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Sample records for acute flaccid paralysis

  1. Acute Flaccid paralysis in adults: Our experience

    Rupesh Kaushik; Parampreet S Kharbanda; Ashish Bhalla; Roopa Rajan; Sudesh Prabhakar

    2014-01-01

    Acute flaccid paralysis (AFP) is a complex clinical syndrome with a broad array of potential etiologies that vary with age. We present our experience of acute onset lower motor neuron paralysis. Materials and Methods: One hundred and thirty-three consecutive adult patients presenting with weakness of duration less than four weeks over 12 months period were enrolled. Detailed history, clinical examination, and relevant investigations according to a pre-defined diagnostic algorithm were carried...

  2. Acute Flaccid paralysis in adults: Our experience

    Rupesh Kaushik

    2014-01-01

    Full Text Available Acute flaccid paralysis (AFP is a complex clinical syndrome with a broad array of potential etiologies that vary with age. We present our experience of acute onset lower motor neuron paralysis. Materials and Methods: One hundred and thirty-three consecutive adult patients presenting with weakness of duration less than four weeks over 12 months period were enrolled. Detailed history, clinical examination, and relevant investigations according to a pre-defined diagnostic algorithm were carried out. The patients were followed through their hospital stay till discharge or death. Results: The mean age was 33.27 (range 13-89 years with male preponderance (67.7%. The most common etiology was neuroparalytic snake envenomation (51.9%, followed by Guillain Barre syndrome (33.1%, constituting 85% of all patients. Hypokalemic paralysis (7.5% and acute intermittent porphyria (4.5% were the other important conditions. We did not encounter any case of acute polio mylitis in adults. In-hospital mortality due to respiratory paralysis was 9%. Conclusion: Neuroparalytic snakebite and Guillain Barre syndrome were the most common causes of acute flaccid paralysis in adults in our study.

  3. A rare cause of acute flaccid paralysis: Human coronaviruses

    Cokyaman Turgay; Tekin Emine; Koken Ozlem; S Paksu Muhammet; A Tasdemir Haydar

    2015-01-01

    Acute flaccid paralysis (AFP) is a life-threatening clinical entity characterized by weakness in the whole body muscles often accompanied by respiratory and bulbar paralysis. The most common cause is Gullian–Barre syndrome, but infections, spinal cord diseases, neuromuscular diseases such as myasthenia gravis, drugs and toxins, periodic hypokalemic paralysis, electrolyte disturbances, and botulism should be considered as in the differential diagnosis. Human coronaviruses (HCoVs) cause common ...

  4. Acute Flaccid Paralysis Associated with Novel Enterovirus C105

    Horner, Liana M.; Poulter, Melinda D.; Brenton, J. Nicholas; Turner, Ronald B.

    2015-01-01

    An outbreak of acute flaccid paralysis among children in the United States during summer 2014 was tentatively associated with enterovirus D68 infection. This syndrome in a child in fall 2014 was associated with enterovirus C105 infection. The presence of this virus strain in North America may pose a diagnostic challenge.

  5. A rare cause of acute flaccid paralysis: Human coronaviruses

    Cokyaman Turgay

    2015-01-01

    Full Text Available Acute flaccid paralysis (AFP is a life-threatening clinical entity characterized by weakness in the whole body muscles often accompanied by respiratory and bulbar paralysis. The most common cause is Gullian-Barre syndrome, but infections, spinal cord diseases, neuromuscular diseases such as myasthenia gravis, drugs and toxins, periodic hypokalemic paralysis, electrolyte disturbances, and botulism should be considered as in the differential diagnosis. Human coronaviruses (HCoVs cause common cold, upper and lower respiratory tract disease, but in the literature presentation with the lower respiratory tract infection and AFP has not been reported previously. In this study, pediatric case admitted with lower respiratory tract infection and AFP, who detected for HCoV 229E and OC43 co-infection by the real-time polymerase chain reaction, has been reported for the first time.

  6. A rare cause of acute flaccid paralysis: Human coronaviruses.

    Turgay, Cokyaman; Emine, Tekin; Ozlem, Koken; Muhammet, S Paksu; Haydar, A Tasdemir

    2015-01-01

    Acute flaccid paralysis (AFP) is a life-threatening clinical entity characterized by weakness in the whole body muscles often accompanied by respiratory and bulbar paralysis. The most common cause is Gullian-Barre syndrome, but infections, spinal cord diseases, neuromuscular diseases such as myasthenia gravis, drugs and toxins, periodic hypokalemic paralysis, electrolyte disturbances, and botulism should be considered as in the differential diagnosis. Human coronaviruses (HCoVs) cause common cold, upper and lower respiratory tract disease, but in the literature presentation with the lower respiratory tract infection and AFP has not been reported previously. In this study, pediatric case admitted with lower respiratory tract infection and AFP, who detected for HCoV 229E and OC43 co-infection by the real-time polymerase chain reaction, has been reported for the first time. PMID:26557177

  7. Paediatric surveillance of Acute Flaccid Paralysis in the Netherlands in 1995 and 1996

    Conyn-van Spaendonck MAE; Geubbels ELPE; Suijkerbuijk AWM; CIE; NSCK

    1998-01-01

    In Nederland wordt de surveillance van acute slappe verlamming (AFP acute flaccid paralysis) sinds oktober 1992 uitgevoerd via het Nederlands Signalerings-Centrum Kindergeneeskunde. Het betreft een vorm van actieve surveillance waarbij klinisch werkzame kinderartsen maandelijks een aantal zeldzame

  8. Acute flaccid paralysis surveillance: A 6 years study, Isfahan, Iran

    Alireza Emami Naeini

    2015-01-01

    Full Text Available Background: Poliomyelitis is still an endemic disease in many areas of the world including Africa and South Asia. Iran is polio free since 2001. However, due to endemicity of polio in neighboring countries of Iran, the risk of polio importation and re-emergence of wild polio virus is high. Case definition through surveillance system is a well-defined method for maintenance of polio eradication in polio free countries. Methods: In a cross-sectional survey from 2007 to 2013, we reviewed all the records of under 15 years old patients reported to Acute Flaccid Paralysis Committee (AFPC in Isfahan province, Iran. All cases were visited by members of the AFPC. Three stool samples were collected from each reported case within 2 weeks of onset of paralysis and sent to National Polio Laboratory in Tehran, Iran, for poliovirus isolation. Data were analyzed by SSPS software (version 22. Student′s t-test and Chi-square was used to compare variables. Statistical significance level was set at P 94%, with six doses of oral polio vaccine (OPV. Accurate surveillance for poliomyelitis is essential for continuing eradication.

  9. Surveillance of acute flaccid paralysis in the Netherlands, 1992-94

    Oostvogel, P.M.; Conyn-Spaendonck, M.A.E. van; Hirasing, R.A.; Loon, A.M. van

    1998-01-01

    Detection and investigation of call cases of acute flaccid paralysis (AFP) in children below 15 years of age are among the criteria for poliomyelitis-free certification. In the absence of poliomyelitis the incidence of AFP is around 1 per 100 000 children aged < 15 years. In the Netherlands, surveil

  10. Epidemiology and clinical findings associated with enteroviral acute flaccid paralysis in Pakistan

    Angez Mehar; Shaukat Shahzad; Sharif Salmaan; Masroor Muhammad; Naeem Asif; Zaidi Sohail Z; Saeed Mohsan; Khan Anis

    2007-01-01

    Abstract Background Enteroviruses are among the most common viruses infecting humans worldwide and they are associated with diverse clinical syndromes. Acute flaccid paralysis (AFP) is a clinical manifestation of enteroviral neuropathy, transverse myelitis, Guillian-Barre Syndrome, Traumatic neuritis and many other nervous system disorders. The objective of this study was to understand the role of Non-Polio Enteroviruses (NPEV) towards this crippling disorder. Methods Stool specimens of 1775 ...

  11. Sudden flaccid paralysis.

    Tariq, Mohammad; Peshin, Rohit; Ellis, Oliver; Grover, Karan

    2015-01-01

    Periodic thyrotoxic paralysis is a genetic condition, rare in the West and in Caucasians. Thyrotoxicosis, especially in western hospitals, is an easily overlooked cause of sudden-onset paralysis. We present a case of a 40-year-old man who awoke one morning unable to stand. He had bilateral lower limb flaccid weakness of 0/5 with reduced reflexes and equivocal plantars; upper limbs were 3/5 with reduced tone and reflexes. ECG sinus rhythm was at a rate of 88/min. PR interval was decreased and QT interval increased. Bloods showed potassium of 1.8 mEq/L (normal range 3.5-5), free T4 of 29.2 pmol/L (normal range 6.5-17) and thyroid-stimulating hormone (TSH) of mEq/L (normal range 12.5-62.5). The patient was admitted initially to intensive therapy unit and given intravenous potassium. His symptoms resolved within 24 h. He was diagnosed with thyrotoxic periodic paralysis. He was discharged on carbimazole and propanolol, and follow-up was arranged in the endocrinology clinic. PMID:25566931

  12. Clinical and neuroimaging features of enterovirus71 related acute flaccid paralysis in patients with hand-foot-mouth disease

    Feng Chen; Jian-Jun Li; Tao Liu; Guo-Qiang Wen; Wei Xiang

    2013-01-01

    Objective: To investigate clinical and neuroimaging features of enterovirus71 (EV71) related acute flaccid paralysis in patients with hand-foot-mouth disease. Methods: Nine patients with acute flaccid paralysis met the criterion of EV71 induced hand-foot-mouth disease underwent spinal and brain MR imaging from May 2008 to Sep 2012. Results: One extremity flaccid was found in four cases (3 with lower limb, 1 with upper limb), two limbs flaccid in three cases (2 with lower limbs, 1 with upper limbs), and four limbs flaccid in two cases. Spinal MRI studies showed lesion with high signal in T2-weighted images (T2WI) and low signal T1-weighted images (T1WI) in the spinal cord of all nine cases, and the lesions were mainly in bilateral and unilateral anterior horn of cervical spinal cord and spinal cord below thoracic 9 (T9) level. In addition, the midbrain, pons, and medulla, which were involved in 3 cases with brainstem encephalitis, demonstrated abnormal signal. Moreover, spinal cord contrast MRI studies showed mild enhancement in corresponding anterior horn of the involved side, and strong enhancement in its ventral root. Conclusions:EV71 related acute flaccid paralysis in patients with hand-foot-mouth disease mainly affected the anterior horn regions and ventral root of cervical spinal cord and spinal cord below T9 level. MR imaging could efficiently show the characteristic pattern and extent of the lesions which correlated well with the clinical features.

  13. Acute flaccid paralysis due to West nile virus infection in adults: A paradigm shift entity

    Boby Varkey Maramattom

    2014-01-01

    Full Text Available Three cases of acute flaccid paralysis (AFP with preceding fever are described. One patient had a quadriparesis with a florid meningoencephalitic picture and the other two had asymmetric flaccid paralysis with fasciculations at the onset of illness. Magnetic resonance imaging in two cases showed prominent hyperintensitities in the spinal cord and brainstem with prominent involvement of the grey horn (polio-myelitis. Cerebrospinal fluid (CSF polymerase chain reaction was positive for West Nile virus (WNV in the index patient. All three cases had a positive WNV immunoglobulin M antibody in serum/CSF and significantly high titer of WNV neutralizing antibody in serum, clearly distinguishing the infection from other Flaviviridae such as Japanese encephalitis. WNV has been recognized in India for many decades; however, AFP has not been adequately described. WNV is a flavivirus that is spread by Culex mosquitoes while they take blood meals from humans and lineage 1 is capable of causing a devastating neuro-invasive disease with fatal consequences or severe morbidity. We describe the first three laboratory confirmed cases of WNV induced AFP from Kerala and briefly enumerate the salient features of this emerging threat.

  14. Epidemiology and clinical findings associated with enteroviral acute flaccid paralysis in Pakistan

    Angez Mehar

    2007-02-01

    Full Text Available Abstract Background Enteroviruses are among the most common viruses infecting humans worldwide and they are associated with diverse clinical syndromes. Acute flaccid paralysis (AFP is a clinical manifestation of enteroviral neuropathy, transverse myelitis, Guillian-Barre Syndrome, Traumatic neuritis and many other nervous system disorders. The objective of this study was to understand the role of Non-Polio Enteroviruses (NPEV towards this crippling disorder. Methods Stool specimens of 1775 children, aged less than 15 years, suffering from acute flaccid paralysis were collected after informed consent within 14 days of onset of symptoms during January 2003 to September 2003. The specimens were inoculated on RD and L20B cells using conventional tube cell culture while micro-neutralization test was used to identify the non-polio enterovirus (NPEV serotypes. Detailed clinical information and 60-days follow-up reports were analyzed for NPEV-associated AFP cases. Results NPEV were isolated from 474 samples. The male to female ratio was 1.4:1. The isolation of NPEV decreased significantly with the increase in age. Cases associated with fever at the onset of NPEV-associated AFP were found to be 62%. The paralysis was found asymmetrical in 67% cases, the progression of paralysis to peak within 4 days was found in 72% cases and residual paralysis after 60 days of paralysis onset was observed in 39% cases associated with NPEV. A clinical diagnosis of Guillian-Barre syndrome was made in 32% cases. On Microneutralization assay, echo-6 (13% and coxsackievirus B (13% were the most commonly isolated serotypes of NPEV along with E-7, E-13, E-11, E-4 and E-30. The isolates (n = 181 found untypable by the antiserum pools were confirmed as NPEV by PCR using Pan-Enterovirus primers. Conclusion The present study suggests that NPEV are a dominant cause of AFP and different serotypes of NPEV are randomly distributed in Pakistan. The untypable isolates need further

  15. Epidemiology of acute flaccid paralysis in Kermanshah province, 2004-2009

    Keyghobad Ghadiri

    2011-09-01

    Full Text Available The aim of this study was to determine epidemiologic features of acute flaccid paralysis (AFP during 2004-2009 in Kermanshah province. This cross-sectional descriptive study was done based on data records from Kermanshah health care center. In total 89 patients, 0-14 years old were enrolled study, which 36 of them were male and 53 were female. 50.6% of subjects were diagnosed as Guillain-barre, 6.7% transverse synovitis and 5.6% as arthritis. No any cases of poliomyelitis were diagnosed. The prevalence of reported of AFP during 2004-2009 in Kermanshah province was more than expected rate of 1 per 100000 according to WHO.

  16. Study of acute flaccid paralysis surveillance system in Kerman (Iran for one decade

    Hossein Ali Ebrahimi

    2014-03-01

    Full Text Available Background — During the past decade, polio eradication has stalled globally. Acute flaccid paralysis (AFP surveillance is a key strategy for monitoring the progress of polio eradication. All AFP patients who referred to expert committee were evaluated about the causes. Methods — This case series study is the result of activities for one decade of expert AFP committee of Kerman University of Medical Sciences from 2002-2011, with coverage of more than 2,650,000 populations and 730,677 child with age of ≤15 years old. All patients have gone under diagnostic and therapeutic managements. Results — The total cases referred to Kerman expert committee of AFP for ten years were 147 cases. In our study the incidence of AFP was 2.016 per 100000 populations for one year.The most common causes of AFP were Guillain-Barre syndrome (GBS. Other causes of AFP were; stroke, synovitis, myelitis, seizures, cerebral palsy, viral infections, tumors, cerebellitis and non-polio AFP. The rate of GBS in our study was 0.96 per 100000 in children 15 years old or smaller, and more in male. In this study the incidence rate in cities with low mean temperature was higher than in cities with high mean temperature. Conclusion — We had no polio case in this period. The most common cause of AFPs was Guillain–Barre syndrome. The incidence of GBS was higher in areas with low mean temperature.

  17. PENGKAJIAN DATA RUMAH SAKIT (HOSPITAL RECORD REVIEW KASUS ACUTE FLACCID PARALYSIS (AFP TAHUN 1999-2000 DI JAWA TIMUR

    Cholis Bachroen

    2012-11-01

    Full Text Available This survey was the evaluation of the program on Polio Eradication through Acute Flaccid Paralysis (AFP Surveillance especially Hospital Based Surveillance. The evaluation was done by reviewing the Hospitals' Record (Hospital Based Survey. The objective of the survey was to estimate the under reported of routine reporting system, which the data of the survey used as a gold standard. The results showed that due to incomplete of the records in several hospitals, some of AFP cases might be could not be covered. However the under reported of the routine surveillance system was more than 50%. It seems that the strengthening of supervision was still needed to increase coverage of the routine surveillance system.   Keywords: hospitals; medical record; acute flocid paralysis

  18. [Investigation of adenovirus isolation frequency from the stool samples of patients suspected with acute flaccid paralysis].

    Bayrakdar, Fatma; Coşgun, Yasemin; Salman Atak, Tunca; Karademir, Hülya; Korukluoğlu, Gülay

    2016-04-01

    Although adenoviruses (AdVs) generally cause upper respiratory tract infections, conjunctivitis/epidemic keratoconjunctivitis, gastroenteritis and pneumonia, they can lead to the involvement of central nervous system. Acute flaccid paralysis (AFP) is a type of seizure, characterized by rapid and sudden onset of extreme weakness in hands and feet, including (less frequently) weakness of respiratory and swallowing, representing with decreased muscle tone, especially in children below 15-year-old. The major viral cause of AFP is polioviruses, however non-polio enteroviruses, mumps virus, rabies virus and flaviviruses can also be responsible for AFP. The data of some recent studies have pointed out the probable aetiological role of AdVs in AFP. The aim of this study was to investigate the frequency of AdVs from stool samples of AFP-suspected patients and their contacts. A total of 6130 stool samples from patients (age range: 0-15 years) prediagnosed as AFP (n= 3185) and their contacts (n= 2945), which were sent to our laboratory from the health care centers located at different regions of Turkey for the monitorization of poliomyelitis as part of national AFP surveillance programme, between 2000-2014, have been retrospectively evaluated in terms of adenovirus isolation frequency. Samples were analyzed according to the algorithm recommended by World Health Organization and inoculated in Hep-2, RD, and L20B cell lines for cultivation. Apart from enteroviruses, in case of the presence of characteristic cytopathic effects for AdVs observed in L20B cells were confirmed by a commercial Adeno agglutination kit (Diarlex Adeno; Orion Diagnostica, Finland). It was noted that AdVs have been isolated from 1.6% (97/6130) of the samples, and out of positive samples 76.3% (74/97) were from AFP-suspected cases, while 23.7% (23/97) were from their contacts. Accordingly the frequencies of AdVs from AFP-suspected cases and their contacts were found as 2.3% (74/3185) and 0.8% (23

  19. Characterization of a novel enterovirus serotype and an enterovirus EV-B93 isolated from acute flaccid paralysis patients.

