Severe Spastic Trismus without Generalized Spasticity after Unilateral Brain Stem Stroke

Impact of Hemorrhagic Stroke on Molar Bite Force: A Prospective Study

Stroke is a neurological deficit of cerebrovascular origin that promotes physical impairments of adult individuals. The present study is aimed to demonstrate whether hemorrhagic stroke affects the maximum molar bite force. The prospective study carried in Centro Universitario Claretiano de Batatais, Brazil, determined the distribution of the sample into two groups: hemorrhagic stroke group (n=18, median age, 62.5 years) and disease-free group (n=18, median age, 62.0 years), with 10 men and 8 women in each group. Subjects were paired one-to-one (age and body mass index). The dynamometer was used to measure the maximum molar bite force (right and left). All analyses were performed with a significance level of 5% (Student's t-test). Differences were found on the right (p=0.048) and left (p=0.042) molar bite force, with lower bite force (both sides) in hemorrhagic stroke group. The study suggests that hemorrhagic stroke negatively affects the maximum molar bite force and necessitates changes in food intake to nutritious and softer consistency foods.

Out of the spasticity box: Off-label uses of botulinum toxin in children

Botulinum toxin is frequently used as a therapeutic for a variety of non-FDA approved indications in children. This narrative literature review explores three off-label uses of botulinum toxin in pediatric conditions including congenital muscular torticollis, spastic trismus, and neonatal brachial plexus palsy. While more research is needed to establish treatment, dosing and localization guidelines for the use of botulinum toxin in these commonly treated conditions, available evidence is discussed.

Botulinum Toxin A for Spastic Trismus Due to Brain Stem Encephalitis in a Pediatric Intensive Care Setting: A Unique Case Report

Injection of botulinum toxin A to masseter and temporalis muscles improved mouth opening and facilitated suction and oral care in a child with spastic trismus. This is the first such report in a 3.5-year-old child on mechanical ventilator in pediatric intensive care unit setting.

Trismus caused by paraneoplastic brainstem encephalitis

We discuss the assessment and differential diagnoses of a middle-aged man who presented with trismus, double vision and behavioural problems. MRI scan of the brain was initially normal, but a month later showed high signal in the hippocampal region on fluid attenuated inversion recovery sequence (FLAIR) imaging. We suspected a paraneoplastic brainstem encephalitis because of his smoking history, rapidly progressive symptoms and abnormal brainstem signs. A positron emission tomography-CT scan identified abnormal subcarinal nodes, shown on biopsy to be metastatic small cell lung cancer. He is currently undergoing treatment with chemotherapy and radiotherapy.