1
| PMID = 20845049
| PMCID =
| oaf = <!-- qualsiasi valore -->
| LCCN =
| OCLC =
}}</ref> two vestibular schwannomas, five meningiomas and two epidermoid tumors were included. Hemifacial spasm occurred on the same side of the lesion in eight patients while it occurred on the opposite side of the lesion in one patient. Regarding the pathogenesis of hemifacial spasms, in six patients the vessels were found to be involved, in one patient the tumor involved the facial nerve lining, compression of the facial nerve hypervascular tumor without damage to the vessels in one patient and a huge tumor which compressed the brainstem thus involving the contralateral facial nerve in another patient. Hemifacial spasm resolved in seven patients, while in two patients with vestibular schwannoma and epidermoid tumor they improved transiently and then recurred at one month. 


Neurol Clin. 2009 Aug;27(3):821-32, vii, doi: 10.1016/j.ncl.2009.04.005.</ref> Da ciò è contestuale considerare imovimenti involontari tra cui gli spasmi anche patologie del Sistema Nervoso Centrale oltre quello periferico. In uno studio di  Seung Hwan Lee et al.<ref>Seung Hwan Lee 1, Bong Arm Rhee, Seok Keun Choi, Jun Seok Koh, Young Jin Lim. [https://pubmed.ncbi.nlm.nih.gov/20845049/ Cerebellopontine angle tumors causing hemifacial spasm: types, incidence, and mechanism in nine reported cases and literature review.] Acta Neurochir (Wien) 2010 Nov;152(11):1901-8. doi: 10.1007/s00701-010-0796-1.Epub 2010 Sep 16.
<blockquote>Therefore, the contributing causes of the central intracranial type should be kept in mind, which could be a contributory cause of facial and / or masticatory spasm, for example, cases of vestibular schwannoma and epidermoid tumors.   
 
</ref>sono stati inclusi due schwannomi vestibolari, cinque meningiomi e due tumori epidermoidi. Lo spasmo emifacciale si è verificato sullo stesso lato della lesione in otto pazienti mentre si è verificato sul lato opposto della lesione in un paziente. Per quanto riguarda la patogenesi degli spasmi emifacciali, in sei pazienti sono stati trovati coinvolti i vasi, in un paziente il tumore aveva coinvolto il rivestimento del nervo facciale, compressione del tumore ipervascolare del nervo facciale senza danneggiamento dei vasi in un paziente e un enorme tumore che comprimeva il tronco cerebrale con coinvolgimento, quindi, del nervo facciale controlaterale in un paziente. Lo spasmo emifacciale è stato risolto in sette pazienti, mentre in due pazienti con uno schwannoma vestibolare e un tumore epidermoide, è migliorato transitoriamente e poi si è ripresentato in un mese.
 
<blockquote>Si tengano, perciò, presenti le concause anche di tipo Centrale intracranico che potrebbero essere concausa di spasmo facciale e/o masticatorio, per esempio, i casi di schwannoma vestibolare e tumore epidermide.   


</blockquote>
</blockquote>

Revision as of 17:26, 11 November 2022

Introduction

Before getting to the heart of the discussion regarding the pathology of our patient Mary Poppins, which from the previous chapters seems to be of a neuromotor type, in particular a 'Hemimasticatory Spasm', we should focus on some fundamental points that will help us to understand the importance of the excursus of the chapters and at the same time to better understand the essence of the decryption process of the neurological signal, already mentioned several times.

Let's start by saying that it is not so complex to make a diagnosis of 'Hemimasticatory Spasm', it is to make a differential diagnosis between Hemimasticatory and Hemifacial Spasm because it does not depend only on the nervous districts involved, but even more it is to understand the nature of the disease to address, subsequently, adequate therapy.

We should, first of all, consider movement disorders which can be defined as involuntary or abnormal movements triggered by trauma to the nerves or cranial or peripheral roots.[1] From this it is contextual to consider involuntary movements including spasms also pathologies of the Central Nervous System as well as the peripheral one. In a study by Seung Hwan Lee et al.[2] two vestibular schwannomas, five meningiomas and two epidermoid tumors were included. Hemifacial spasm occurred on the same side of the lesion in eight patients while it occurred on the opposite side of the lesion in one patient. Regarding the pathogenesis of hemifacial spasms, in six patients the vessels were found to be involved, in one patient the tumor involved the facial nerve lining, compression of the facial nerve hypervascular tumor without damage to the vessels in one patient and a huge tumor which compressed the brainstem thus involving the contralateral facial nerve in another patient. Hemifacial spasm resolved in seven patients, while in two patients with vestibular schwannoma and epidermoid tumor they improved transiently and then recurred at one month.

Therefore, the contributing causes of the central intracranial type should be kept in mind, which could be a contributory cause of facial and / or masticatory spasm, for example, cases of vestibular schwannoma and epidermoid tumors.