    Shahzad Shaukat

    Full Text Available Non-polio enteroviruses (NPEVs are among the most common viruses infecting humans worldwide. Most of these infections are asymptomatic but few can lead to systemic and neurological disorders like Acute Flaccid Paralysis (AFP. Acute Flaccid Paralysis is a clinical syndrome and NPEVs have been isolated frequently from the patients suffering from AFP but little is known about their causal relationship. The objective of this study was to identify and characterize the NPEV serotypes recovered from 184 stool samples collected from AFP patients in Federally Administered Tribal Areas (FATA in north-west of Pakistan. Overall, 44 (95.6 % isolates were successfully typed through microneutralization assay as a member of enterovirus B species including echovirus (E-2, E-3, E-4, E-6, E-7, E-11, E-13, E-14, E-21 and E-29 while two isolates (PAK NIH SP6545B and PAK NIH SP1202B remained untypeable. The VP1 and capsid regions analysis characterized these viruses as EV-B93 and EV-B106. Phylogenetic analysis confirmed that PAK NIH isolates had high genetic diversity and represent distinct genotypes circulating in the country. Our findings highlight the role of NPEVs in AFP cases to be thoroughly investigated especially in high disease risk areas, with limited surveillance activities and health resources.

  20. MRI findings of spine: acute flaccid paralysis associated with enterovirus 71 infected hand-foot-mouth disease

    Objective: To investigate the characteristics of spinal MR images in acute flaccid paralysis (AFP) associated with enterovirus 71 infected hand-foot-mouth disease. Methods: The spinal MR images of eight infants with AFP and positive EV71 cultures were analyzed during an outbreak of hand-foot-mouth disease in China in 2008. Results: Acute paralysis was observed in one lower limb in 4 of the 8 patients, in four limbs in 2 patients, in one upper limb and both lower limbs in 1 patient, 2 of the 8 patients also had brain stem encephalitis. Lesions were identified in anterior horn regions of spinal cord with hyperintensity on T2-weighted images and hypointensity on T1-weighted images. Location of the lesions included C3 to C7 (1 case), T10 extending to conus medullaris (5 cases) and a combination of the above (2 cases). Five of the 8 patients presented with unilateral paralysis. Two of the 5 cases showed unilateral hyperintense lesions in anterior horn regions and the remaining 3 cases showed bilateral hyperintense lesions in anterior horn regions with a unilateral predominance. One of the 3 patients with bilateral lesions showed slight enhancement of anterior horn with prominent enhancement of ventral roots after intravenous injections of contrast medium. Three of the 8 patients with bilateral paralysis showed bilateral hyperintensity in both anterior horn regions. Conclusion: MR is the imaging modality of choice for the detection of radiculomyelitis of AFP associated with EV71 infection. (authors)

  1. Surveillance of acute flaccid paralysis (AFP) in Lombardy, Northern Italy, from 1997 to 2011 in the context of the national AFP surveillance system

    Pellegrinelli, Laura; Primache, Valeria; Fiore, Lucia; Amato, Concetta; Fiore, Stefano; Bubba, Laura; Pariani, Elena; Amendola, Antonella; Barbi, Maria; Binda, Sandro

    2014-01-01

    An Acute Flaccid Paralysis (AFP) surveillance system was set up in Lombardy (Northern Italy) in 1997 in the framework of the national AFP surveillance system, as part of the polio eradication initiative by the World Health Organization (WHO). This surveillance system can now be used to detect Poliovirus (PV) reintroductions from endemic countries. This study aimed at describing the results of the AFP surveillance in Lombardy, from 1997 to 2011.

  2. Isolation and Characterization of a Highly Mutated Chinese Isolate of Enterovirus B84 from a Patient with Acute Flaccid Paralysis

    Zheng, Huanying; Zhang, Yong; Liu, Leng; Lu, Jing; Guo, Xue; Li, Hui; Zeng, Hanri; Fang, Ling; Xu, Wenbo; Ke, Changwen

    2016-01-01

    Enterovirus B84 (EV-B84) is a newly identified serotype within the species Enterovirus B (EV-B). To date, only ten nucleotide sequences of EV-B84 are published and only one full-length genome sequence (the prototype strain) is available in the GenBank database. Here, a highly mutated EV-B84 (strain AFP452/GD/CHN/2004) was recovered from a patient with acute flaccid paralysis in the Guangdong province of China in 2004 making this the first report of EV-B84 in China. Sequence comparison and phylogenetic dendrogram analysis revealed high variation from the global EV-B84 strains (African and Indian strains) and frequent intertypic recombination in the non-structural protein region, suggesting high genetic diversity in EV-B84. The Chinese EV-B84 strain, apparently evolving independently of the other ten strains, strongly suggests that the EV-B84 strain has been circulating for many years. However, the extremely low isolation rate suggests that it is not a prevalent EV serotype in China or worldwide. This study provides valuable information about the molecular epidemiology of EV-B84 in China, and will be helpful in future studies to understand the association of EV-B84 with neurological disorders; it also helps expand the number of whole virus genome sequences of EV-B84 in the GenBank database. PMID:27499334

  3. [Genetic Characteristics of Coxsackievirus Group A Type 4 Isolated from Patients with Acute Flaccid Paralysis in Shaanxi, China].

    Wang, Dongyan; Xu, Yi; Zhang, Yong; Zhu, Shuangli; Si, Yuan; Yan, Dongmei; Zhu, Hui; Yang, Qian; Ji, Tianjiao; Xu, Wenbo

    2016-03-01

    We analyzed the genetic characteristics of coxsackievirus A4 (CV-A4) based on the entire VP1 coding region. Samples were isolated from patients with acute flaccid paralysis (AFP) in Shaanxi, China from 2006 to 2010. We wished to ascertain the predominant genotype and the relationship between CV-A4 infection and AFP. Sixty-eight non-polio enteroviruses were inoculated onto RD cells (to increase the virus titer) and molecular typing was undertaken. The entire VP1 coding region was amplified. Percentage of CV-A4 was 10.3% (7/68). Analyses of genetic identify and creation of phylogenetic trees revealed that CV-A4 could be classified into A, B and C genotypes. Seven CV-A4 strains from Shaanxi and other CV-A4 strains from China formed an independent evolution lineage located in group 4 and belonged to the C2 sub-genotype. These data suggested that CV-A4 strains of sub-genotype C2 were the predominant genotypes in China. These strains co-evolved and co-circulated with those from other provinces in China, so continued monitoring of CV-A4 (by clinical and genetic surveillance) should be enhanced. PMID:27396156

  4. Vaccine associated paralytic poliomyelitis cases from children presenting with acute flaccid paralysis in Uganda.

    Nanteza, Mary B; Kisakye, Annet; Ota, Martin O; Gumede, Nicksy; Bwogi, Josephine

    2015-12-01

    A retrospective study to identify VAPP cases from the entire Uganda was conducted between January 2003 and December 2011. Eleven of the 106 AFP cases were VAPPs. The VAPP rate ranged from 0 to 3.39 cases per 1,000,000 birth cohorts and the peak was in 2009 when there was scaling up of OPV immunization activities following an importation of wild poliovirus in the country. All the subsequent polio suspect cases since then have been vaccine-associated polio cases. Our data support the strategy to withdraw OPV and introduce IPV progressively in order to mitigate against the paralysis arising from Sabin polioviruses. PMID:26058454

  5. Surveillance of Acute Flaccid Paralysis in the Netherlands 1992-1994

    Oostvogel PM; Conyn-van Spaendonck MAE; Hirasing RA; van Loon AM; LIO; CIE; Nederlands Signalerings Centrum Kindergeneeskunde (NSCK); TNO

    1996-01-01

    Surveillance van acute slappe verlamming (ASV) bij kinderen in Nederland vindt plaats in het kader van het mondiale uitroeiingsinitiatief van poliomyelitis van de Wereld Gezondheidsorganisatie. Ervaring elders leert dat de incidentie van ASV, in afwezigheid van poliomyelitis, ongeveer 1 op de 100.0

  6. Complete Genome Sequence of a Novel Human Enterovirus 85 (HEV85) Recombinant with an Unknown New Serotype HEV-B Donor Sequence Isolated from a Child with Acute Flaccid Paralysis

    Sun, Qiang; Zhang, Yong; Cui, Hui; Zhu, Shuangli; Zhu, Zhen; Huang, Guohong; Li, Xiaolei; Zhang, Bo; Yan, Dongmei; An, Hongqiu; Xu, Wenbo

    2013-01-01

    A Chinese human enterovirus 85 (HEV85) isolate, HTYT-ARL-AFP02F/XJ/CHN/2011, was isolated from a stool specimen of a child with acute flaccid paralysis in Xinjiang, China, in 2011. The complete genome sequence revealed that a natural intertypic recombination event had occurred between HEV85 and a previously undescribed serotype of HEV-B.

  7. Frequency of isolation of polioviruses and non polio enteroviruses from patients with acute flaccid paralysis, enterovirus infection and children from groups at risk

    N. I. Romanenkova

    2012-01-01

    Full Text Available The article describes the frequency of isolation of polioviruses and non polio enteroviruses from different categories of the investigated children. The percentage of detection of polioviruses from the patients with acute flaccid paralysis was lower than that from the children from groups at risk. Among the patients with the enterovirus infection the polioviruses were rarely revealed. The frequency of isolation of non polio enteroviruses from these patients was significantly higher than that from the other categories of investigated persons. The improvement of poliomyelitis surveillance and the reinforcement of virological surveillance of children from groups at risk and those with enterovirus infection will provide the important data for Global Polio Eradication Initiative and the maintenance of polio free status of the Russian Federation.

  8. Surveillance of acute flaccid paralysis (AFP) in Lombardy, Northern Italy, from 1997 to 2011 in the context of the national AFP surveillance system.

    Pellegrinelli, Laura; Primache, Valeria; Fiore, Lucia; Amato, Concetta; Fiore, Stefano; Bubba, Laura; Pariani, Elena; Amendola, Antonella; Barbi, Maria; Binda, Sandro

    2015-01-01

    An Acute Flaccid Paralysis (AFP) surveillance system was set up in Lombardy (Northern Italy) in 1997 in the framework of the national AFP surveillance system, as part of the polio eradication initiative by the World Health Organization (WHO). This surveillance system can now be used to detect Poliovirus (PV) reintroductions from endemic countries. This study aimed at describing the results of the AFP surveillance in Lombardy, from 1997 to 2011.   Overall, 131 AFP cases in Lombardy were reported with a mean annual incidence rate of 0.7/100 000 children <15 years of age (range: 0.3/100 000-1.1/100 000). The sensitivity of the surveillance system was optimal from 2001-2003. The monthly distribution of AFP cases was typical with peaks in November, in January, and in March. The major clinical diagnoses associated with AFP were Guillain-Barré Syndrome (GBS, 40%) and encephalomyelitis/myelitis (13%). According to the virological results, no poliomyelitis cases were caused by wild PV infections, but two Vaccine-Associated Paralytic Paralysis (VAPP) cases were reported in 1997 when the Sabin oral polio vaccine (OPV) was still being administered in Italy. Since a surveillance system is deemed sensitive if at least one case of AFP per 100,000 children <15 years of age is detected each year, our surveillance system needs some improvement and must be maintained until global poliovirus eradication will be declared. PMID:25483546

  9. Support for children identified with acute flaccid paralysis under the global polio eradication programme in Uttar Pradesh, India: a qualitative study

    Yotsu Rie R

    2012-03-01

    Full Text Available Abstract Background Cases of polio in India declined after the implementation of the polio eradication programme especially in these recent years. The programme includes surveillance of acute flaccid paralysis (AFP to detect and diagnose cases of polio at early stage. Under this surveillance, over 40,000 cases of AFP are reported annually since 2007 regardless of the number of actual polio cases. Yet, not much is known about these children. We conducted a qualitative research to explore care and support for children with AFP after their diagnosis. Methods The research was conducted in a district of western Uttar Pradesh classified as high-risk area for polio. In-depth interviews with parents of children with polio (17, with non-polio AFP (9, healthcare providers (40, and key informants from community including international and government officers, religious leaders, community leaders, journalists, and academics (21 were performed. Results Minimal medicine and attention were provided at government hospitals. Therefore, most parents preferred private-practice doctors for their children with AFP. Many were visited at homes to have stool samples collected by authorities. Some were visited repetitively following the sample collection, but had difficulty in understanding the reasons for these visits that pertained no treatment. Financial burden was a common concern among all families. Many parents expressed resentment for their children's disease, notably have been affected despite receiving multiple doses of polio vaccine. Both parents and healthcare providers lacked information and knowledge, furthermore poverty minimised the access to available healthcare services. Medicines, education, and transportation means were identified as foremost needs for children with AFP and residual paralysis. Conclusions Despite the high number of children diagnosed with AFP as part of the global polio eradication programme, we found they were not provided with

  10. Viral Aetiology of Acute Flaccid Paralysis Surveillance Cases, before and after Vaccine Policy Change from Oral Polio Vaccine to Inactivated Polio Vaccine

    T. S. Saraswathy Subramaniam

    2014-01-01

    Full Text Available Since 1992, surveillance for acute flaccid paralysis (AFP cases was introduced in Malaysia along with the establishment of the National Poliovirus Laboratory at the Institute for Medical Research. In 2008, the Ministry of Health, Malaysia, approved a vaccine policy change from oral polio vaccine to inactivated polio vaccine (IPV. Eight states started using IPV in the Expanded Immunization Programme, followed by the remaining states in January 2010. The objective of this study was to determine the viral aetiology of AFP cases below 15 years of age, before and after vaccine policy change from oral polio vaccine to inactivated polio vaccine. One hundred and seventy-nine enteroviruses were isolated from the 3394 stool specimens investigated between 1992 and December 2012. Fifty-six out of 107 virus isolates were polioviruses and the remaining were non-polio enteroviruses. Since 2009 after the sequential introduction of IPV in the childhood immunization programme, no Sabin polioviruses were isolated from AFP cases. In 2012, the laboratory AFP surveillance was supplemented with environmental surveillance with sewage sampling. Thirteen Sabin polioviruses were also isolated from sewage in the same year, but no vaccine-derived poliovirus was detected during this period.

  11. Clinical Observation on Electroacupuncture for Post-stroke Flaccid Paralysis

    Zhu Xian-min; Hou Jing-yue

    2013-01-01

    Objective:To observe the clinical efficacy of electroacupuncture (EA) in treating post-stroke flaccid paralysis.Methods:Forty patients with post-stroke flaccid paralysis were randomized by the random number table into a treatment group and a control group,20 cases in each.The treatment group was intervened by acupuncture at Jiquan (HT 1),Tianquan (PC 2),Ququan (LR 8),Yinlingquan (SP 9),and Yongquan (KI 1),and the control group was treated by acupuncture with conventional acupoint selection.Barthel index (BI) was adopted for evaluating the activities of daily living (ADL),and therapeutic efficacy was analyzed.Results:The two groups both had marked increases of BI score after treatment.Compared to the control group after 1 treatment course and 2treatment courses respectively,the treatment group had significant differences in BI score (P<0.01).The total effective rate was 100.0% in the treatment group versus 90.0% in the control group,and the difference was statistically significant (P<0.01).Conclusion:EA at Jiquan (HT 1),Tianquan (PC 2),Ququan (LR 8),Yinlingquan (SP 9),Yongquan (KI 1) is an effective approach in treating post-stroke flaccid paralysis.

