The nuclear and infranuclear pathway of eye movement begins from the ocular mo-tor nuclei situated in thebrain stem, where the axons originate and form three ocular motor nerve s. Although each of the ocular motornerves follows a distinct route to reach the end organ, the extraocular muscles, they also have common housings inthe cavernous sinus and at the orbital apex, where part or all of them are frequently and simultaneously affectedby a common disease process. Since the fine details of normal and diseased structures can frequently be seen onradiologic imaging, especially mag-netic resonance (MR) imaging, a knowledge of the basic anatomy invo l ved innuclear and infranuclear eye movement is important. In this description, in addition to the normal nuclear andinfranuclear pathway of eye movement, we have noted the radio-logic findings of typical diseases involving eachsegment of the nuclear and infranu-clear pathway, particularly as seen on magnetic resonance images. Briefcomments on ocular motor pseudopalsy, which mimics ocular motor palsy, are also included.
Axons ; Brain ; Cavernous Sinus ; Cranial Nerves ; Eye Movements ; Muscles ; Ocular Motility Disorders* ; Orbit ; Paralysis

Reversible airway obstruction and wheezing are typical features of bronchial asthma, but these features may also be observed in other conditions. However, the inclusion of these conditions in the differential diagnosis of asthma-like symptoms in adults is often neglected, resulting in a correct diagnosis being made after months of unsuccessful treatment for asthma. We report two cases of an upper airway obstruction masquerading as asthma. In case one, adenoid cystic carcinoma was identified in the trachea of a patient showing asthma-like symptoms, positive response to allergic skin test and methacholine inhalation challenge. In the other case, aspirated foreign body was misdiagnosed and treated as asthma for more than one year. A high degree of suspicion and a thorough medical evaluation censisting of history, physical examination and pulmonary function test including shapes of spirogram are essential to the differential diagnosis of asthma-like symptoms
Adenoids* ; Adult ; Airway Obstruction* ; Asthma* ; Carcinoma, Adenoid Cystic* ; Diagnosis ; Diagnosis, Differential ; Foreign Bodies* ; Humans ; Inhalation ; Methacholine Chloride ; Physical Examination ; Respiratory Function Tests ; Respiratory Sounds ; Skin Tests ; Trachea

The ideal approach in microvascular decompression(MVD) for hemifacial spasm(HFS) should provide the shortest and perpendicular route to the facial nerve root exit zone(FNREZ) with minimal cerebellar retraction and early cerebrospinal fluid drainage to avoid surgical morbidity. Small basal craniectomy anterior, posterior and superior to the condylar foramen would be the ideal approach for HFS, because it is maximal basal route to FNREZ. We performed this approach in 15 patients with HFS. Slightly curved skin incision 5cm in length was placed from inferior nuchal line 2cm posterior to the mastoid notch toward the angle of the mandible and the neck muscles were splitted. Posterior condylar emissary vein was elevated from condylar fossa. Small basal craniectomy extending from the inferior nuchal line to the condylar foramen was made. Jugular process was drilled out along the superior margin of the occipital condyle to expose distal sigmoid sinus and the junction of sigmoid sinus and jugular bulb. Lateral margin of foramen magnum posteroinferior to the condylar foramen was removed for early drainage of CSF from lateral medullary cistern. Dura was opened in T-shaped manner. With minimal elevation of cerebellum, arachnoid around lower cranial nerves can be dissected and FNREZ can be identified easily and safely. In conclusion, para-condylar foraminal approach can be considered to be minimally invasive and maximally safe in MVD for HFS.
Arachnoid ; Cerebellum ; Cerebrospinal Fluid ; Colon, Sigmoid ; Cranial Nerves ; Drainage ; Facial Nerve ; Foramen Magnum ; Hemifacial Spasm* ; Humans ; Mandible ; Mastoid ; Microvascular Decompression Surgery* ; Neck Muscles ; Skin ; Veins