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Della Corte M, Delehaye C, Savastano E, De Leva MF, Bernardo P, Varone A. Neuropsychiatric syndrome with myoclonus after SARS-CoV-2 infection in a paediatric patient. Clin Neurol Neurosurg 2022; 213:107121. [PMID: 35030418 PMCID: PMC8739821 DOI: 10.1016/j.clineuro.2022.107121] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
We report the case of a 12-years-old patient who subacutely developed a positive and negative myoclonus of limbs and face, drowsiness and memory deficits after getting infected by SARS-CoV-2. On admission, nasopharyngeal swab for SARS-CoV-2, brain and spinal MRI with and without contrast, EEG, chest X-ray and abdominal ultrasound were negative. CSF physical-chemical examination, culture, PCR testing for SARS-CoV-2 and other pathogens, and oligoclonal IgG bands were negative as well. A full panel blood test, including clotting, autoimmunity and paraneoplastic blood studies, did not show any alteration. The neuropsychological examination showed an impairment in memory, visual-motor coordination, inductive reasoning skills, attention, and concentration. The patient was first treated with clonazepam and then with intravenous methylprednisolone for five days, with poor response. For this reason, he then received a cycle of IVIG, thus reaching a gradual and complete recovery. To date, this is the first case of a COVID-19 associated myoclonus affecting a paediatric patient.
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Affiliation(s)
- M Della Corte
- Department of Neurosciences, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Via M. Fiore 6, 80129 Naples, Italy.
| | - C Delehaye
- Department of Paediatrics, University of Campania "Luigi Vanvitelli", Piazza L. Miraglia, 2, 80138 Naples, Italy
| | - E Savastano
- Department of Neurosciences, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Via M. Fiore 6, 80129 Naples, Italy
| | - M F De Leva
- Department of Neurosciences, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Via M. Fiore 6, 80129 Naples, Italy
| | - P Bernardo
- Department of Neurosciences, Pediatric Psychiatry and Neurology Santobono-Pausilipon Children's Hospital, Via M. Fiore 6, 80129 Naples, Italy
| | - A Varone
- Department of Neurosciences, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Via M. Fiore 6, 80129 Naples, Italy
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Borroni B, Gazzina S, Dono F, Mazzoleni V, Liberini P, Carrarini C, Russo M, Pontolillo M, Vecchiet J, Onofrj M, Bonanni L. Diaphragmatic myoclonus due to SARS-CoV-2 infection. Neurol Sci 2020; 41:3471-3474. [PMID: 33090303 PMCID: PMC7579554 DOI: 10.1007/s10072-020-04766-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 09/24/2020] [Indexed: 12/31/2022]
Abstract
A wide range of neurological signs and symptoms have been associated with SARS-CoV-2 infection. In the present report, we described two Italian patients diagnosed with diaphragmatic myoclonus after COVID-19. In both cases, mild lymphocytosis at cerebrospinal fluid analysis and no structural brain changes were reported. The pathophysiological origin of the myoclonus in the two cases was different. In case 1, electroencephalogram did not reveal any cortical correlates and brain imaging of the spine was unremarkable, while in case 2, cortical origin of myoclonus was demonstrated. With the present two cases, we confirm and extend the neurological manifestations of SARS-CoV-2 infection.
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Affiliation(s)
- Barbara Borroni
- Neurology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
- Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Stefano Gazzina
- Neurology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Valentina Mazzoleni
- Neurology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Liberini
- Neurology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Michela Pontolillo
- Department of Medicine and Aging Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Jacopo Vecchiet
- Department of Medicine and Aging Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - M Onofrj
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Bonanni
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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Shah J, Sijun L, Hui Z, Zeb F, Haq IU, Ullah A. Neurological Complications Of Hand, Foot And Mouth Disease In Children: A Review. J Ayub Med Coll Abbottabad 2020; 32:562-569. [PMID: 33225664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hand-Foot-and-Mouth disease (HFMD) is a viral illness commonly seen in young children, characterized by fever, vomiting, ulcerative lesions in oral mucosa, and vesicles on hands and feet. The early symptoms resolve but sometimes, it leads to more harsh neurological complications and even death. Therefore, the objective of this review was set to provide an overview of the symptoms, pathogenic agents, and treatment of neurological complications associated with HFMD. METHODS We reviewed literature from PubMed and Science Direct covering at least one of our objectives from inception to 4th March 2018. RESULTS This review represents 6 countries including China, Vietnam, Cambodia, South Korea, Taiwan, and Australia. Fifteen studies with a total of 1043 patients were included. The majority of HFMD cases with neurological complications were reported in China, predominance in boys as compared to girls, with 97% cases under 15 years of age. Meningoencephalitis and brainstem encephalitis contributed 70% of all neurological complications related to HFMD. Human Enterovirus71 genotype C, especially C4a was a causative agent associated with severe complications. Among symptoms, fever, vomiting, myoclonic jerks or seizure, headache, convulsion, and rashes were reported in almost all neurological complications. The common and supportive treatments were the administration of intravenous immunoglobulin and glucocorticoid therapies. CONCLUSIONS Early detection and appropriate treatment of severe neurological complications can minimize the risk of adverse health outcomes. Evidence based clinical practice guidelines for early detection and treatment would be significant in the management of these devastating neurological complications.