  12. Analysis on virological surveillance of acute flaccid paralysis in Chongqing (2008-2011)%重庆市2008-2011年急性驰缓性麻痹病例监测结果

    赵春芳; 赵华; 陈应琼; 彭靖尧; 凌华; 张敏

    2012-01-01

    目的 评价重庆市2008-2011年急性驰缓性麻痹(AFP)病例监测运转情况.方法 按照《脊灰病毒检验手册》操作规程进行病毒分离与鉴定,由国家脊灰实验室用PCR-RFLP法和ELISA法对分离到的脊灰病毒株进行型内鉴定.结果 从307例AFP病例粪便标本中分离到脊灰病毒(PV)10株,分离率为3.26%,其中脊灰Ⅱ型5株,Ⅲ型3株,PV混合2株,Ⅱ型为我市的主要型别占50.00%,其次是Ⅲ型、PV混合型分别占30.00%、20.00%.所有PV经国家脊灰实验室进行型内鉴定,有9株为疫苗相关株,另外有1株Ⅱ型有6个核苷酸序列变异,鉴定为疫苗高变异株.分离非脊灰肠道病毒(NPEV) 26株,分离率为8.47%.结论重庆市2008-2011年急性驰缓性麻痹病例中未发现脊灰野病毒,维持了无脊灰状态.在实现无脊灰目标后,仍应加强AFP病例的病毒学监测工作,以确保最终实现全球消灭脊灰的目标.%Objective To evaluate the surveillance system of the acute flaccid paralysis( AFP) cases in Chongqing from 2008 to 2011. Methods Viruses were isolated and identified according to the Polio Laboratory Manual,and the results were conducted intratypic differentiation at the National Poliomyelitis Laboratory by PCR-RFLP and ELJSA methods. Results 10 strains of poliomyelitis virus( PV) were isolated from human fecal samples of 307 AFP cases,The isolating rate was 3. 26% , which included 5 strains of the type Ⅱ poliovirus ,3 strains of the type Ⅲ poliovirus and 2 strains of the mixed poliovirus. The principle prevalent type was Ⅱ, accounted for 50. 00% , followed by type Ⅲ and PV hybrid, accounted for 30. 00% and 20. 00% respectively. All the PVs were sent to the National Poliomyelitis Laboratory for further intratypic differentiation and identification. The results indicated that 9 strains were vaccine-related. Meanwhile, 6 nucleotide sequence variations were found in 1 strain of the type Ⅱ poliovirus, which was confirmed as the

  13. 深圳市2001-2011年残留麻痹的急性弛缓性麻痹病例情况分析%Analysis on the situation of residual paralysis of acute flaccid paralysis cases from 2001 to 2011 in Shenzhen City

    卢紫燕; 杨卫红; 单芙香

    2013-01-01

    目的 了解深圳市2001-2011年残留麻痹的继续弛缓性麻痹(acute flaccid paralysis,AFP)病例流行病特征,提高AFP监测质量.方法 对深圳市2001-2011年残留麻痹AFP病例个案资料和病原学检测结果进行描述性流行病学分析.结果 深圳市2001-2011年共报告残留麻痹AFP病例60例,主要发生在小年龄组儿童,<3岁的儿童40例,占66.67%;发病高峰为4~8月,男女比例为1.61∶1;麻痹部位以双下肢麻痹较多,其次为四肢肢体麻痹;残留麻痹的AFP病例以疫苗相关病例(VAPP)和格林巴利综合征(GBS)为主,其次为横贯性脊髓炎、创伤性神经炎等.结论 VAPP的发生是接种脊髓灰质炎减毒活疫苗(OPV)难以克服的弱点,为减少VAPP病例及防止脊灰疫苗衍生病毒(VDPV)的发生,应在消灭脊灰后期科学、合理地调整消灭脊灰的免疫策略.%Objective To understand the epidemiological characteristics of the residual paralysis of acute flaccid paralysis (AFP) cases and to raise quality of the AFP surveillance.Methods The data of AFP cases and the results of pathogenic detection were analyzed by description epidemiological method.Results A total of 60 residual paralysis of AFP cases were reported in Shenzhen from 2001 to 2011,which occurred mainly in children at low age.There were 40 cases of children less than 3 years old,accounting for 66.67%.The peak incidence of the residual paralysis cases concentrated from April to August and the ratio of male to female was 1.61:1.The residual paralysis was mainly on both lower limbs,secondly was on unilateral lower limbs.The cases of residual paralysis of AFP were mainly VAPP cased and Guillain-Barre Snydrome and followed by transverse myelitis,traumatic neuritis and so on.Conclusions The occurrence of VAPP was the serious weakness of OPV.In order to reduce the VAPP cases and prevent the occurrence of VDPV,we should scientifically and reasonably adjust the immunization policy in the later stage

  14. Clinical Analysis of Acute Flaccid Paralysis in Infants and Young Children with Hand-foot-mouth Disease%手足口病致急性迟缓性麻痹的临床特点研究

    于春梅

    2011-01-01

    Objective To analyze the clinical features of acute flaccid paralysis ( AFP ) in infants and young children with hand - foot - mouth disease ( HFMD ). Methods Twenty - eight HFMD cases with AFP were enrolled. The etiology, ce-rebrospinal fluid ( CSF ), myocardial enzymes, spinal cord magnetic resonance imaging ( MRI ) findings were collected. Patients were treated with immunoglobulin, dexamethasone, mecobalamin, and rat nerve growth factor. They were followed up for two months. Results AFP due to HFMD was confirmed in 22 patients. Typical skin rash was observed in the pre - paralysis phase in all patients. Twenty patients were accompanied with viral encephalitis. In addition, 20 patients experienced abnormal CSF or routine examination findings. Throat swab and sero - immunological examinations showed positive enteric virus -71 ( EV71 ) in 9 patients. The muscle strength began to be improved in a week, and basically recovered two weeks after acute phase in 21 patients. The muscle strength was basically recovered in 25 patients during the 2 - month follow - up. Conclusion HFMD patients have a high incidence of central nervous system involvement. EV71 is a major virus that can causes AFP by damaging anterior horn cells. The prognosis usually is good in infants and young children after active treatment.%目的 探讨手足口病致急性迟缓性麻痹的临床特点.方法 对28例手足口病伴急性迟缓性麻痹患儿进行临床观察,行病原学检查、颅脑和脊髓磁共振检查及脑脊液检查,行心肌酶、神经-肌电图检查.给予免疫球蛋白、地塞米松、鼠神经生长因子、弥可保等治疗.随访2个月观察预后.结果 手足口病所致急性迟缓性麻痹多见于2岁以下儿童(22/28);麻痹前期均有典型手足口病的皮疹.81.5%(20/28)的患儿合并病毒性脑炎.81.5%(20/28)的患儿脑脊液压力或常规异常.咽拭子EVPCR和血清免疫学检查均显示有9例患儿肠道病毒71型(EV71)

  15. Clinical study of 15 children with hand foot and month disease and acute flaccid paralysis%手足口病合并急性弛缓性瘫痪15例临床分析

    王玉光; 陈志海; 张璐; 卢联合; 冯亮; 王凌航; 徐艳利; 任娜; 庞琳; 李兴旺

    2009-01-01

    Objective To discuss the clinical characteristics and prognosis of 15 children with hand foot and mouth disease (HFMD) and acute flaccid paralysis (AFP) who were admitted to Beijing Ditan Hospital during the outbreak of HFMD in 2008. Method The epidemiology, clinical manifestations, cerebrospinal fluid (CSF),magnetic resonance imaging and prognosis of 15 children with HFMD and AFP were retrospectively reviewed. The recovery of the patients' affected extremities were monitored for 4 weeks. Results The mean age of these patients was (22.47 ± 20.68) months (range: 5~72 months). Acute paralysis developed (3.47 ± 1.68) days after the onset of fever and progressed to maximum severity within (1~2) days. Poliomyelitis-like syndrome was observed in all cases. Of the 15 cases, 10 had monoplegia of lower limbs, two had paraplegia, one had monoplegia of upper limbs and two had quadriplegia. In these cases, the muscle power varied from level 0 to level 4, and six even showed no muscle power in their affected extremities. Thirteen cases developed neurologic complications (encephalitis, meningitis or ataxia) and three had transient urinary retention. Cerebrospinal MRI examination in eight cases showed hyperintense lesions on T2-weighted images, predominantly in the impaired anterior horn regions of the spinal cord (C2~C7 for cases with upper extremity impairments and T12~L1 for cases with lower extremity impairments), and displayed long T1 signals and long T2 signals. In addition, the midbrain, brain-stem or medulla was also involved in four cases who also contracted encephalitis or meningitis. The muscle strength in 11 patients with single lower extremity impairment showed improvements in the distal limb muscles within 4~8 days, and the other cases showed recovery 2~3 weeks later. Conclusions HFMD in combination with AFP most commonly occurs in children aged less than 2 years old. Acute paralysis develops during the early stage of infection and progresses to a

  16. 肠道病毒71型引起急性弛缓性瘫痪:二例报告并文献复习%Enterovirus 71- induced acute flaccid paralysis: two case reports with review of literatures

    晋兴楠; 邹映雪; 张艳芬; 吴波; 任立歆

    2011-01-01

    Objective To investigate the clinical characteristics and prognosis of hand-foot-and-mouth disease (HFMD) complicated with acute flaccid paralysis (AFP). Methods The clinical features, MRI, electroencephalogram (EEG), neurophysiological examination and prognosis of 2 cases of HFMD complicated with AFP were analyzed retrospectively. Functional recovery was followed up for 9 weeks. Related literatures were reviewed. Results Both of the two cases are infants. AFP occurred at the 7 th day, and advanced to severe degree at 1-2 d after onset. Paralysis affected one limb in one case and 3 limbs in another case. Muscle strength ranged from 0 to 3 degree. Cranial MRI indicated broadened extracerebral lacuna. Cervical MRI presented long T2 lesion in the spinal cord. EEG recorded symmetrical slow background waves. Neurophysiological examination showed minor or moderate spontaneous potential at the paralytic limb. The duration of motor unit potential was prolonged, but the amplitude declined. Motor nerve conduction velocity was normal. Terminal latent period was intact. The amplitude of muscle motor potential declined. Sensory nerve conduction velocity was normal. F wave disappeared. Both of the 2 patients began to recover 2-3 weeks later. Conclusion HFMD complicated with AFP usually affects infant. Paralysis usually occurs around 1 week during the course of HFMD and progresses rapidly to peak 1-2 days after onset. Unique or multi limbs can be affected and the paralysis can recover rapidly. MRI, EEG, and neurophysiological examination are valuable for diagnosis and predicting prognosis.%目的 探讨2例手足口病并发急性弛缓性瘫痪患儿的临床特征及预后.方法 对2例手足口病并发急性弛缓性瘫痪患儿的临床表现,以及MRI、脑电图、神经电生理学检查结果及预后进行回顾分析,并对其瘫痪肢体的功能恢复情况进行随访.结果 2例患儿均为婴儿,于病程第7天出现急性弛缓性瘫痪,发病1~2d即进展

  17. A case report of acute flaccid paralysis following the pre-inoculation with oral poliomyelitis attenuated live vaccine%提前接种脊髓灰质炎减毒活疫苗发生急性弛缓性麻痹1例报道

    马敬仓; 杨传欣

    2014-01-01

    Objective To investigate whether the occurrence of acute flaccid paralysis was caused by the vaccination of oral poliomyelitis Attenuated Live Vaccine. Methods The investigation of the case,collecting case, s medical records,presenting the diagnostic opinion after summary and analysis. Results The case,with vaccination history of oral poliomyelitis vaccine 16 days later, had main symptoms of fever,limb weakness,etc.The case had inpatient treatment successively in a municipal hospital and a provincial hospital,and was diagnosed of acute flaccid paralysis and poliomyelitis.Polio virus and other enteroviruses were not detected in the case's specimens. The opinions of the municipal diagnosis experts group on adverse events following immunization for the diagnosis was that the patient did not meet the diagnostic conditions of vaccine associated paralytic poliomyelitis,but clinical polio compatible. Conclusion There was relationship between acute flaccid paralysis and the vaccinations of oral poliomyelitis attenuated live vaccine.%目的:调查某急性弛缓性麻痹病例是否因为口服脊髓灰质炎减毒活疫苗所引发。方法对患者开展个案调查,收集患者的病历资料,汇总分析后提出诊断意见。结果该患者有口服脊髓灰质炎减毒活疫苗的记录。在接种口服脊髓灰质炎减毒活疫苗后约16d开始发病,主要症状有发热、四肢无力等,先后在市级医院和省级医院住院治疗,主要诊断为急性弛缓性麻痹、脊髓灰质炎等;所采集的该患者大便标本判定为不合格标本,未检出脊髓灰质炎病毒、其他肠道病毒;市级预防接种异常反应调查诊断专家组意见为不符合确诊脊髓灰质炎疫苗相关患者的诊断条件,但临床表现符合脊髓灰质炎。结论该病例接种口服脊髓灰质炎减毒活疫苗与发生急性弛缓性麻痹有关。

  18. Clinical and biochemical spectrum of hypokalemic paralysis in North: East India

    Ashok K Kayal; Munindra Goswami; Marami Das; Rahul Jain

    2013-01-01

    Background: Acute hypokalemic paralysis, characterized by acute flaccid paralysis is primarily a calcium channelopathy, but secondary causes like renal tubular acidosis (RTA), thyrotoxic periodic paralysis (TPP), primary hyperaldosteronism, Gitelman′s syndrome are also frequent. Objective: To study the etiology, varied presentations, and outcome after therapy of patients with hypokalemic paralysis. Materials And Methods: All patients who presented with acute flaccid paralysis with hypokalemia...

  19. Lower motor neuron paralysis with extensive cord atrophy in parainfectious acute transverse myelitis

    Sunil Pradhan; Ajit Kumar

    2014-01-01

    We describe a young patient of acute transverse myelitis (ATM) who developed true lower motor neuron (LMN) type flaccid paraplegia as a result of anterior horn cell damage in the region of cord inflammation that extended from conus upwards up to the D4 transverse level. We infer that flaccidity in acute phase of ATM is not always due to spinal shock and may represent true LMN paralysis particularly if the long segment myelits is severe and extending up to last spinal segment.

  20. Investigation of the Effect of Wax Therapy on Acute Flaccid Paralysis Caused by Hand-foot-and-mouth Disease%蜡疗对治疗手足口病合并急性迟缓性麻痹的疗效探讨

    张岩; 尚清; 马彩云; 刘冬芝

    2015-01-01

    目的:探讨蜡疗对手足口病合并急性迟缓性麻痹的临床疗效。方法随机选择该院2014年3月-2015年3月收治的80例手足口病合并急性迟缓性麻痹患儿,随机分为蜡疗组和对照组各40例。对照组给予运动训练,作业疗法,电子生物反馈等康复治疗,蜡疗组在对照组基础上加用蜡疗,观察时间为2个月,采用粗大运动功能评估量表比较两组在治疗前后运动功能变化。结果治疗2个月后,GMFM评分蜡疗组(26.87±3.90)高于对照组(22.71±4.31),差异有统计学意义(P<0.05),治疗中两组均未见明显不良反应。结论加用蜡疗可提高手足口病合并急性迟缓性麻痹的康复效果,且无明显不良反应。%Objective To investigation the clinical curative effect of wax therapy on acute flaccid paralysis caused by hand-foot-and-mouth disease. Methods 80 cases with acute flaccid paralysis caused by hand-foot-and-mouth disease admitted to our hospital from March 2014 to March 2015 were selected and randomly divided into the wax therapy and the control group with 40 cases in each. Both groups were given exercise therapy, occupational therapy and bioedback therapy and oth-er rehabilitation therapy for 2 months, the observation group was additionally given wax therapy. The motor function was e-valuated in the two groups by the Gross Motor Function Measure (GMFM) before and after 2 months of treatment. Results The GMFM scores were much higher in the wax therapy group than those in the control group [(26.87±3.90) points vs (22.71±4.31) points], there was statistically significant difference between the two groups (P<0.05). There was no untoward reaction in the two groups during treatment. Conclusion Wax therapy combined with rehabilitation therapy can improve the effect of rehabilitation in acute flaccid paralysis caused by hand-foot-and-mouth disease without any obvious adverse reac-tions.

  1. Lower motor neuron paralysis with extensive cord atrophy in parainfectious acute transverse myelitis

    Sunil Pradhan

    2014-01-01

    Full Text Available We describe a young patient of acute transverse myelitis (ATM who developed true lower motor neuron (LMN type flaccid paraplegia as a result of anterior horn cell damage in the region of cord inflammation that extended from conus upwards up to the D4 transverse level. We infer that flaccidity in acute phase of ATM is not always due to spinal shock and may represent true LMN paralysis particularly if the long segment myelits is severe and extending up to last spinal segment.

  2. Acute flaccid paralysis surveillance: A 6 years study, Isfahan, Iran

    Alireza Emami Naeini; Mohamadreza Ghazavi; Sharareh Moghim; Amirhosein Sabaghi; Reza Fadaei

    2015-01-01

    Background: Poliomyelitis is still an endemic disease in many areas of the world including Africa and South Asia. Iran is polio free since 2001. However, due to endemicity of polio in neighboring countries of Iran, the risk of polio importation and re-emergence of wild polio virus is high. Case definition through surveillance system is a well-defined method for maintenance of polio eradication in polio free countries. Methods: In a cross-sectional survey from 2007 to 2013, we reviewed all...

  3. Clinical and Neuroimaging Features of Enterovirus Type 71 Infected Hand-Foot-Mouth Disease Combined Acute Flaccid Paralysis%肠道病毒71型感染手足口病合并急性 弛缓性麻痹的临床和影像学特征

    陈峰; 刘涛; 李建军; 文国强

    2011-01-01

    Objective: To observe the clinical and neuroimaging features of enterovirus 7KEV71) infec ted hand-foot-mouth disease (HFMD) combined with acute flaccid paralysis (AFP). Methods: Nine cases of HFMD with acute flaccid paralysis during the recent EV71 outbreaks in Hainan Province, China from May 2008 to September 2010 were retrospectively studied, and the related literatures were reviewed. Results; Of the nine cases, three had monoplegia of lower limbs, one had monoplegia of upper limb, two had paraplegia, one had plegia of both upper limbs and two had quadriplegia. Spinal MRI examination in all the cases showed hyper-intense lesions on T2-weighted images, predominantly in the impaired anterior horn regions of the spinal cord, and dis played long T1 signals and long T2 signals. Lesions of spinal cord chiefly occurred in cervical and T9 spinal cord to conus medullaris. In addition, the pons, medulla, or midbrain was also involved in three cases. Mild enhancement of anterior horn and strong enhancement of the bilateral ventral root were seen in the contrast-enhanced axial T1-weighted image. Conclusion: In HFMD combined with AFP cases, MRI of spinal cord shows unilateral or bilateral lesions in the anterior horn regions of the spinal cord (cervical spinal cord or T9 to Conus medullaris) on T1/T2-weighted images. MRI is an effective method to investigate AFP combined with the enterovirus 71 epidemic. MRI examination is particularly valuable for the diagnosis and prognosis of AFP because of its high sensitivity and accuracy.%目的:通过病例观察和文献复习探讨肠道病毒71型(EV71)感染合并急性弛缓性麻痹(AFP)的临床、影像学表现及特征.方法:报告2008-2010年中国海南EV71感染流行期间9例伴有AFP的EV71型感染手足口病患儿临床、MRI表现,并做文献复习,分析其可能机制.结果:9例患儿中,单侧肢体无力4例(其中单下肢3例,单上肢1例),双侧肢体无力3例(双下肢2例,双上肢l例),四肢无力2

  4. 2004-2010年郑州市金水区急性弛缓性麻痹病例流行病学分析与监测系统评价%Epidemiological analysis on acute flaccid paralysis cases and evaluation on its surveillance system in jinshui district of Zhengzhou from 2004 to 2010

    韩焕侠; 杨雯雯; 张书彦; 王豪佳; 谷园园; 李瑞燕

    2011-01-01

    目的 通过分析郑州市金水区急性弛缓性麻痹(AFP)病例的流行病学特征及监测系统敏感性,巩固和维持无脊髓灰质炎(脊灰)状态,指导本区消灭脊灰工作.方法 应用中国免疫规划监测信息管理系统软件对数据进行统计分析.结果 2004 -2010年共报告AFP病例698例,其中本地病例58例,年报告发病率为3.67/10万~11.62/10万,5岁以下儿童占发病数的96.55%,有17.24%的儿童未全程免疫或免疫史不详;无脊灰病毒野毒株检出和脊髓灰质炎病例报告.结论 AFP发病趋于小年龄化,易感人群依然存在,病例及时就诊率低,应广泛开展家长课堂和社区健康教育,提高家长的免疫接种意识和及时就诊率,同时加强查漏补种和强化免疫工作,提高疫苗免疫覆盖率.%Objective To analyze the epidemiological characters of acute flaccid paralysis (AFP) cases and the sensitivity of monitoring System in Jinshui district of Zhengzhou city, so as to maintain poliomyelitis - free environment and guide us to exterminate the poliomyelitis. Methods All the data were analyzed by China surveillance system of information on national immunization program. Results Totally 698 AFP cases were reported in the period from 2004 to 2010, in which the local cases were 58. The annual report incidence of AFP was from 3. 67 per 100000 to 11. 62 per 100000. The 96. 55% of AFP cases were the children under 5 years old. The children who were not full immunization or were not unknowing immune history hold 17. 24%. No wild - type poliovirus or poliomyelitis case were found. Conclusions The AFP case tends to the group of little children. In addition, the susceptible population still exists. The rate of timely consultancy was low. So, in order to improve the parents conscious of immunization and the rate of timely consultancy, we should launch parents - classroom and community health education extensively. In the meanwhile, the omissions searching and replant

  5. Single Assay Detection of Acute Bee Paralysis Virus, Kashmir Bee Virus and Israeli Acute Paralysis Virus

    Francis, Roy Mathew; Kryger, Per

    2012-01-01

    A new RT-PCR primer pair designed to identify Acute Bee Paralysis Virus (ABPV), Kashmir Bee Virus (KBV) or Israeli Acute Bee Paralysis Virus (IAPV) of honey bees (Apis mellifera L.) in a single assay is described. These primers are used to screen samples for ABPV, KBV, or IAPV in a single RT...

