Hereditary essential chin myoclonus (HECM) is a rare movement disorder characterised by involuntary and irregular twitches of the chin. It can be considered a benign, focal variant of hereditary essential myoclonus. We studied two families that had several members suffering from HECM. Both families showed an autosomal dominant transmission with incomplete penetrance. Extensive neurophysiological studies were carried out on three patients. The results confirmed the myoclonic nature of phenotypical appearance and allowed identification of the subcortical origin of the myoclonus. The neurophysiological mechanisms underlying HECM are still unknown. It is supposed that pontine reticular formation, not controlled by superior centers, may be responsible of an abnormal activation of motor neurons innervating mentalis muscle. We treated three patients with periodic injections of botulinum toxin; a complete disappearance of chin myoclonus improved their quality of life.

We report a case of myocardial infarction associated with the use of sumatriptan and review the literature regarding similar cases. A 54-year-old woman with a history of migraine without aura, mild arterial hypertension, depression, and no history of coronary artery disease was admitted to our hospital for acute myocardial infarction, 30 minutes after using 6 mg of subcutaneous sumatriptan. Coronary angiography performed several days later revealed a normal coronary arterial system. Although at discharge the patient was advised to permanently avoid triptans, she continued the use of oral sumatriptan at low dosage (25-50 mg) without any problems.

An 18-year-old man with a history of migraine without aura and normal neurological examination carried out a cerebral CT scan during a spontaneous typical migraine attack. While the CT scan demonstrated left temporal-parietal-occipital low attenuation, a brain magnetic resonance imaging, performed 5 days later, did not show any lesions. Based on this evidence, we can speculate that the dysfunction of the cerebrovascular system, either in the cerebral cortex or in the subcortical regions, is an important mechanism in the pathophysiology of migraine.

We report 2 very unusual cases of thunderclap headache complicating minimally invasive medical procedures. In the first case headache developed as the consequence of a pneumocephalus caused by an inadvertent intrathecal puncture during oxygen-ozone therapy for lumbar disk herniation. The second case involved intracranial hypotension, caused by the persistence of the needle, used for epidural anesthesia, and then penetrated in the subarachnoid space.

We describe a 68-year-old woman who experienced pain and phantom limb sensation following an above-the-knee amputation of the right leg. A month later, the patient had myoclonic jerks of the stump. Polymyo-graphic recordings showed synchronous jerks in the vastus medialis and adductors of the thigh on the right side. The patient responded to clonazepam. We conclude that the myoclonic jerks were of spinal cord origin.

Pyomyositis is a bacterial infection of skeletal muscle. We describe the clinical case of a 77-year-old woman affected by gait disturbance, repetitive falls, low back pain and left thigh and groin pain, but without symptoms of systemic infection. Computed tomography and magnetic resonance imaging of the abdomen and pelvis showed abscesses in the left psoas and adductor brevis muscles. Investigations of urogenital tract and gastrointestinal system were normal. Systemic antibiotic treatment alone was not efficient, while surgical drainage improved the clinical picture. The aetiological organism, isolated from the abscess, was Staphylococcus aureus. We suggest that this patient had a primary pyomyositis rather than a secondary form. This is the first report of concomitant abscesses of psoas and adductor brevis muscles with early neurological involvement.

A 43-year-old man had been suffering from exertional headache for 10 years. Sagittal sections on magnetic resonance imaging showed a Chiari type 1 malformation and a cerebellar arachnoid cyst. This syndrome, named hindbrain hernia headache, disappeared with oral acetazolamide. This treatment should be tried in patients with hindbrain hernia headache prior to considering surgical decompression of the foramen magnum.