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Affiliation(s)
- Jahan Shah
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
| | - Liu Sijun
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
| | - Zhao Hui
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
| | - Falak Zeb
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
| | - Ijaz Ul Haq
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
| | - Amin Ullah
- Department of Social Medicine and Health Education, School of Public Health, Nanjing Medical University, Nanjing 211166, Jiangsu Province, P.R. China
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Lee CY, Cheng SJ, Chou CL. Myoclonus as the main presentation of Epstein-Barr virus encephalitis. Acta Neurol Belg 2015; 115:479-80. [PMID: 25027162 DOI: 10.1007/s13760-014-0329-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 06/24/2014] [Indexed: 10/25/2022]
Affiliation(s)
- Chuo-Yu Lee
- Department of Neurology, Mackay Memorial Hospital, No. 92, Sec. 2, Zhongshan N. Rd., Taipei City, 10449, Taiwan
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Striano P, Tortora F, Evoli A, Palmieri G, Elefante A, Zara F, Tarr PE, Striano S. Periodic myoclonus due to cytomegalovirus encephalitis in a patient with good syndrome. ACTA ACUST UNITED AC 2007; 64:277-9. [PMID: 17296846 DOI: 10.1001/archneur.64.2.277] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Good syndrome (GS) refers to a constellation of thymoma and adult-onset immunodeficiency characterized by low or absent B cells, hypogammaglobulinemia, and variable defects in cell-mediated immunity with an inverted CD4/CD8(+) T-cell ratio. Patients may develop severe or chronic infections as a result of this immunodeficiency. OBJECTIVE To describe a patient with GS who developed cytomegalovirus (CMV) encephalitis and showed a periodic electroencephalographic pattern and myoclonus. DESIGN Case report. SETTING Outpatient neurology clinic at a university medical center. Patient A 64-year-old man who developed periodic myoclonus involving the right half of his body and the left arm. RESULTS Five years previously, the patient had undergone resection of a pathologically confirmed epithelial thymoma. Quantitative CMV polymerase chain reaction of the serum and cerebrospinal fluid showed strongly positive results (1:10 000), allowing the diagnosis of CMV encephalitis. CONCLUSIONS To the best of our knowledge, myoclonus and periodic electroencephalographic pattern have not previously been reported in CMV encephalitis. Opportunistic CMV infection should be considered early in the evaluation of patients with GS or a history of thymoma who develop unusual neurological symptoms.
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Affiliation(s)
- Pasquale Striano
- Department of Neurological Science, Federico II University, Via Pansini 5, 80131 Naples, Italy.