  6. Acute toxemic schistosomiasis complicated by a acute flaccid paraplegia due to schistosomal myeloradiculopathy in Sudan

    A 55-year old Sudanese physician presented with one month history of diarrhea, loss of weight 10 kg and low grade nocturnal fever. Following colonoscopy, he rapidly developed paraparesis and retention of urine. Magnetic resonance imaging (MRI) of the spinal cord showed low cord lesion suggestive of transverse myelitis. We present a detailed account of diagnostic and management challenges and a literature review of the final diagnosis of acute toxemic schistosomiasis, complicated by acute flaccid paraplegia due to schistosomal myeloradiculopathy. We are reporting this case to increase the awareness of physicians of schistosomal myeloradiculopathy, as it needs urgent specific treatment praziquantel and steroids. An early follow-up with MRI of the spinal cord 2 weeks treatment may help in preventing unnecessary neurosurgical intervention. Bilharziasis may be contracted on the banks of river White Nile in urban areas. Finally clinicians should make use of the Google search for diagnosis in difficult cases. (author)

  7. Evolution and prognosis of the acute flaccid paralysis associated with enterovirus 71 infection evaluated through a clinical and magnetic resonance imaging follow-up study%从临床和磁共振成像看非脊髓灰质炎肠道病毒71型相关性急性弛缓性瘫痪的演变和预后

    彭炳蔚; 杜志宏; 李小晶; 林海生; 刘鸿圣; 陈文雄; 麦坚凝; 梁惠慈

    2012-01-01

    目的 研究手足口病患儿中合并急性弛缓性瘫痪(AFP)的临床特征和影像学改变,探讨这类非脊髓灰质炎肠道病毒71型( EV71)相关性AFP的发生演变过程.方法 对我院2011年5至8月收治手足口病患儿中合并AFP者进行临床观察和影像学检查及随访,进行早期强化康复治疗,评价疗效,根据早期强化康复后肌力是否恢复4级分为康复组和后遗症组,分析临床特征在两组间的差别,寻找影响预后的因素.应用SPSS10.0统计包对组间差异进行独立样本的t检验和x2检验.结果 16例AFP患儿7例最重的瘫痪肢体肌力达到0级,14例非0级瘫痪肢体合并出现踝阵挛,8例恢复满意(康复组),8例遗留后遗症(后遗症组),最初肌力是否0级(0例vs 7例,x2=12.4)、最初腱反射是否消失(2例vs 8例,x2=9.6),肌肉是否明显萎缩(0例vs 8例,x2=16)在两组间差异有统计学意义(P均<0.01).起病1周内行磁共振成像(MRI)检查可见脊髓腹侧内和脑干背侧异常信号且有强化,1周后查则无强化改变,1个月后复查病灶更清晰.结论 非脊髓灰质炎EV71感染所致的AFP常常同时合并上运动神经元损害,由于病初瘫痪程度和前角损害严重性的不同,完全恢复或残留后遗瘫痪.MRI的随访有助于了解AFP的病理过程.%Objective To explore the development and prognosis of the acute flaccid paralysis (AFP) associated with enterovirus 71 ( EV71 ) infection through clinical follow-up study for clinical and magnetic resonance imaging ( MRI ) features based on the research progress of virology and pathology.Method Sixteen children with HFMD associated with AFP in hospital from May 1,2011 to August 31,2011 were investigated and the patients received intensive rehabilitation training.The 16 cases were divided into two groups (the recovery or the sequela) by if the muscle strength recovered to level 4 after intensive rehabilitation.The MRI findings of 15 children were analyzed and among

  8. Molecular epidemiology of enterovirus B77 isolated from non polio acute flaccid paralytic patients in Pakistan during 2013.

    Angez, Mehar; Shaukat, Shahzad; Zahra, Rabaab; Khurshid, Adnan; Sharif, Salmaan; Alam, Muhammad Masroor; Zaidi, Syed Sohail Zahoor

    2015-01-01

    Human enteroviruses are associated with various clinical syndromes and severe neurological disorders. The aim of this study was to determine the molecular epidemiology of non polio enteroviruses and their correlation with acute flaccid paralysis (AFP) patients living in Khyber Pakhtunkhwa (KP) and Federally Administered Tribal Areas (FATA) of Pakistan. The stool samples collected from these patients were used for isolation of non polio enteroviruses (NPEVs). Out of 38 samples, 29 (76.3%) were successfully typed by microneutralization assay into eleven serotypes including echovirus (E)-3 (5.3%), E-7 (2.6%), E-11 (13.2%), E-12 (7.9%), E-13 (10.5%), E-20 (7.9%), E-27 (5.3%), E-29 (10.5%), E-30 (7.9%), E-33 (2.6%), coxsackievirus (CV) B5 (2.6%) and nine isolates (23.7%) remained untyped which were confirmed as NPEVs by real time RT-PCR. Complete VP1 genetic sequencing data characterized untypeable isolates into enterovirus B77 (EV-B77). Moreover, molecular phylogenetic analysis classified these viruses into two new genotypes having high genetic diversity (at least 17.7%) with prototype. This study provides valuable information on extensive genetic diversity of EV-B77 genotypes. Although, its association with neurological disorder has not yet been known but isolation of nine EV-B77 viruses from AFP cases highlights the fact that they may have a contributing role in the etiology of AFP. In addition, it is needed to establish enterovirus surveillance system and laboratory diagnostic facilities for early detection of NPEVs that may cause poliomyelitis like paralysis especially in the situation when we are at the verge of polio eradication. PMID:25433133

  9. Acute flaccid paraplegia:neurological approach, diagnostic workup, and therapeutic options

    Gentian Vyshka; Altin Kuqo; Serla Grabova; Eris Ranxha; Liro Buda; Jera Kruja

    2015-01-01

    Acute flaccid paraplegia is a clinical occurrence with extreme importance, due to the dramatic presentation, the severity of the underlying disorder, and the generally poor prognosis that follows such a condition. Among etiological factors, the traumatic events are of particular interest, with the clinical treating dealing with a severely ill patient, following fall from height, motor vehicle collisions, and direct shocks applied over the vertebral column. The non-traumatic list is more numerous;however the severity of the acute paraplegia is not necessarily of a lesser degree. Viral infections, autoimmune disorders, and ischemic events involving feeding spinal arteries have been imputed. However, chemical and medications injected during procedures or accidentally intrathecal administration can produce acute flaccid paraplegia. A careful neurological assessment and complete electrophysiological and imaging studies must follow. In spite of the poor prognosis, different therapeutic options have been proposed and applied. Neurosurgical and orthopedic interventions are often necessary when trauma is present, with high dose glucocorticoids treatment preceding the intervention, in a hope to decrease edema-related compression over the spinal cord. Immunoglobulins and plasmapheresis are logical and helpful options when a polyradiculoneuritis produces such a clinical picture. The role of decompression, as neurosurgical exclusivity, has been considered as well.

  10. Vaccine-associated Paralytic Poliomyelitis : A Case Report of Flaccid Monoparesis after Oral Polio Vaccine

    Kim, Sun Jun; Kim, Sung Han; Jee, Young Mee; Kim, Jung Soo

    2007-01-01

    This report describes a case of acute flaccid paralysis after administration of oral polio vaccine (OPV). A 4 month-old male patient with the decreased movement of left lower extremity for 1 month was transferred to the Department of Pediatrics. He received OPV with DTaP at 2 months of age. Flaccid paralysis was detected 4 weeks after OPV immunization. Attempts to isolate Sabin-like viruses in the two stool and CSF samples failed because those specimens were collected more than 2 month after ...

  11. Thyrotoxic hypokalemic periodic paralysis in an African male: a case report.

    Belayneh, Dereje K; Kellerth, Thomas

    2015-02-01

    Thyrotoxic hypokalemic periodic paralysis is a rare manifestation of thyrotoxicosis and is rarely reported in non-Asian populations. A 26-year-old Ethiopian male who presented with recurrent flaccid tetraparesis, hypokalemia, and hyperthyroidism is reported here. Thyroid function should be routinely checked in patients with acute or recurrent hypokalemic paralysis. PMID:25767707

  12. Thyrotoxic hypokalemic periodic paralysis in an African male: a case report

    Belayneh, Dereje K; Kellerth, Thomas

    2014-01-01

    Key Clinical Message Thyrotoxic hypokalemic periodic paralysis is a rare manifestation of thyrotoxicosis and is rarely reported in non-Asian populations. A 26-year-old Ethiopian male who presented with recurrent flaccid tetraparesis, hypokalemia, and hyperthyroidism is reported here. Thyroid function should be routinely checked in patients with acute or recurrent hypokalemic paralysis.

  13. Identification and Functional Characterization of Kir2.6 Mutations Associated with Non-familial Hypokalemic Periodic Paralysis*

    Cheng, Chih-Jen; Lin, Shih-Hua; Lo, Yi-Fen; Yang, Sung-Sen; Hsu, Yu-Juei; Cannon, Stephen C.; Huang, Chou-Long

    2011-01-01

    Hypokalemic periodic paralysis (hypoKPP) is characterized by episodic flaccid paralysis of muscle and acute hypokalemia during attacks. Familial forms of hypoKPP are predominantly caused by mutations of either voltage-gated Ca2+ or Na+ channels. The pathogenic gene mutation in non-familial hypoKPP, consisting mainly of thyrotoxic periodic paralysis (TPP) and sporadic periodic paralysis (SPP), is largely unknown. Recently, mutations in KCNJ18, which encodes a skeletal muscle-specific inwardly ...

  14. Clinical Efficacy of Electroneurography in Acute Facial Paralysis

    2016-01-01

    The estimated incidence of acute facial paralysis is approximately 30 patients per 100000 populations annually. Facial paralysis is an extremely frightening situation and gives extreme stress to patients because obvious disfiguring face may cause significant functional, aesthetic, and psychological disturbances. For stressful patients with acute facial paralysis, it is very important for clinicians to answer the questions like whether or not their facial function will return to normal, how much of their facial function will be recovered, and how long this is going to take. It is also important for clinicians to treat the psychological aspects by adequately explaining the prognosis, in addition to providing the appropriate medical treatment. For decades, clinicians have used various electrophysiologic tests, including the nerve excitability test, the maximal stimulation test, electroneurography, and electromyography. In particular, electroneurography is the only objective measure that is useful in early stage of acute facial paralysis. In this review article, we first discuss the pathophysiology of injured peripheral nerve. And then, we describe about various electrophysiologic tests and discuss the electroneurography extensively. PMID:27144227

  15. Clinical Efficacy of Electroneurography in Acute Facial Paralysis.

    Lee, Dong-Hee

    2016-04-01

    The estimated incidence of acute facial paralysis is approximately 30 patients per 100000 populations annually. Facial paralysis is an extremely frightening situation and gives extreme stress to patients because obvious disfiguring face may cause significant functional, aesthetic, and psychological disturbances. For stressful patients with acute facial paralysis, it is very important for clinicians to answer the questions like whether or not their facial function will return to normal, how much of their facial function will be recovered, and how long this is going to take. It is also important for clinicians to treat the psychological aspects by adequately explaining the prognosis, in addition to providing the appropriate medical treatment. For decades, clinicians have used various electrophysiologic tests, including the nerve excitability test, the maximal stimulation test, electroneurography, and electromyography. In particular, electroneurography is the only objective measure that is useful in early stage of acute facial paralysis. In this review article, we first discuss the pathophysiology of injured peripheral nerve. And then, we describe about various electrophysiologic tests and discuss the electroneurography extensively. PMID:27144227

  16. Etiology of Hypokalemic Paralysis in Korea: Data from a Single Center

    Wi, Jung-Kook; Lee, Hong Joo; Kim, Eun Young; Cho, Joo Hee; Chin, Sang Ouk; Rhee, Sang Youl; Moon, Ju-Young; Lee,Sang-Ho; Jeong, Kyung-Hwan; Ihm, Chun-Gyoo; Lee, Tae-Won

    2012-01-01

    Recognizing the underlying causes of hypokalemic paralysis seems to be essential for the appropriate management of affected patients and their prevention of recurrent attacks. There is, however, a paucity of documented reports on the etiology of hypokalemic paralysis in Korea. We retrospectively analyzed 34 patients with acute flaccid weakness due to hypokalaemia who were admitted during the 5-year study period in order to determine the spectrum of hypokalemic paralysis in Korea and to identi...

  17. Re-analysis of metagenomic sequences from acute flaccid myelitis patients reveals alternatives to enterovirus D68 infection [v2; ref status: indexed, http://f1000r.es/5mz

    Florian P. Breitwieser

    2015-07-01

    Full Text Available Metagenomic sequence data can be used to detect the presence of infectious viruses and bacteria, but normal microbial flora make this process challenging. We re-analyzed metagenomic RNA sequence data collected during a recent outbreak of acute flaccid myelitis (AFM, caused in some cases by infection with enterovirus D68. We found that among the patients whose symptoms were previously attributed to enterovirus D68, one patient had clear evidence of infection with Haemophilus influenzae, and a second patient had a severe Staphylococcus aureus infection caused by a methicillin-resistant strain. Neither of these bacteria were identified in the original study. These observations may have relevance in cases that present with flaccid paralysis because bacterial infections, co-infections or post-infection immune responses may trigger pathogenic processes that may present as poliomyelitis-like syndromes and may mimic AFM.  A separate finding was that large numbers of human sequences were present in each of the publicly released samples, although the original study reported that human sequences had been removed before deposition.

  18. Acute paralysis viruses of the honey bee

    Chunsheng; Hou; Nor; Chejanovsky

    2014-01-01

    <正>The alarming decline of honey bee(Apis mellifera)colonies in the last decade drove the attention and research to several pathogens of the honey bee including viruses.Viruses challenge the development of healthy and robust colonies since they manage to prevail in an asymptomatic mode and reemerge in acute infections following external stresses,as well as they are able to infect new healthy colonies(de Miranda J R,et al.,2010a;de Miranda J R,et al.,2010b;Di Prisco G,et al.,2013;Nazzi F,et al.,2012;Yang X L,et al.,2005).

  19. Thyrotoxic hypokalemic periodic paralysis as the presenting symptom of silent thyroiditis

    Debmalya Sanyal

    2013-01-01

    Full Text Available Silent thyroiditis is a rare cause of thyrotoxic periodic paralysis. The objective was to present a case of silent thyroiditis presenting as periodic paralysis. A 23-year-old man presented with recurrent acute flaccid predominantly proximal weakness of all four limbs. He had a similar episode 3 weeks back. On examination he was found to have hypokalemia secondary to thyrotoxicosis. Clinically there were no features of thyrotoxicosis or thyroiditis. He was initially treated with intravenous and later oral potassium supplementation and propranolol. At 8 weeks of follow-up his thyroid profile became normal and his propranolol was stopped. He had no further recurrence of paralysis. He was diagnosed as a case silent thyroiditis presenting as thyrotoxic periodic paralysis. In cases of recurrent or acute flaccid muscle paralysis, it is important to suspect thyrotoxicosis, even if asymptomatic. Definitive treatment of thyrotoxicosis prevents recurrence.

  20. Thyrotoxic hypokalemic periodic paralysis as the presenting symptom of silent thyroiditis

    Debmalya Sanyal; Shakya Bhattacharjee

    2013-01-01

    Silent thyroiditis is a rare cause of thyrotoxic periodic paralysis. The objective was to present a case of silent thyroiditis presenting as periodic paralysis. A 23-year-old man presented with recurrent acute flaccid predominantly proximal weakness of all four limbs. He had a similar episode 3 weeks back. On examination he was found to have hypokalemia secondary to thyrotoxicosis. Clinically there were no features of thyrotoxicosis or thyroiditis. He was initially treated with intravenous an...

  1. Assembly of recombinant Israeli Acute Paralysis Virus capsids.

    Junyuan Ren

    Full Text Available The dicistrovirus Israeli Acute Paralysis Virus (IAPV has been implicated in the worldwide decline of honey bees. Studies of IAPV and many other bee viruses in pure culture are restricted by available isolates and permissive cell culture. Here we show that coupling the IAPV major structural precursor protein ORF2 to its cognate 3C-like processing enzyme results in processing of the precursor to the individual structural proteins in a number of insect cell lines following expression by a recombinant baculovirus. The efficiency of expression is influenced by the level of IAPV 3C protein and moderation of its activity is required for optimal expression. The mature IAPV structural proteins assembled into empty capsids that migrated as particles on sucrose velocity gradients and showed typical dicistrovirus like morphology when examined by electron microscopy. Monoclonal antibodies raised to recombinant capsids were configured into a diagnostic test specific for the presence of IAPV. Recombinant capsids for each of the many bee viruses within the picornavirus family may provide virus specific reagents for the on-going investigation of the causes of honeybee loss.

  2. Thyrotoxic periodic paralysis triggered by β2-adrenergic bronchodilators.

    Yeh, Fu-Chiang; Chiang, Wen-Fang; Wang, Chih-Chiang; Lin, Shih-Hua

    2014-05-01

    Hypokalemic periodic paralysis is the most common form of periodic paralysis and is characterized by attacks of muscle paralysis associated with a low serum potassium (K+) level due to an acute intracellular shifting. Thyrotoxic periodic paralysis (TPP), characterized by the triad of muscle paralysis, acute hypokalemia, and hyperthyroidism, is one cause of hypokalemic periodic paralysis. The triggering of an attack of undiagnosed TPP by β2-adrenergic bronchodilators has, to our knowledge, not been reported previously. We describe two young men who presented to the emergency department with the sudden onset of muscle paralysis after administration of inhaled β2-adrenergic bronchodilators for asthma. In both cases, the physical examination revealed an enlarged thyroid gland and symmetrical flaccid paralysis with areflexia of lower extremities. Hypokalemia with low urine K+ excretion and normal blood acid-base status was found on laboratory testing, suggestive of an intracellular shift of K+, and the patients' muscle strength recovered at serum K+ concentrations of 3.0 and 3.3 mmol/L. One patient developed hyperkalemia after a total potassium chloride supplementation of 110 mmol. Thyroid function testing was diagnostic of primary hyperthyroidism due to Graves disease in both cases. These cases illustrate that β2-adrenergic bronchodilators should be considered a potential precipitant of TPP. PMID:24852589

  3. Clinical and biochemical spectrum of hypokalemic paralysis in North: East India

    Ashok K Kayal

    2013-01-01

    Full Text Available Background: Acute hypokalemic paralysis, characterized by acute flaccid paralysis is primarily a calcium channelopathy, but secondary causes like renal tubular acidosis (RTA, thyrotoxic periodic paralysis (TPP, primary hyperaldosteronism, Gitelman′s syndrome are also frequent. Objective: To study the etiology, varied presentations, and outcome after therapy of patients with hypokalemic paralysis. Materials And Methods: All patients who presented with acute flaccid paralysis with hypokalemia from October 2009 to September 2011 were included in the study. A detailed physical examination and laboratory tests including serum electrolytes, serum creatine phosphokinase (CPK, urine analysis, arterial blood gas analysis, thyroid hormones estimation, and electrocardiogram were carried out. Patients were further investigated for any secondary causes and treated with potassium supplementation. Result: The study included 56 patients aged 15-92 years (mean 36.76 ± 13.72, including 15 female patients. Twenty-four patients had hypokalemic paralysis due to secondary cause, which included 4 with distal RTA, 4 with Gitelman syndrome, 3 with TPP, 2 each with hypothyroidism, gastroenteritis, and Liddle′s syndrome, 1 primary hyperaldosteronism, 3 with alcoholism, and 1 with dengue fever. Two female patients were antinuclear antibody-positive. Eleven patient had atypical presentation (neck muscle weakness in 4, bladder involvement in 3, 1 each with finger drop and foot drop, tetany in 1, and calf hypertrophy in 1, and 2 patient had respiratory paralysis. Five patients had positive family history of similar illness. All patients improved dramatically with potassium supplementation. Conclusion: A high percentage (42.9% of secondary cause for hypokalemic paralysis warrants that the underlying cause must be adequately addressed to prevent the persistence or recurrence of paralysis.

  4. A potentially novel overlapping gene in the genomes of Israeli acute paralysis virus and its relatives

    Price Nicholas

    2009-09-01

    Full Text Available Abstract The Israeli acute paralysis virus (IAPV is a honeybee-infecting virus that was found to be associated with colony collapse disorder. The IAPV genome contains two genes encoding a structural and a nonstructural polyprotein. We applied a recently developed method for the estimation of selection in overlapping genes to detect purifying selection and, hence, functionality. We provide evolutionary evidence for the existence of a functional overlapping gene, which is translated in the +1 reading frame of the structural polyprotein gene. Conserved orthologs of this putative gene, which we provisionally call pog (predicted overlapping gene, were also found in the genomes of a monophyletic clade of dicistroviruses that includes IAPV, acute bee paralysis virus, Kashmir bee virus, and Solenopsis invicta (red imported fire ant virus 1.

  5. Thyrotoxic Periodic Paralysis: A Case Report

    Morović-Vergles, Jadranka; Ostrički, Branko; Galešić, Krešimir; Škoro, Mirko; Zelenika, Dijana

    2002-01-01

    A case of thyrotoxic periodic paralysis in a 24-year-old male with hyperthyroidism is presented. Clinical manifestations included progressive symmetrical weakness that led to flaccid paralysis due to hypokalemia with concurrent thyrotoxicosis. Intravenous administration of potassium chloride resulted in complete regression of the symptoms of muscle weakness and paralysis. Hypokalemic periodic paralysis is an uncommon complication of thyrotoxicosis, which primarily occurs in Orientals, with a ...

  6. Hypokalemic paralysis and acid-base balance

    Ivo Casagranda; Riccardo Boverio; Andrea Defrancisci; Sara Ferrillo; Francesca Gargiulo

    2006-01-01

    Three cases of hypokalemic paralysis are reported, presenting to the Emergency Department. The first is a patient with a hypokalemic periodic paralysis with a normal acid-base status, the second is a case of hypokalemic flaccid paralysis of all extremities with a normal anion gap metabolic acidosis, the last is a patient with a hypokalemic distal paralysis of right upper arm with metabolic alkalosis. Afterwards some pathophysiologic principles and the clinical aspects of hypokalemia are discu...

  7. Polio and Prevention

    ... and pain in the limbs. Acute flaccid paralysis (AFP) One in 200 infections leads to irreversible paralysis, ... lifeless – a condition known as acute flaccid paralysis (AFP). All cases of acute flaccid paralysis (AFP) among ...

  8. Síndrome de Hopkins no diagnóstico diferencial das paralisias flácidas na infância: aspectos clínicos e neurofisiológicos. Relato de caso Hopkins' syndrome in the differential diagnosis of flaccid paralysis in children: clinical and neurophysiological features. Case report

    Daniel B. Nora

    2003-06-01

    Full Text Available INTRODUÇÃO: A síndrome de Hopkins (SH é caracterizada por monoplegia ou diplegia, decorrente de lesão no corno anterior da medula, que se segue a um ataque agudo de asma, ocorre geralmente em crianças e sua etiologia ainda não está definida. Há 34 casos descritos no mundo, sendo este o primeiro relato na América do Sul e durante o primeiro ano de vida. CASO: Criança internada aos 4 meses de idade com quadro de sibilância e insuficiência respiratória. Cerca de 3 dias após melhora do quadro respiratório, observou-se perda de força nos membros inferiores. Teve alta hospitalar com regressão do quadro respiratório mantendo a paraparesia. Reinternada aos 9 meses de idade por novo quadro de broncoespasmo, demonstrando paralisia flácida assimétrica (E>D e atrofia nos membros inferiores. EXAME NEUROLÓGICO: força e reflexos miotáticos normais nos membros superiores, arreflexia miotática nos membros inferiores e sensibilidade preservada. Exames de líquor, ressonância magnética de coluna lombossacra e potencial evocado somatossensitivo dos membros inferiores: normais. BIÓPSIA MUSCULAR: Grupamento de fibras. A eletroneuromiografia demonstrou sinais de lesão do neurônio motor do corno anterior da medula nos metâmeros lombossacros. CONCLUSÃO: A Síndrome de Hopkins, apesar de rara, deve ser lembrada no diagnóstico diferencial de paralisias flácidas, quando houver concomitância com asma.INTRODUCTION: Hopkins syndrome is a motor neuron disease which leads to a flaccid paralysis affecting one or more limbs resembling poliomyelites. It follows an asthmatic attack and the prognosis is poor. All the 34 related cases occured after 13 months of age and there is no report in South America. Our objective is to describe a case of Hopkins Syndrome in Brazil affecting a patient younger than 1 year. CASE: Male 4 months-old infant, started presenting wheezing that turned into respiratory failure which required mecanical ventilation. Three

  9. Relapsing and difficult to control hypokalemia in a patient with acute lymphoid leukemia

    Nieto-Ríos, John Fredy; Serna-Higuita, Lina María; Valencia-Chicué, Libardo Humberto; Ocampo-Kohn, Catalina; Aristizábal-Alzate, Arbey; Zuluaga-Valencia, Gustavo Adolfo

    2015-01-01

    Hypokalemia is an electrolytic disorder, in some occasions difficult to control. When severe, it may be life-threatening. We report the case of a patient with relapse of acute lymphoid leukemia, who presented to the hospital with flaccid paralysis associated with severe hypokalemia. The cause was a tubulopathy associated with leukemic infiltration of the kidneys.

  10. Hypokalemic paralysis and acid-base balance

    Ivo Casagranda

    2006-10-01

    Full Text Available Three cases of hypokalemic paralysis are reported, presenting to the Emergency Department. The first is a patient with a hypokalemic periodic paralysis with a normal acid-base status, the second is a case of hypokalemic flaccid paralysis of all extremities with a normal anion gap metabolic acidosis, the last is a patient with a hypokalemic distal paralysis of right upper arm with metabolic alkalosis. Afterwards some pathophysiologic principles and the clinical aspects of hypokalemia are discussed and an appropriate approach to do in Emergency Department, to identify the hypokalemic paralysis etiologies in the Emergency Department, is presented, beginning from the evaluation of acid-base status.

  11. Thyrotoxic periodic paralysis

    A case of thyrotoxic periodic paralysis is reported in a Hispanic man with an unusual recurrence six weeks after radioactive iodine treatment. Thyrotoxic periodic paralysis has now been well characterized in the literature: it occurs primarily in Orientals with an overwhelming male preponderance and a higher association of specific HLA antigens. Clinical manifestations include onset after high carbohydrate ingestion or heavy exertion, with progressive symmetric weakness leading to flaccid paralysis of the extremities and other muscle groups, lasting several hours. If hypokalemia is present, potassium administration may help abort the attack. Although propranolol can be efficacious in preventing further episodes, the only definitive treatment is establishing a euthyroid state. The pathophysiology is still controversial, but reflects altered potassium and calcium dynamics as well as certain morphologic characteristics within the muscle unit itself

  12. Clinical and neurophysiological features of tick paralysis.

    Grattan-Smith, P J; Morris, J G; Johnston, H M; Yiannikas, C; Malik, R; Russell, R; Ouvrier, R A

    1997-11-01

    The clinical and neurophysiological findings in six Australian children with generalized tick paralysis are described. Paralysis is usually caused by the mature female of the species Ixodes holocyclus. It most frequently occurs in the spring and summer months but can be seen at any time of year. Children aged 1-5 years are most commonly affected. The tick is usually found in the scalp, often behind the ear. The typical presentation is a prodrome followed by the development of an unsteady gait, and then ascending, symmetrical, flaccid paralysis. Early cranial nerve involvement is a feature, particularly the presence of both internal and external ophthalmoplegia. In contrast to the experience with North American ticks, worsening of paralysis in the 24-48 h following tick removal is common and the child must be carefully observed over this period. Death from respiratory failure was relatively common in the first half of the century and tick paralysis remains a potentially fatal condition. Respiratory support may be required for > 1 week but full recovery occurs. This is slow with several weeks passing before the child can walk unaided. Anti-toxin has a role in the treatment of seriously ill children but there is a high incidence of acute allergy and serum sickness. Neurophysiological studies reveal low-amplitude compound muscle action potentials with normal motor conduction velocities, normal sensory studies and normal response to repetitive stimulation. The biochemical structure of the toxin of I. holocyclus has not been fully characterized but there are many clinical, neurophysiological and experimental similarities to botulinum toxin. PMID:9397015

  13. Metagenomic detection of viral pathogens in Spanish honeybees: co-infection by Aphid Lethal Paralysis, Israel Acute Paralysis and Lake Sinai Viruses.

    Fredrik Granberg

    Full Text Available The situation in Europe concerning honeybees has in recent years become increasingly aggravated with steady decline in populations and/or catastrophic winter losses. This has largely been attributed to the occurrence of a variety of known and "unknown", emerging novel diseases. Previous studies have demonstrated that colonies often can harbour more than one pathogen, making identification of etiological agents with classical methods difficult. By employing an unbiased metagenomic approach, which allows the detection of both unexpected and previously unknown infectious agents, the detection of three viruses, Aphid Lethal Paralysis Virus (ALPV, Israel Acute Paralysis Virus (IAPV, and Lake Sinai Virus (LSV, in honeybees from Spain is reported in this article. The existence of a subgroup of ALPV with the ability to infect bees was only recently reported and this is the first identification of such a strain in Europe. Similarly, LSV appear to be a still unclassified group of viruses with unclear impact on colony health and these viruses have not previously been identified outside of the United States. Furthermore, our study also reveals that these bees carried a plant virus, Turnip Ringspot Virus (TuRSV, potentially serving as important vector organisms. Taken together, these results demonstrate the new possibilities opened up by high-throughput sequencing and metagenomic analysis to study emerging new diseases in domestic and wild animal populations, including honeybees.

  14. Israeli Acute Paralysis Virus: Epidemiology, Pathogenesis and Implications for Honey Bee Health

    Chen, Yan Ping; Pettis, Jeffery S.; Corona, Miguel; Chen, Wei Ping; Li, Cong Jun; Spivak, Marla; Visscher, P. Kirk; DeGrandi-Hoffman, Gloria; Boncristiani, Humberto; Zhao, Yan; vanEngelsdorp, Dennis; Delaplane, Keith; Solter, Leellen; Drummond, Francis; Kramer, Matthew; Lipkin, W. Ian; Palacios, Gustavo; Hamilton, Michele C.; Smith, Barton; Huang, Shao Kang; Zheng, Huo Qing; Li, Ji Lian; Zhang, Xuan; Zhou, Ai Fen; Wu, Li You; Zhou, Ji Zhong; Lee, Myeong-L.; Teixeira, Erica W.; Li, Zhi Guo; Evans, Jay D.

    2014-01-01

    Israeli acute paralysis virus (IAPV) is a widespread RNA virus of honey bees that has been linked with colony losses. Here we describe the transmission, prevalence, and genetic traits of this virus, along with host transcriptional responses to infections. Further, we present RNAi-based strategies for limiting an important mechanism used by IAPV to subvert host defenses. Our study shows that IAPV is established as a persistent infection in honey bee populations, likely enabled by both horizontal and vertical transmission pathways. The phenotypic differences in pathology among different strains of IAPV found globally may be due to high levels of standing genetic variation. Microarray profiles of host responses to IAPV infection revealed that mitochondrial function is the most significantly affected biological process, suggesting that viral infection causes significant disturbance in energy-related host processes. The expression of genes involved in immune pathways in adult bees indicates that IAPV infection triggers active immune responses. The evidence that silencing an IAPV-encoded putative suppressor of RNAi reduces IAPV replication suggests a functional assignment for a particular genomic region of IAPV and closely related viruses from the Family Dicistroviridae, and indicates a novel therapeutic strategy for limiting multiple honey bee viruses simultaneously and reducing colony losses due to viral diseases. We believe that the knowledge and insights gained from this study will provide a new platform for continuing studies of the IAPV–host interactions and have positive implications for disease management that will lead to mitigation of escalating honey bee colony losses worldwide. PMID:25079600

  15. HYPOKALEMIC PERIODIC PARALYSIS: AGE OF ONSET IN A RETROSPECTIVE STUDY

    M. H. Harirchian

    2003-08-01

    Full Text Available Primary hypokalemic periodic paralysis is a familial channelopathy inherited as an autosomal dominant trait. The first attack of paralysis may be evolved at any age, but has been reported to be most common in the second decade, so that some authorities believe that an episodic weakness beginning after age 25 is almost never due to primary periodic paralysis. In this retrospective study, we reviewed 50 patients admitted in two hospitals of Tehran University of Medical Sciences during 1992-2001 with acute flaccid weakness and hypokalemia, twenty-three of whom fulfilled our inclusion and exclusion criteria. Two patients showed first attack below age 15, 8 in 15-20, 4 in 20-25, 3 in 25-35, 4 in 35-45, and 2 beyond age 45. In our study, in contrast to previous ones, the first attack was beyond age 20 in 13 patients (56.5% and beyond 25 in 9 (39 %. Age at first attack is more than other studies, which seems to be due to a difference between our epidemiological characteristics compared to that in the West. In other words, in our epidemiological condition, periodic weakness, although started beyond second decade of age, could be due to primary periodic paralysis if secondary hypokalemia had been ruled out.

  16. Molecular cloning of ion channels in Felis catus that are related to periodic paralyses in man: a contribution to the understanding of the genetic susceptibility to feline neck ventroflexion and paralysis

    Marlyn Zapata

    2014-07-01

    Full Text Available Neck ventroflexion in cats has different causes; however, the most common is the hypokalemia associated with flaccid paralysis secondary to chronic renal failure. In humans, the most common causes of acute flaccid paralysis are hypokalemia precipitated by thyrotoxicosis and familial forms linked to mutations in sodium, potassium, and calcium channel genes. Here, we describe the sequencing and analysis of skeletal muscle ion channels in Felis catus that could be related to periodic paralyses in humans, contributing to the understanding of the genetic susceptibility to feline neck ventroflexion and paralysis. We studied genomic DNA from eleven cats, including five animals that were hyperthyroid with hypokalemia, although only one presented with muscle weakness, and six healthy control domestic cats. We identified the ion channel ortholog genes KCNJ2, KCNJ12, KCNJ14, CACNA1S and SCN4A in the Felis catus genome, together with several polymorphic variants. Upon comparative alignment with other genomes, we found that Felis catus provides evidence for a high genomic conservation of ion channel sequences. Although we hypothesized that neck ventroflexion in cats could be associated with a thyrotoxic or familial periodic paralysis channel mutation, we did not identify any previously detected human channel mutation in the hyperthyroid cat presenting hypokalemia. However, based on the small number of affected cats in this study, we cannot yet rule out this molecular mechanism. Notwithstanding, hyperthyroidism should still be considered as a differential diagnosis in hypokalemic feline paralysis.