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Misra UK, Kalita J, Syam UK, Dhole TN. Neurological manifestations of dengue virus infection. J Neurol Sci 2006; 244:117-22. [PMID: 16524594 DOI: 10.1016/j.jns.2006.01.011] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Revised: 11/15/2005] [Accepted: 01/11/2006] [Indexed: 10/24/2022]
Abstract
AIM Paucity of studies on neurological manifestations in dengue virus infection prompted this study. We aim to correlate clinical, radiological and neurophysiological changes in dengue patients with neurological manifestations. METHOD Consecutive IgM seropositive dengue patients admitted in neurology ward during 2003-2005 have been prospectively evaluated. They were subjected to detailed clinical evaluation, blood counts, coagulation profile, serum chemistry including creatine kinase (CK), cerebrospinal fluid (CSF), cranial CT and/or MRI, electroencephalogram (EEG), nerve conduction and needle electromyography (EMG). RESULTS There were 17 patients, aged 5 to 56 years; 11 presented with encephalopathy and 6 with acute motor weakness. In the patients with encephalopathy, seizures were present in 3, myoclonus in 1, CSF pleocytosis and EEG slowing in 8 each and globus pallidus and thoracic spinal cord involvement on MRI in 1 patient each. In the pure motor weakness group, CK was elevated in 5 and EMG and muscle biopsy were consistent with myositis in 1 patient each. The patients with pure motor weakness improved completely but in the encephalopathy group 3 died, 2 had partial, 1 poor and 5 complete recovery by 1 month. CONCLUSION Dengue patients presenting with encephalopathy had more severe illness and worse outcome compared to acute pure motor weakness.
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Affiliation(s)
- U K Misra
- Department of Neurology, Sanjay Gandhi PGIMS, Lucknow 226014, India.
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Borghi E, Pagani E, Mancuso R, Delbue S, Valli M, Mazziotti R, Giordano L, Micheli R, Ferrante P. Detection of herpesvirus-6A in a case of subacute cerebellitis and myoclonic dystonia. J Med Virol 2005; 75:427-9. [PMID: 15648060 DOI: 10.1002/jmv.20285] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This is a case study of a child who developed roseola infantum first, then varicella, and was later affected by acute cerebellar syndrome, severe truncal ataxia, and myoclonic dystonia. Human herpesvirus 6 (HHV-6) A and B were detected in the cerebrospinal fluid (CSF) and peripheral blood, respectively, upon ataxia onset. The intricacy of this case suggests multifaceted conclusions ranging from the need for a multidirectional approach to neurological diseases, to confirmation of a more pronounced neurotropism of HHV-6A and a possible role of viruses in myoclonic dystonia syndrome, although this last hypothesis should be confirmed by larger studies.
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Affiliation(s)
- Elisa Borghi
- Department of Biomedical Science and Technology, University of Milan, Milan, Italy
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Sejvar JJ, Haddad MB, Tierney BC, Campbell GL, Marfin AA, Van Gerpen JA, Fleischauer A, Leis AA, Stokic DS, Petersen LR. Neurologic manifestations and outcome of West Nile virus infection. JAMA 2003; 290:511-5. [PMID: 12876094 DOI: 10.1001/jama.290.4.511] [Citation(s) in RCA: 373] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT The neurologic manifestations, laboratory findings, and outcome of patients with West Nile virus (WNV) infection have not been prospectively characterized. OBJECTIVE To describe prospectively the clinical and laboratory features and long-term outcome of patients with neurologic manifestations of WNV infection. DESIGN, SETTING, AND PARTICIPANTS From August 1 to September 2, 2002, a community-based, prospective case series was conducted in St Tammany Parish, La. Standardized clinical data were collected on patients with suspected WNV infection. Confirmed WNV-seropositive patients were reassessed at 8 months. MAIN OUTCOME MEASURES Clinical, neurologic, and laboratory features at initial presentation, and long-term neurologic outcome. RESULTS Sixteen (37%) of 39 suspected cases had antibodies against WNV; 5 had meningitis, 8 had encephalitis, and 3 had poliomyelitis-like acute flaccid paralysis. Movement disorders, including tremor (15 [94%]), myoclonus (5 [31%]), and parkinsonism (11 [69%]), were common among WNV-seropositive patients. One patient died. At 8-month follow-up, fatigue, headache, and myalgias were persistent symptoms; gait and movement disorders persisted in 6 patients. Patients with WNV meningitis or encephalitis had favorable outcomes, although patients with acute flaccid paralysis did not recover limb strength. CONCLUSIONS Movement disorders, including tremor, myoclonus, and parkinsonism, may be present during acute illness with WNV infection. Some patients with WNV infection and meningitis or encephalitis ultimately may have good long-term outcome, although an irreversible poliomyelitis-like syndrome may result.