  17. Molecular cloning of ion channels in Felis catus that are related to periodic paralyses in man: a contribution to the understanding of the genetic susceptibility to feline neck ventroflexion and paralysis.

    Zapata, Marlyn; Kunii, Ilda S; Paninka, Rolf M; Simões, Denise M N; Castillo, Víctor A; Reche, Archivaldo; Maciel, Rui M B; Dias da Silva, Magnus R

    2014-01-01

    Neck ventroflexion in cats has different causes; however, the most common is the hypokalemia associated with flaccid paralysis secondary to chronic renal failure. In humans, the most common causes of acute flaccid paralysis are hypokalemia precipitated by thyrotoxicosis and familial forms linked to mutations in sodium, potassium, and calcium channel genes. Here, we describe the sequencing and analysis of skeletal muscle ion channels in Felis catus that could be related to periodic paralyses in humans, contributing to the understanding of the genetic susceptibility to feline neck ventroflexion and paralysis. We studied genomic DNA from eleven cats, including five animals that were hyperthyroid with hypokalemia, although only one presented with muscle weakness, and six healthy control domestic cats. We identified the ion channel ortholog genes KCNJ2, KCNJ12, KCNJ14, CACNA1S and SCN4A in the Felis catus genome, together with several polymorphic variants. Upon comparative alignment with other genomes, we found that Felis catus provides evidence for a high genomic conservation of ion channel sequences. Although we hypothesized that neck ventroflexion in cats could be associated with a thyrotoxic or familial periodic paralysis channel mutation, we did not identify any previously detected human channel mutation in the hyperthyroid cat presenting hypokalemia. However, based on the small number of affected cats in this study, we cannot yet rule out this molecular mechanism. Notwithstanding, hyperthyroidism should still be considered as a differential diagnosis in hypokalemic feline paralysis. PMID:25063199

  18. Large-scale field application of RNAi technology reducing Israeli Acute Paralysis Virus Disease in honey bees (Apis mellifera, Hymenoptera; Apidae)

    We present the first successful use of RNAi under a large-scale real-world application for disease control. Israeli acute paralysis virus, IAPV, has been linked as a contributing factor in coolly collapse, CCD, of honey bees. IAPV specific homologous dsRNA were designed to reduce impacts from IAPV i...

  19. Tick Paralysis

    ... Physician’s Resources Contact About The Foundation Select Page Tick Paralysis Menu What is Tick Paralysis? Where is ... How to Remove a Tick Deer Tick Ecology Tick-Borne Diseases Anaplasmosis Babesiosis Borrelia myamotoi Infections Colorado ...

  20. Importance of brood maintenance terms in simple models of the honeybee - Varroa destructor - acute bee paralysis virus complex

    Hermann J. Eberl

    2010-09-01

    Full Text Available We present a simple mathematical model of the infestation of a honeybee colony by the Acute Paralysis Virus, which is carried by parasitic varroa mites (Varroa destructor. This is a system of nonlinear ordinary differential equations for the dependent variables: number of mites that carry the virus, number of healthy bees and number of sick bees. We study this model with a mix of analytical and computational techniques. Our results indicate that, depending on model parameters and initial data, bee colonies in which the virus is present can, over years, function seemingly like healthy colonies before they decline and disappear rapidly (e.g. Colony Collapse Disorder, wintering losses. This is a consequence of the fact that a certain number of worker bees is required in a colony to maintain and care for the brood, in order to ensure continued production of new bees.

  1. Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

    A 31/2-year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

  2. Effect of oral infection with Kashmir bee virus and Israeli acute paralysis virus on bumblebee (Bombus terrestris) reproductive success.

    Meeus, Ivan; de Miranda, Joachim R; de Graaf, Dirk C; Wäckers, Felix; Smagghe, Guy

    2014-09-01

    Israeli acute paralysis virus (IAPV) together with Acute bee paralysis virus (ABPV) and Kashmir bee virus (KBV) constitute a complex of closely related dicistroviruses. They are infamous for their high mortality after injection in honeybees. These viruses have also been reported in non-Apis hymenopteran pollinators such as bumblebees, which got infected with IAPV when placed in the same greenhouse with IAPV infected honeybee hives. Here we orally infected Bombus terrestris workers with different doses of either IAPV or KBV viral particles. The success of the infection was established by analysis of the bumblebees after the impact studies: 50days after infection. Doses of 0.5×10(7) and 1×10(7) virus particles per bee were infectious over this period, for IAPV and KBV respectively, while a dose of 0.5×10(6) IAPV particles per bee was not infectious. The impact of virus infection was studied in micro-colonies consisting of 5 bumblebees, one of which becomes a pseudo-queen which proceeds to lay unfertilized (drone) eggs. The impact parameters studied were: the establishment of a laying pseudo-queen, the timing of egg-laying, the number of drones produced, the weight of these drones and worker mortality. In this setup KBV infection resulted in a significant slower colony startup and offspring production, while only the latter can be reported for IAPV. Neither virus increased worker mortality, at the oral doses used. We recommend further studies on how these viruses transmit between different pollinator species. It is also vital to understand how viral prevalence can affect wild bee populations because disturbance of the natural host-virus association may deteriorate the already critically endangered status of many bumblebee species. PMID:25004171

  3. Acute kidney injury: A rare cause

    Satish Mendonca

    2015-01-01

    Full Text Available We present a young lady who consumed hair dye, which contained paraphenylene diamine (PPD, as a means of deliberate self-harm. This resulted in severe angio-neurotic edema for which she had to be ventilated, and thereafter developed rhabdomyolysis leading to acute kidney injury (AKI. The unusual aspect was that the patient continued to have flaccid quadriparesis and inability to regain kidney function. Renal biopsy performed 10 weeks after the dye consumption revealed severe acute tubular necrosis with myoglobin pigment casts. This suggests that PPD has a long-term effect leading to ongoing myoglobinuria, causing flaccid paralysis to persist and preventing the recovery of AKI. In such instances, timely treatment to prevent AKI in the form alkalinization of urine should be initiated promptly. Secondly, because PPD is a nondialyzable toxin, and its long-term effect necessitates its speedy removal, hemoperfusion might be helpful and is worth considering

  4. Acute kidney injury: A rare cause.

    Mendonca, Satish; Barki, Satish; Mishra, Mayank; Kumar, R S V; Gupta, Devika; Gupta, Pooja

    2015-09-01

    We present a young lady who consumed hair dye, which contained paraphenylene diamine (PPD), as a means of deliberate self-harm. This resulted in severe angio-neurotic edema for which she had to be ventilated, and thereafter developed rhabdomyolysis leading to acute kidney injury (AKI). The unusual aspect was that the patient continued to have flaccid quadriparesis and inability to regain kidney function. Renal biopsy performed 10 weeks after the dye consumption revealed severe acute tubular necrosis with myoglobin pigment casts. This suggests that PPD has a long-term effect leading to ongoing myoglobinuria, causing flaccid paralysis to persist and preventing the recovery of AKI. In such instances, timely treatment to prevent AKI in the form alkalinization of urine should be initiated promptly. Secondly, because PPD is a nondialyzable toxin, and its long-term effect necessitates its speedy removal, hemoperfusion might be helpful and is worth considering. PMID:26354573

  5. Guillain-Barre Syndrome Presenting as Acute Abdomen

    Faruk incecik

    2015-09-01

    Full Text Available Guillain-Barr and eacute; syndrome (GBS is the most common cause of acute flaccid paralysis in childhood. Symmetric weakness, headache, respiratory symptom, neuropathic pain, muscle pain, paresthesia, and facial palsy were the most common clinical presentations. We report 13-year-old boy with GBS who presented with acute abdominal pain. This is the first report, to our knowledge, first presented of acute abdomen of a pediatric patient with GBS. [Cukurova Med J 2015; 40(3.000: 601-603

  6. Rabies virus neuritic paralysis: immunopathogenesis of nonfatal paralytic rabies.

    Weiland, F; Cox, J. H.; Meyer, S.; Dahme, E; Reddehase, M J

    1992-01-01

    Two pathogenetically distinct disease manifestations are distinguished in a murine model of primary rabies virus infection with the Evelyn-Rokitnicky-Abelseth strain, rabies virus neuritic paralysis (RVNP) and fatal encephalopathogenic rabies. RVNP develops with high incidence in immunocompetent mice after intraplantar infection as a flaccid paralysis restricted to the infected limb. The histopathologic correlate of this monoplegia is a degeneration of the myelinated motor neurons of the peri...

  7. Hyperkalaemic periodic paralysis: a rare presentation of Addison's disease.

    Sowden, J. M.; Borsey, D. Q.

    1989-01-01

    A 44 year old man with longstanding diabetes mellitus gave a 6-month history of periodic attacks of flaccid quadriplegia. Following one of these episodes he was admitted for assessment. In view of persistent hyperkalaemia, hypoadrenalism was suspected and Addison's disease was confirmed biochemically. Adrenal replacement therapy restored the potassium levels to normal and resulted in no further attacks of paralysis.

  8. In vitro infection of pupae with Israeli acute paralysis virus suggests disturbance of transcriptional homeostasis in honey bees (Apis mellifera.

    Humberto F Boncristiani

    Full Text Available The ongoing decline of honey bee health worldwide is a serious economic and ecological concern. One major contributor to the decline are pathogens, including several honey bee viruses. However, information is limited on the biology of bee viruses and molecular interactions with their hosts. An experimental protocol to test these systems was developed, using injections of Israeli Acute Paralysis Virus (IAPV into honey bee pupae reared ex-situ under laboratory conditions. The infected pupae developed pronounced but variable patterns of disease. Symptoms varied from complete cessation of development with no visual evidence of disease to rapid darkening of a part or the entire body. Considerable differences in IAPV titer dynamics were observed, suggesting significant variation in resistance to IAPV among and possibly within honey bee colonies. Thus, selective breeding for virus resistance should be possible. Gene expression analyses of three separate experiments suggest IAPV disruption of transcriptional homeostasis of several fundamental cellular functions, including an up-regulation of the ribosomal biogenesis pathway. These results provide first insights into the mechanisms of IAPV pathogenicity. They mirror a transcriptional survey of honey bees afflicted with Colony Collapse Disorder and thus support the hypothesis that viruses play a critical role in declining honey bee health.

  9. Dynamics of the Presence of Israeli Acute Paralysis Virus in Honey Bee Colonies with Colony Collapse Disorder

    Chunsheng Hou

    2014-05-01

    Full Text Available The determinants of Colony Collapse Disorder (CCD, a particular case of collapse of honey bee colonies, are still unresolved. Viruses including the Israeli acute paralysis virus (IAPV were associated with CCD. We found an apiary with colonies showing typical CCD characteristics that bore high loads of IAPV, recovered some colonies from collapse and tested the hypothesis if IAPV was actively replicating in them and infectious to healthy bees. We found that IAPV was the dominant pathogen and it replicated actively in the colonies: viral titers decreased from April to September and increased from September to December. IAPV extracted from infected bees was highly infectious to healthy pupae: they showed several-fold amplification of the viral genome and synthesis of the virion protein VP3. The health of recovered colonies was seriously compromised. Interestingly, a rise of IAPV genomic copies in two colonies coincided with their subsequent collapse. Our results do not imply IAPV as the cause of CCD but indicate that once acquired and induced to replication it acts as an infectious factor that affects the health of the colonies and may determine their survival. This is the first follow up outside the US of CCD-colonies bearing IAPV under natural conditions.

  10. Paralysis: Rehabilitation

    ... Forum About Us Donate Living with Paralysis > Rehabilitation Rehabilitation Rehabilitation and exercise are key to enhancing your health and quality of life. Find a rehabilitation center near you and become familiar with different ...

  11. Leptospirosis presenting as a flaccid paraplegia.

    C Mumford; Dudley, N.; Terry, H.

    1990-01-01

    A fatal case of leptospirosis in a 64 year old farm worker is described. The dramatic neurological presentation with a rapidly evolving flaccid paraplegia associated with biochemical evidence of renal and hepatic dysfunction is discussed. Attention is drawn to the wide range of neurological symptoms reported in leptospirosis, and to the possibility that this infectious disease may present neurologically.

  12. Hypokalemic periodic paralysis; two different genes responsible for similar clinical manifestations

    Hunmin Kim; Hee Hwang; Hae Il Cheog; Hye Won Park

    2011-01-01

    Primary hypokalemic periodic paralysis (HOKPP) is an autosomal dominant disorder manifesting as recurrent periodic flaccid paralysis and concomitant hypokalemia. HOKPP is divided into type 1 and type 2 based on the causative gene. Although 2 different ion channels have been identified as the molecular genetic cause of HOKPP, the clinical manifestations between the 2 groups are similar. We report the cases of 2 patients with HOKPP who both presented with typical clinical manifestations, but wi...

  13. Clinical features of Todd's post-epileptic paralysis.

    Rolak, L A; Rutecki, P; Ashizawa, T; Harati, Y

    1992-01-01

    Two hundred and twenty nine patients with generalised tonic-clonic seizures were prospectively evaluated. Fourteen were identified who had transient focal neurological deficits thought to be Todd's post-epileptic paralysis (PEP). Eight of these 14 patients had underlying focal brain lesions associated with the postictal deficits. All patients with PEP were weak, but there was wide variation in the pattern (any combination of face, arm, leg), severity (plegia to mild), tone (spastic, flaccid, ...

  14. Clinical curative effect observation of acupuncture treatment on acute peripheral facial paralysis%针灸治疗急性期周围性面瘫的临床疗效观察

    黄沐春; 张杨; 唐诗; 陈冬梅

    2014-01-01

    目的:探讨针灸治疗急性期周围性面瘫的临床疗效。方法对急性期周围性面瘫患者使用针灸治疗,采用House-Brack-mann分级量表进行疗效观察与评价。结果针灸治疗可以明显改善周围性面瘫患者的临床症状。结论治疗周围性面瘫介入越早越好,留下后遗症的几率越小。%ObjectiveTo investigate the clinical efficacy of acupuncture treatment on peripheral facial paralysis in acute stage.Methods the patients in acute stage of peripheral facial paralysis were treated with acupuncture.The House-Brack-mann grading scale was used to evaluate the treatment effect.Results The acupuncture therapy can significantly improve the clinical symptoms of patients with peripheral facial paralysis. Conclusion the treatment of peripheral facial paralysis was the sooner,the better.

  15. [Primary hypokalemic periodic paralysis. Presentation of 18 cases].

    Ariza-Andraca, C R; Frati-Munari, A C; Ceron, E; Chavez de los Rios, J M; Martinez-Mata, J

    1993-01-01

    The clinical features of 16 males and 2 females with hypokalemic periodic paralysis (HPP) are presented. Five patients had familial HPP, 4 thyrotoxic HPP and 9 sporadic disease. The age of onset ranged from 6 to 42 years. Clinical pictures varied from paraparesis to severe quadriplegia. The disease onset was earlier in familial HPP (p paralysis (p paralysis. Glucose-insulin provocation test was positive in 5/5 patients. Oral potassium chloride and amiloride were useful to prevent paralysis. Contrasting with reports from USA and Europe, in México, HPP is not exceptional, and should be considered in the differential diagnosis of acute paralysis. PMID:7926395

  16. 综合康复治疗贝尔面瘫瘫32例%Treatment of Bell facial paralysis by comprehensive rehabilitation therapy

    徐纪香

    2002-01-01

    Background:Bell facial paralysis is characterized by acutely peripheral facial paralysis.Simple approaches can aggravate symptoms and induce permanent facial paralysis.Optimal therapy time may be missed.Comprehensive therapy is effective in treating the condition.

  17. Clinical Profile in Hypokalemic Periodic Paralysis Cases

    Agrawal, Amit

    2014-01-01

    The present article was aimed to study demographic and clinical pattern, periodicity and precipitating events for hypokalemic paralysis and to assess the response to treatment both during acute attacks and as prophylaxis in comparison with available literature. Forty patients with hypokalemic paralysis were admitted in Narayana Medical College and Hospital during the last two years, in all the medical units and neurology wards. Patients were assessed clinically, with symptomatology and precip...

  18. Episodic paralysis in a young male

    de Lloyd, Anna Claire; Davies, Stephen

    2009-01-01

    A 19-year-old Caucasian male presented acutely describing several episodes of profound paralysis. At the time of admission he had recovered completely and his neurological examination and routine biochemistry were normal. A diagnosis of thyrotoxic periodic paralysis was made after the thyroid function tests returned confirming hyperthyroidism. He was given β blockers and received a block and replacement regime before proceeding on to radioactive iodine therapy. He suffered a relapse of hypert...

  19. Large-scale field application of RNAi technology reducing Israeli acute paralysis virus disease in honey bees (Apis mellifera, Hymenoptera: Apidae.

    Wayne Hunter

    Full Text Available The importance of honey bees to the world economy far surpasses their contribution in terms of honey production; they are responsible for up to 30% of the world's food production through pollination of crops. Since fall 2006, honey bees in the U.S. have faced a serious population decline, due in part to a phenomenon called Colony Collapse Disorder (CCD, which is a disease syndrome that is likely caused by several factors. Data from an initial study in which investigators compared pathogens in honey bees affected by CCD suggested a putative role for Israeli Acute Paralysis Virus, IAPV. This is a single stranded RNA virus with no DNA stage placed taxonomically within the family Dicistroviridae. Although subsequent studies have failed to find IAPV in all CCD diagnosed colonies, IAPV has been shown to cause honey bee mortality. RNA interference technology (RNAi has been used successfully to silence endogenous insect (including honey bee genes both by injection and feeding. Moreover, RNAi was shown to prevent bees from succumbing to infection from IAPV under laboratory conditions. In the current study IAPV specific homologous dsRNA was used in the field, under natural beekeeping conditions in order to prevent mortality and improve the overall health of bees infected with IAPV. This controlled study included a total of 160 honey bee hives in two discrete climates, seasons and geographical locations (Florida and Pennsylvania. To our knowledge, this is the first successful large-scale real world use of RNAi for disease control.