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Affiliation(s)
- James J Sejvar
- Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
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Abstract
OBJECTIVE To report on the effects of the ketogenic diet on a 9-year-old boy with myoclonic jerks due to subacute sclerosing panencephalitis (SSPE). METHODS A 9-year-old boy presented with progressively worsening myoclonus unresponsive to valproic acid and clonazepam. He was started on the ketogenic diet maintaining urine ketones at greater than 80 mg x dl(-1). RESULTS Within 2 weeks of dietary initiation, myoclonic jerks stopped. Four weeks later he developed cognitive slowing. Results of electroencephalogram and cerebrospinal fluid analysis were consistent with SSPE. Three months after ketogenic diet initiation, myoclonic jerks reappeared and were refractory to treatment. CONCLUSION The ketogenic diet may be useful in controlling, even temporarily, the myoclonic jerks of SSPE.
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Affiliation(s)
- Ramon Edmundo D Bautista
- Department of Neurology, University of Florida Health Sciences Centre, Jacksonville, FL 32209, USA.
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Cruzado D, Masserey-Spicher V, Roux L, Delavelle J, Picard F, Haenggeli CA. Early onset and rapidly progressive subacute sclerosing panencephalitis after congenital measles infection. Eur J Pediatr 2002; 161:438-41. [PMID: 12172828 DOI: 10.1007/s00431-002-0979-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2002] [Revised: 05/22/2002] [Accepted: 05/23/2002] [Indexed: 11/25/2022]
Abstract
UNLABELLED We report an 18-month-old girl with rapidly progressive subacute sclerosing panencephalitis, whose non immunised mother had measles at the time of delivery. The patient presented with repetitive episodes of myoclonic jerks of the head and arms, followed by a drop of head and trunk with frequent falls. EEG, CSF studies and MRI confirmed the diagnosis. Despite therapy with isoprinosine and valproate, seizure activity continued and she became vegetative within 2 months, with severe spasticity and swallowing difficulties, and died at the age of 28 months. Early age of onset and rapid progression were most likely related to haematogenous in utero acquisition of the measles virus prior to delivery, as well as immaturity of neuronal and immune systems. CONCLUSION this case emphasises the importance of a high measles vaccine coverage in the population in order to prevent the risk of disease in general and, in particular, gestational measles.
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Affiliation(s)
- Dounia Cruzado
- Department of Paediatrics, Child Neurology, Children's Hospital, Rue Willy-Donzé 6, 1211 Geneva 14, Switzerland
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Abstract
A case of progressive myoclonic ataxia in an AIDS patient is described, which evolved over a 13 month period. The ataxia persisted as the only clinical finding for several months before the appearance of a severe tetraparesis and cachexia. Throughout the clinical progression, magnetic resonance imaging (MRI) revealed the presence of bilateral, progressive, isolated, and symmetrical lesions involving the red nuclei, subthalami, thalami, lenticular nuclei, and primary motor cortices. Neuropathological examination, supplemented by in situ hybridisation for JC virus DNA, confirmed that the lesions were those of progressive multifocal leucoencephalopathy (PML). The exceptional clinical presentation of PML in this case is the first report of progressive myoclonic ataxia caused by PML. The selective nature of the lesions confirms the role of the dentato-rubral-thalamo-cortical tract in the pathogenesis of progressive myoclonic ataxia. The atypical MRI findings further emphasise the need for expanded diagnostic criteria for PML in AIDS patients and support the use of more aggressive diagnostic methods as new treatments become available.
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Affiliation(s)
- P Fontoura
- University Department of Neurology, Hospital de Egas Moniz, Lisbon, Portugal.
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Srivastava T, Thussu A. Palatal myoclonus in postinfectious opsoclonus myoclonus syndrome : a case report. Neurol India 1999; 47:133-5. [PMID: 10402340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
An adult male presenting with acute onset opsoclonus, myoclonus and cerebellar ataxia is being reported. Patient had myoclonus involving limbs and palate. There are only a few reported cases associated with palatal myoclonus. Patient showed gradual spontaneous recovery. Possibility of underlying malignancy was excluded by detailed investigations.
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Affiliation(s)
- T Srivastava
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Fiorito DA. Multiple oral procedures performed on a dog with distemper myoclonus. J Vet Dent 1993; 10:10-1. [PMID: 7917067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 3-year-old male mixed-breed dog was treated for an oral defect along the rostral portion of the hard palate and an oronasal fistula secondary to a severe mandibular brachygnathism and persistent canine distemper virus associated myoclonus. This report describes the treatment using a bilateral radical premaxillectomy, oronasal fistula repair, and pulpotomy.
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