  20. Ticks and tick paralysis: imaging findings on cranial MR

    Tick paralysis is an acute, progressive, and potentially fatal muscle paralysis secondary to a toxin secreted by a pregnant tick during a bite. Although tick bites can occur anywhere on the body, ticks are frequently overlooked on the scalp because of overlying hair. Children with acute neurologic symptoms frequently undergo MR scanning that may incidentally reveal the offending tick. Timely identification and removal of the tick leads to rapid recovery from tick paralysis. We report the MRI findings at 1.5 T of tick paralysis with an attached tick. (orig.)

  1. Ticks and tick paralysis: imaging findings on cranial MR

    Burke, Michael S.; Fordham, Lynn Ansley [University of North Carolina Chapel Hill, UNC School of Medicine, Department of Radiology, NC (United States); Hamrick, Harvey J. [University of North Carolina Hospitals, Department of Pediatrics, Chapel Hill (United States)

    2005-02-01

    Tick paralysis is an acute, progressive, and potentially fatal muscle paralysis secondary to a toxin secreted by a pregnant tick during a bite. Although tick bites can occur anywhere on the body, ticks are frequently overlooked on the scalp because of overlying hair. Children with acute neurologic symptoms frequently undergo MR scanning that may incidentally reveal the offending tick. Timely identification and removal of the tick leads to rapid recovery from tick paralysis. We report the MRI findings at 1.5 T of tick paralysis with an attached tick. (orig.)

  2. Periodic paralysis complicating malaria.

    Senanayake, N; Wimalawansa, S J

    1981-01-01

    Episodic muscular weakness, commonly associated with alterations of serum potassium, is the cardinal feature of periodic paralysis. The combination of transient hyperkalaemia and rigors occurring during febrile episodes of malaria is suggested as the underlying cause which precipitated the muscular paralysis. Three patients with malaria who developed a similar paralysis during the paroxysms of fever are described to illustrate this.

  3. A Case of Hypokalemic Paralysis in a Patient With Neurogenic Diabetes Insipidus

    Nguyen, Frederic N.; Kar, Jitesh K.; Verduzco-Gutierrez, Monica; Zakaria, Asma

    2014-01-01

    Acute hypokalemic paralysis is characterized by muscle weakness or paralysis secondary to low serum potassium levels. Neurogenic diabetes insipidus (DI) is a condition where the patient excretes large volume of dilute urine due to low levels of antidiuretic hormone. Here, we describe a patient with neurogenic DI who developed hypokalemic paralysis without a prior history of periodic paralysis. A 30-year-old right-handed Hispanic male was admitted for refractory seizures and acute DI after dev...

  4. [Thyrotoxic hypokalemic periodic paralysis in patients of African descent].

    Maia, Morgana Lima e; Trevisam, Paula Grasiele Carvalho; Minicucci, Marcos; Mazeto, Glaucia M F S; Azevedo, Paula S

    2014-10-01

    Thyrotoxic hypokalemic periodic paralysis (THPP) is an endocrine emergency marked by recurrent attacks of muscle weakness associated with hypokalemia and thyrotoxicosis. Asiatic male patients are most often affected. On the other hand, African descents rarely present this disease. The case described shows an afrodescendant patient with hypokalemia and tetraparesis, whose diagnosis of hyperthyroidism was considered during this crisis. The THPP, although rare, is potentially lethal. Therefore, in cases of flaccid paresis crisis this diagnosis should always be considered, especially if associated with hypokalemia. In this situation, if no previous diagnosis of hyperthyroidism, this should also be regarded. PMID:25372590

  5. Tick holocyclotoxins trigger host paralysis by presynaptic inhibition

    Chand, Kirat K.; Lee, Kah Meng; Lavidis, Nickolas A.; Rodriguez-Valle, Manuel; Ijaz, Hina; Koehbach, Johannes; Clark, Richard J.; Lew-Tabor, Ala; Noakes, Peter G.

    2016-01-01

    Ticks are important vectors of pathogens and secreted neurotoxins with approximately 69 out of 692 tick species having the ability to induce severe toxicoses in their hosts. The Australian paralysis tick (Ixodes holocyclus) is known to be one of the most virulent tick species producing a flaccid paralysis and fatalities caused by a family of neurotoxins known as holocyclotoxins (HTs). The paralysis mechanism of these toxins is temperature dependent and is thought to involve inhibition of acetylcholine levels at the neuromuscular junction. However, the target and mechanism of this inhibition remain uncharacterised. Here, we report that three members of the holocyclotoxin family; HT-1 (GenBank AY766147), HT-3 (GenBank KP096303) and HT-12 (GenBank KP963967) induce muscle paralysis by inhibiting the dependence of transmitter release on extracellular calcium. Previous study was conducted using extracts from tick salivary glands, while the present study is the first to use pure toxins from I. holocyclus. Our findings provide greater insight into the mechanisms by which these toxins act to induce paralysis. PMID:27389875

  6. Toxic C17-Sphinganine Analogue Mycotoxin, Contaminating Tunisian Mussels, Causes Flaccid Paralysis in Rodents

    Riadh Marrouchi

    2013-11-01

    Full Text Available Severe toxicity was detected in mussels from Bizerte Lagoon (Northern Tunisia using routine mouse bioassays for detecting diarrheic and paralytic toxins not associated to classical phytoplankton blooming. The atypical toxicity was characterized by rapid mouse death. The aim of the present work was to understand the basis of such toxicity. Bioassay-guided chromatographic separation and mass spectrometry were used to detect and characterize the fraction responsible for mussels’ toxicity. Only a C17-sphinganine analog mycotoxin (C17-SAMT, with a molecular mass of 287.289 Da, was found in contaminated shellfish. The doses of C17-SAMT that were lethal to 50% of mice were 750 and 150 μg/kg following intraperitoneal and intracerebroventricular injections, respectively, and 900 μg/kg following oral administration. The macroscopic general aspect of cultures and the morphological characteristics of the strains isolated from mussels revealed that the toxicity episodes were associated to the presence of marine microfungi (Fusarium sp., Aspergillus sp. and Trichoderma sp. in contaminated samples. The major in vivo effect of C17-SAMT on the mouse neuromuscular system was a dose- and time-dependent decrease of compound muscle action potential amplitude and an increased excitability threshold. In vitro, C17-SAMT caused a dose- and time-dependent block of directly- and indirectly-elicited isometric contraction of isolated mouse hemidiaphragms.

  7. Management of a patient with hyperkalemic periodic paralysis requiring coronary artery bypass grafts

    Sanjay Orathi Patangi

    2012-01-01

    Full Text Available Hyperkalemic periodic paralysis (HPP is an autosomal-dominant inherited muscle disease characterized by episodes of flaccid weakness and intermittent myotonia. There are no previous reports in the literature about anesthesia for cardiac surgery with cardiopulmonary bypass in this disorder. We describe perioperative anesthetic management for on-pump coronary artery bypass grafting in a 75-year-old man with a history of hyperkalemic periodic paralysis. This case report outlines our management strategy and the issues encountered during the perioperative period.

  8. Three cases of thyrotoxic periodic paralysis due to painless thyroiditis

    Debmalya Sanyal; Moutusi Raychaudhuri; Shakya Bhattacharjee

    2013-01-01

    We present three cases of thyrotoxic periodic paralysis (TPP) due to painless thyroiditis presenting as acute quadriparesis. All responded to potassium supplementation and propranolol. TPP may be due to thyrotoxicosis of any etiology, commonly Grave's disease. The absence of clinical signs of thyrotoxicosis can delay diagnosis and treatment. Thyroid function tests should be a routine evaluation in all cases of hypokalemic periodic paralysis.

  9. Isolated sleep paralysis

    Sawant, Neena S.; Shubhangi R Parkar; Tambe, Ravindra

    2005-01-01

    Sleep paralysis (SP) is a cardinal symptom of narcolepsy. However, little is available in the literature about isolated sleep paralysis. This report discusses the case of a patient with isolated sleep paralysis who progressed from mild to severe SP over 8 years. He also restarted drinking alcohol to be able to fall asleep and allay his anxiety symptoms. The patient was taught relaxation techniques and he showed complete remission of the symptoms of SP on follow up after 8 months.

  10. Treatment for periodic paralysis

    Sansone, [No Value; Meola, G.; Links, T. P.; Panzeri, M.; Rose, M. R.

    2008-01-01

    Background Primary periodic paralyses are rare inherited muscle diseases characterised by episodes of flaccid weakness affecting one or more limbs, lasting several hours to several days, caused by mutations in skeletal muscle channel genes. Objectives The objective of this review was to systematical

  11. Thyrotoxic periodic paralysis: a short clinical review

    Rashmi Aggarwal

    2015-06-01

    Full Text Available Thyrotoxic Periodic Paralysis (TPP is a potentially lethal manifestation of hyperthyroidism which is characterized by hypokalemia and muscular weakness. It mainly affects Asian men in the age group of 20 to 40 years. Immediate supplementation with oral or intravenous potassium will help to not only abort the acute attack of paralysis but will also prevent serious and life threatening cardiac arrhythmias. Non selective beta blockers like propranolol can also be used to ameliorate and prevent subsequent paralytic attack. Acetazolamide has no role in the treatment of TPP. [Int J Res Med Sci 2015; 3(3.000: 539-542

  12. Concurrent acute disseminated encephalomyelitis and Guillain-Barré syndrome in a child

    Isha S Deshmukh

    2015-01-01

    Full Text Available Acute disseminated encephalomyelitis (ADEM and Guillain-Barrι syndrome (GBS are distinct demyelinating disorders that share an autoimmune pathogenesis and prior history of viral infection or vaccination. Our patient is a 10 years with acute flaccid paralysis, quadriparesis (lower limbs affected more than upper limbs, generalized areflexia and urinary retention. He had difficulty in speech and drooling of saliva. He also presented with raised intracranial pressure with papilledema; then bilateral optic neuritis developed during the later course of illness. Based on the temporal association and exclusion of alternative etiologies, diagnosis of the association between ADEM and GBS was made. Electro-diagnosis (electromyography-nerve conduction velocity and magnetic resonance imaging study supported our diagnosis. He improved remarkably after treatment with intravenous immunoglobulin and intravenous methylprednisolone.

  13. 急性运动轴索性神经病的研究进展%Research progress of acute motor axonal neuropathy

    张刚; 秦新月

    2014-01-01

    Acute motor axonal neuropathy (AMAN) is one of the main subtypes of Guillain-Barré syndrome (GBS), which presents with acute ascending flaccid paralysis like acute inflammatory demyelinating polyneuropathy (AIDP). But AMAN can be different with AIDP in clinical manifestation, immunopathogenesis, electrophysiology, serum antibody, prognosis, et al. This review focused on the research progress of AMAN.%急性运动轴索性神经病(AMAN)是吉兰-巴雷综合征(GBS)的主要亚型之一,与GBS主要亚型急性炎症性脱髓鞘性多发性神经病(AIDP)在临床表现、免疫病理生理机制、神经电生理检查、血清学抗体等方面均有不同。本文就AMAN相关研究进展做一综述。

  14. Isolated sleep paralysis

    ... from sleep. It is not associated with another sleep disorder. ... Sleep paralysis can be a symptom of narcolepsy . But if you do not have other symptoms of narcolepsy, there is usually no need to have sleep studies done.

  15. Hypokalemic periodic paralysis

    Abbas, Haider; Kothari, Nikhil; Bogra, Jaishri

    2012-01-01

    Hypokalemic periodic paralysis is a rare genetic disorder characterized by recurrent attacks of skeletal muscle weakness with associated hypokalemia which is precipitated by stress, cold, carbohydrate load, infection, glucose infusion, hypothermia, metabolic alkalosis, anesthesia, and steroids. We encountered one such incidence of prolonged recovery after general anesthesia, which on further evaluation revealed a case of hypokalemic paralysis. The key to successful management of such a patien...

  16. Thyrotoxic Periodic Paralysis: An Underdiagnosed and Under-recognized Condition.

    Tella, Sri Harsha; Kommalapati, Anuhya

    2015-01-01

    Thyrotoxic hypokalemic periodic paralysis (TPP) is a condition characterized by the triad of acute hypokalemia without total body potassium deficit, episodic muscle paralysis, and thyrotoxicosis. We describe two cases of thyrotoxic periodic paralysis who presented to our hospital with potassium values of 1.3 MeQ/l and 1.2 MeQ/l, respectively. Surprisingly, the two patients had no documented past medical history. Based on the clinical features of high heart rate, palpitations (seen in both the patients), and exophthalmos (seen in one patient), thyrotoxic periodic paralysis was suspected. A thorough laboratory workup confirmed the diagnosis of thyrotoxicosis. Beta blockers were initiated promptly, along with intravenous potassium chloride, and the patients eventually improved symptomatically. These patients were eventually diagnosed with Graves' disease and were placed on methimazole, which prevented further attacks. Thyroid periodic paralysis (TPP) is a rare clinical manifestation of hyperthyroidism. Patients present with sudden onset paralysis associated with severe hypokalemia. The presence of paralysis and hypokalemia in a patient who has a history of hyperthyroidism should prompt the physician about thyrotoxic periodic paralysis. A high index of suspicion, prompt diagnosis, and management of the condition can prevent severe complications, such as cardiac arrhythmias. PMID:26623197

  17. Fatal Dysrhythmia Following Potassium Replacement for Hypokalemic Periodic Paralysis

    Ahmed, Imdad; Chilimuri, Sridhar S.

    2010-01-01

    We present a case of fatal rebound hyperkalemia in a patient with thyrotoxic periodic paralysis (TPP) treated with potassium supplementation. Although TPP is a rare hyperthyroidism-related endocrine disorder seen predominantly in men of Asian origin, the diagnosis should be considered in patients of non-Asian origins presenting with hypokalemia, muscle weakness or acute paralysis. The condition may present as a life threatening emergency and unfamiliarity with the disease could result in a fa...

  18. Three cases of thyrotoxic periodic paralysis due to painless thyroiditis

    Debmalya Sanyal

    2013-01-01

    Full Text Available We present three cases of thyrotoxic periodic paralysis (TPP due to painless thyroiditis presenting as acute quadriparesis. All responded to potassium supplementation and propranolol. TPP may be due to thyrotoxicosis of any etiology, commonly Grave′s disease. The absence of clinical signs of thyrotoxicosis can delay diagnosis and treatment. Thyroid function tests should be a routine evaluation in all cases of hypokalemic periodic paralysis.

  19. Etiological spectrum of hypokalemic paralysis: A retrospective analysis of 29 patients

    Ravindra Kumar Garg; Hardeep Singh Malhotra; Rajesh Verma; Pawan Sharma; Maneesh Kumar Singh*,

    2013-01-01

    Background: Hypokalemic paralysis is characterized by episodes of acute muscle weakness associated with hypokalemia. In this study, we evaluated the possible etiological factors in patients of hypokalemic paralysis. Materials and Methods: We reviewed the records of 29 patients who were admitted with a diagnosis of hypokalemic paralysis. Modified Guillain-Barre΄ Syndrome disability scale was used to grade the disability. Results: In this study, 15 (51.7%) patients had secondary causes of hypok...

  20. Hypokalaemic Periodic Paralysis in a Patient with Subclinical Hyperthyroidism: A Rare Case

    Hegde, Swati; Shaikh, Mohammed Aslam; Gummadi, Thejaswi

    2016-01-01

    Thyrotoxic Periodic Paralysis (TPP) is an uncommon disorder. Though many cases of hypokalaemic periodic paralysis are reported in overt hyperthyroidism, hypokalaemic paralysis in subclinical hyperthyroidism is very rare. Subclinical hyperthyroidism is characterised by circulating TSH levels below reference range and normal thyroid hormone levels. We describe a case of 32-year-old Asian male who presented to the emergency department with acute onset weakness and hypokalaemia with no previous h...

  1. SYSTEMIC LUPUS ERYTHEMATOSUS PRESENTING AS HYPOKALEMIC PERIODIC PARALYSIS SECONDARY TO DISTAL RENAL TUBULAR ACIDOSIS

    Ranjeet; Gurinder

    2014-01-01

    Systemic lupus erythematosus, referred to as SLE or lupus, is sometimes called the “great imitator.” Why? Because of its wide range of symptoms, people often confuse lupus with other health problems. We report the case of a 22-year-old woman who presented with a flaccid paralysis of limbs due to severe hypokalemia as a consequence of distal renal tubular acidosis (dRTA). A search for the cause of dRTA revealed latent Systemic Lupus Erythematosus (SLE). SLE presenting as dRTA ...

  2. SYSTEMIC LUPUS ERYTHEMATOSUS PRESENTING AS HYPOKALEMIC PERIODIC PARALYSIS SECONDARY TO DISTAL RENAL TUBULAR ACIDOSIS

    Ranjeet

    2014-05-01

    Full Text Available Systemic lupus erythematosus, referred to as SLE or lupus, is sometimes called the “great imitator.” Why? Because of its wide range of symptoms, people often confuse lupus with other health problems. We report the case of a 22-year-old woman who presented with a flaccid paralysis of limbs due to severe hypokalemia as a consequence of distal renal tubular acidosis (dRTA. A search for the cause of dRTA revealed latent Systemic Lupus Erythematosus (SLE. SLE presenting as dRTA is uncommon

  3. A case of periodic hypokalemic paralysis in a patient with celiac disease.

    Ranjan, Amitabh; Debata, Pradeep K

    2014-06-01

    A 4-year-old male child presented with recurrent episodes of diarrhoea for 6-months, each episode associated with weakness of all four limbs and documented hypokalemia who on examination had some pallor, short stature, flaccid quadriparesis with absent DTR. The patient responded clinically and biochemically to potassium supplement. TTG and Intestinal biopsy confirmed celiac disease. Patient was put on gluten free diet and patient is doing well with no recurrence. We present a case of Recurrent hypokalemic paralysis with previously unsuspected celiac disease who was not in celiac crisis. PMID:25121038

  4. [Hypokalemic paralysis during pregnancy: a report of two cases].

    Hernández Pacheco, José Antonio; Estrada Altamirano, Ariel; Pérez Borbón, Guadalupe María; Torres Torres, Cutberto

    2009-12-01

    The hypokalemic paralysis is a disease characterized by the development of acute muscular weakness, associated to low levels of blood potassium (cuadriplegia associated to blood potassium level of 1.4 meq/L, diagnosed with distal tubular acidosis; she required mechanical ventilation for respiratory paralysis. The medical profile remits with potassium intravenous replacement and the pregnancy ends with a spontaneous abortion. The second case is a 15 years old woman with 26.5 weeks of pregnancy, who suffers a generalized paralysis with blood potassium of 2.7 meq/L, requiring also mechanical ventilation for respiratory paralysis; the final diagnosis was Barterr syndrome, and the medical profile remited after potassium supplement. Her pregnancy got complicated with a severe preeclampsia, enough reason for interrumpting the pregnancy at 29.1 weeks of gestation. In both cases Guilliain-Barre syndrome was ruled out. PMID:20077884

  5. Thyrotoxic periodic paralysis in long standing Graves′ disease: An unusual presentation with normokalemia

    Lakshmi Kannan

    2015-01-01

    Full Text Available Context: Thyrotoxic periodic paralysis (TPP is a potentially life-threatening complication of hyperthyroidism that is underdiagnosed and frequently missed. It is relatively common in Asian men with Graves′ disease. TPP attacks are frequently associated with hypokalemia. Case Report: Here we report a non-Asian female patient with Graves′ disease, who presented with flaccid paralysis associated with an episode of subacute thyroiditis (SAT. Interestingly, she was found to have low normal potassium levels in the serum during the initial attack despite which she continues to require low dose potassium supplementation to prevent recurrent TPP attacks. Unique features in our patient include her gender, ethnicity, time lag between initial diagnosis of Graves′ disease, and the development of TPP and borderline low potassium levels, with the continuous need for prophylactic potassium supplementation. Conclusion: It is important to be aware of this complication of hyperthyroidism that has a dramatic yet variable presentation, but is readily amenable to therapy.

  6. Genetics Home Reference: hypokalemic periodic paralysis

    ... paralysis Patient Support and Advocacy Resources (2 links) Muscular Dystrophy Association Resource list from the University of Kansas Medical Center GeneReviews (1 link) Hypokalemic Periodic Paralysis Genetic Testing Registry (3 links) Hypokalemic periodic paralysis Hypokalemic ...

  7. Psychological contents and social effects associated to peripheral facial paralysis: a speech-language approach

    Silva, Mabile Francine Ferreira

    2011-10-01

    Full Text Available Introduction: The peripheral facial paralysis (PFP results from the reduction or interruption of the axonal transport to the seventh cranial nerve resulting in complete or partial paralysis of the facial movements. The facial deformity and limitation of movements, besides affecting the aesthetics and functionality, can significantly interfere with interpersonal communication. Objective: Investigate the psychological contents and other social effects associated to PFP in adult subjects, performing a comparative analysis in three groups of subjects with PFP: at flaccid, recovery and sequel phases. Method: Quantitative and qualitative research. 16 adult subjects, from both sexes, aging between 43 and 88 years old, with PFP. Procedure: Open interviews with subjects. The material was recorded in audio and video, literally transcribed, systematized through categorical and statistical analysis. Results: The subjects bearing sequels presented higher statistical significance of psychological contents and social effects associated to PFP. Followed, respectively, by those that were on flaccid and recovery phases. The results suggest that the speech-language therapist, besides performing functional and aesthetical rehabilitation with the subject with PFP, needs to be aware of psychological and social aspects that may be involved, in order to evaluate and seek to reduce the degree of psychological distress and promote the social adjustment of these patients. Conclusion: The biopsychosocial approach to patients with PFP revealed a wide and significant range of subjective contents that warrant new studies that may contribute to the effectiveness of the speech-language clinical method to approach this medical condition.

  8. MARATHON DESPITE UNILATERAL VOCAL FOLD PARALYSIS

    Matthias Echternach

    2008-06-01

    vocal fold paralysis for the first time. Although a marathon race is an endurance exertion without maximum acute strain on the respiratory system (McArdle et al., 2001, the sport medical examinations also showed no restriction at maximum exertion, neither expiratory nor inspiratory. An unilateral vocal fold paralysis is apparently not such a serious obstacle to the respiratory tract that one would have to reckon with a clear-cut respiratory deficit. Exercise testing of larger samples of patients with vocal fold paralysis should be performed concerning their capacity to endure exertion.The question in the present case thus remains the causal connection between the paralysis and unspecific respiratory complaints. The laryngological examination speaks against an acute event. A possible cause of the vocal fold paralysis is the thoracotomy or the pleuritis in childhood; Due to the time lapse of over 40 years, this cannot be proven. The entire diagnostic spectrum excluded another organic cause for her respiratory complaints, so that we tend to assume a functional or psychosomatic nature. As the symptoms vanished spontaneously, no further proof of this can be offered

  9. 手足口病合并病毒性脑炎、急性弛缓性瘫痪患儿的护理%Nursing of Children with Hand Foot and Mouth Disease Complicated with Viral Encephalitis and Acute Flaccid Paralysis

    杨琦; 孙丽华

    2010-01-01

    @@ 手足口病(hand,foot and mouth disease,HFMD)是由多种肠道病毒引起的急性传染病,主要病原体有人肠道病毒71 型(enterovirus 71,EV71)和科萨奇病毒A16型(coxsackievirus A16,CoxA16),多发生于5岁以下儿童.多数患儿表现为手、足、口腔等部位的皮疹、疱疹,大多预后良好[1].

  10. Practical aspects in the management of hypokalemic periodic paralysis

    Levitt Jacob O

    2008-01-01

    Abstract Management considerations in hypokalemic periodic paralysis include accurate diagnosis, potassium dosage for acute attacks, choice of diuretic for prophylaxis, identification of triggers, creating a safe physical environment, peri-operative measures, and issues in pregnancy. A positive genetic test in the context of symptoms is the gold standard for diagnosis. Potassium chloride is the favored potassium salt given at 0.5–1.0 mEq/kg for acute attacks. The oral route is favored, but if...

  11. Etiological spectrum of hypokalemic paralysis: A retrospective analysis of 29 patients

    Ravindra Kumar Garg

    2013-01-01

    Full Text Available Background: Hypokalemic paralysis is characterized by episodes of acute muscle weakness associated with hypokalemia. In this study, we evaluated the possible etiological factors in patients of hypokalemic paralysis. Materials and Methods: We reviewed the records of 29 patients who were admitted with a diagnosis of hypokalemic paralysis. Modified Guillain-Barre΄ Syndrome disability scale was used to grade the disability. Results: In this study, 15 (51.7% patients had secondary causes of hypokalemic paralysis and 14 patients (42.3% had idiopathic hypokalemic paralysis. Thyrotoxicosis was present in six patients (20.6%, dengue infection in four patients (13.7%, distal renal tubular acidosis in three patients (10.3%, Gitelman syndrome in one patient (3.4%, and Conn′s syndrome in one patient (3.4%. Preceding history of fever and rapid recovery was seen in dengue infection-induced hypokalemic paralysis. Approximately 62% patients had elevated serum creatinine phosphokinase. All patients had recovered completely following potassium supplementation. Patients with secondary causes were older in age, had significantly more disability, lower serum potassium levels, and took longer time to recover. Conclusion: In conclusion, more than half of patients had secondary causes responsible for hypokalemic paralysis. Dengue virus infection was the second leading cause of hypokalemic paralysis, after thyrotoxicosis. Presence of severe disability, severe hypokalemia, and a late disease onset suggested secondary hypokalemic paralysis.

  12. Paralysis Analysis: Investigating Paralysis Visit Anomalies in New Jersey

    Hamby, Teresa; Tsai, Stella; Genese, Carol; Walsh, Andrew; Bradford, Lauren; Lifshitz, Edward

    2013-01-01

    Objective To describe the investigation of a statewide anomaly detected by a newly established state syndromic surveillance system and usage of that system. Introduction On July 11, 2012, New Jersey Department of Health (DOH) Communicable Disease Service (CDS) surveillance staff received email notification of a statewide anomaly in EpiCenter for Paralysis. Two additional anomalies followed within three hours. Since Paralysis Anomalies are uncommon, staff initiated an investigation to determin...

  13. MR features in patients with residual paralysis following aseptic meningitis

    Suh, Dae Chul; Park, Young Seo [College of Medicine, Asan Meidcal Center, University of Ulsan, Seoul (Korea, Republic of)

    1991-01-15

    MR studies were performed in three patients with paralysis in the lower extremities. Poliomyelitis-like paralysis can be caused by neurovirulent strains of nonpolioenteroviruses. Entervirus 71 (EV 71) is documented as one of the potentially neurovirulent strains and a causative agent of some epidemics (1-7). The clinical manifestations associated with the EV 71 infection include aseptic meningitis, hand-food-mouth disease (HFMD), acute respiratory illness and gastrointestinal disease(6). Although rarely fatal, flaccidparalysis can be followed by EV 71 induced aseptic meningitis. Anterior horn cell necrosis was suggested on MR in two patients with residual paralysis (7). MR features, however, have not yet been described in detail. In this report we present three cases of patients with clinical evidence of EV 71 induced aseptic meningitis whose MR studies showed residual changes in spinal cord.

  14. MR features in patients with residual paralysis following aseptic meningitis

    MR studies were performed in three patients with paralysis in the lower extremities. Poliomyelitis-like paralysis can be caused by neurovirulent strains of nonpolioenteroviruses. Entervirus 71 (EV 71) is documented as one of the potentially neurovirulent strains and a causative agent of some epidemics (1-7). The clinical manifestations associated with the EV 71 infection include aseptic meningitis, hand-food-mouth disease (HFMD), acute respiratory illness and gastrointestinal disease(6). Although rarely fatal, flaccidparalysis can be followed by EV 71 induced aseptic meningitis. Anterior horn cell necrosis was suggested on MR in two patients with residual paralysis (7). MR features, however, have not yet been described in detail. In this report we present three cases of patients with clinical evidence of EV 71 induced aseptic meningitis whose MR studies showed residual changes in spinal cord

  15. Thyrotoxic Hypokalemic Periodic Paralysis: A Case Report

    Tuna, Mazhar Muslum; Aycicek Dogan, Bercem; Nasiroglu Imga, Narin; Karakilic, Ersen; Karadeniz, Mine; Tutuncu, Yasemin; Isik, Serhat; Berker, Dilek; Guler, Serdar

    2014-01-01

    AbstractHypokalemic periodic paralysis is a rare disorder characterized by reversible attacks of muscle weakness accompanied by episodic hypokalemia. The most common causes of hypokalemic periodic paralysis (HPP) are familial periodic paralysis, thyrotoxic periodic paralysis (TPP) and sporadic periodic paralysis, respectively. There are generally some precipitating factors such as stress, vigorous exercise and high carbohydrate food consumption which all ease the occurrence of attacks. The du...

  16. A case of hypokalemic paralysis in a patient with neurogenic diabetes insipidus.

    Nguyen, Frederic N; Kar, Jitesh K; Verduzco-Gutierrez, Monica; Zakaria, Asma

    2014-04-01

    Acute hypokalemic paralysis is characterized by muscle weakness or paralysis secondary to low serum potassium levels. Neurogenic diabetes insipidus (DI) is a condition where the patient excretes large volume of dilute urine due to low levels of antidiuretic hormone. Here, we describe a patient with neurogenic DI who developed hypokalemic paralysis without a prior history of periodic paralysis. A 30-year-old right-handed Hispanic male was admitted for refractory seizures and acute DI after developing a dental abscess. He had a history of pituitary adenoma resection at the age of 13 with subsequent pan-hypopituitarism and was noncompliant with hormonal supplementation. On hospital day 3, he developed sudden onset of quadriplegia with motor strength of 0 of 5 in the upper extremities bilaterally and 1 of 5 in both lower extremities with absent deep tendon reflexes. His routine laboratory studies revealed severe hypokalemia of 1.6 mEq/dL. Nerve Conduction Study (NCS) revealed absent compound motor action potentials (CMAPs) with normal sensory potentials. Electromyography (EMG) did not reveal any abnormal insertional or spontaneous activity. He regained full strength within 36 hours following aggressive correction of the hypokalemia. Repeat NCS showed return of CMAPs in all nerves tested and EMG revealed normal motor units and normal recruitment without myotonic discharges. In patients with central DI with polyuria, hypokalemia can result in sudden paralysis. Hypokalemic paralysis remains an important differential in an acute case of paralysis and early recognition and appropriate management is key. PMID:24707338

  17. Potassium-Related Periodic Paralysis

    A Lesani; MH Moradi Nejad

    1995-01-01

    Potassium-related periodic paralysis may be associated with hypo, normo, or hyperkalemic disturbance of the Potassium level. Clinical features, laboratory findings and ECG as well as EMG changes are different in the 3 types of the disease. The treatment demands correction of the Potassium level of the blood serum. The disease is normally transferred as an autosomal dominant trait. In this article we present a 9-year old girl who suffered from hypokalemic paralysis since she was 4 years old.

  18. Successful rehabilitation in conversion paralysis.

    Delargy, M A; Peatfield, R C; Burt, A A

    1986-01-01

    A rehabilitation programme for patients with conversion paralysis has been introduced in which they are offered physical rehabilitation. During an eight month period between October 1984 and May 1985 six patients who had been diagnosed as dependent on wheelchairs owing to conversion paralysis for a mean of 3 years (range 1-6 years) were entered into the inpatient neurorehabilitation programme. All six patients were able to walk within a mean of 41 days (range 10-70 days), and then relinquishe...

  19. Iodine-induced thyrotoxic hypokalemic paralysis after ingestion of Salicornia herbace.

    Yun, Seong Eun; Kang, Yeojin; Bae, Eun Jin; Hwang, Kyungo; Jang, Ha Nee; Cho, Hyun Seop; Chang, Se-Ho; Park, Dong Jun

    2014-04-01

    A 56-year-old Korean man visited to emergency room due to paroxysmal flaccid paralysis in his lower extremities. There was no family or personal history of periodic paralysis. His initial potassium levels were 1.8 mmol/L. The patient had been taking Salicornia herbacea for the treatment of diabetes and hypertension. Results of a thyroid function test were as follows: T3 = 130.40 ng/dL, TSH = 0.06 mIU/L, and free T4 = 1.73 ng/dL. A thyroid scan exhibited a decreased uptake (0.6%). His symptoms clearly improved and serum potassium levels increased to 4.4 mmol/L by intravenous infusion of only 40 mmol of potassium chloride. Eight months after the discontinuation of only Salicornia herbacea, the patient's thyroid function tests were normalized. Large amounts of iodine can induce hypokalemic thyrotoxic paralysis and it may be necessary to inquire about the ingestion of iatrogenic iodine compounds, such as Salicornia herbacea. PMID:24344747

  20. A 10-year analysis of thyrotoxic periodic paralysis in 135 patients: focus on symptomatology and precipitants

    Chang, Chin-Chun; Cheng, Chih-Jen; Sung, Chih-Chien; Chiueh, Tzong-Shi; Lee, Chien-Hsing; Chau, Tom; Lin, Shih-Hua

    2013-01-01

    Background A comprehensive analysis has not been performed on patients with thyrotoxic periodic paralysis (TPP) characterized by acute hypokalemia and paralysis in the setting of thyrotoxicosis. Purpose The aim of this study was to analyze the detailed symptomatology of thyrotoxicosis and precipitating factors for the attack in a large cohort of TPP patients. Patients and methods A prospective observational study enrolled patients with TPP consecutively over 10 years at an academic medical ce...

  1. Mutations in Potassium Channel Kir2.6 Cause Susceptibility to Thyrotoxic Hypokalemic Periodic Paralysis

    Ryan, Devon P.; da Silva, Magnus R. Dias; Soong, Tuck Wah; Fontaine, Bertrand; Donaldson, Matt R.; Kung, Annie W.C.; Jongjaroenprasert, Wallaya; Liang, Mui Cheng; Khoo, Daphne H.C.; Cheah, Jin Seng; Ho, Su Chin; Bernstein, Harold S.; Macie, Rui M.B.; Brown, Robert H.; Ptáčcek, Louis J.

    2010-01-01

    Thyrotoxic hypokalemic periodic paralysis (TPP) is characterized by acute attacks of weakness, hypokalemia, and thyrotoxicosis of various etiologies. These transient attacks resemble those of patients with familial hypokalemic periodic paralysis (hypoKPP) and resolve with treatment of the underlying hyperthyroidism. Because of the phenotypic similarity of these conditions, we hypothesized that TPP might also be a channelopathy. While sequencing candidate genes, we identified a previously unre...

  2. Rifampin-associated tubulointersititial nephritis and Fanconi syndrome presenting as hypokalemic paralysis

    2013-01-01

    Background Rifampin is one of the most important drugs in first-line therapies for tuberculosis. The renal toxicity of rifampin has been reported sporadically and acute tubulointerstitial nephritis (ATIN) is a frequent histological finding. We describe for the first time a case of ATIN and Fanconi syndrome presenting as hypokalemic paralysis, associated with the use of rifampin. Case presentation A 42-year-old man was admitted with sudden-onset lower extremity paralysis and mild renal insuffi...

  3. Unilateral laryngeal paralysis

    Mitrović Slobodan

    2003-01-01

    Full Text Available Introduction Phoniatric rehabilitation is mainly aimed at restoring satisfactory phonation. Voice quality depends on the capacity of intact vocal cords to compensate the deficiency involved, as well as on automatism of phonation. Material and methods The study included 50 patients. All subjects underwent history taking, reported symptoms that urged them to visit a phoniatrician; they were submitted to a clinical otorhinolaryngologic and phoniatric examinations, voice assessment by subjective acoustic analysis spectral analysis by digital sonography and laryngostroboscopy. All patients underwent Seeman's method of laryngeal compression. Results The examined group of 50 subjects included 17 males (34% and 33 females (66%. Vocal cord palsy was most often due to neck surgery (strumectomy in 19 patients (38% followed by an idiopathic palsy involved in 12 patients (24%. Disocclusion of 1-2 mm and 3-3 mm was registered in 54 % and 24% patients, respectively After treatment total occlusion was established in 20 % of patients, while disocclusion of up to 1mm, 1-2 mm or 2-3 mm persisted in 36 %, 20% and 2% of patients, respectively. T-test revealed a statistically significant difference in glottic incompetence prior to and after treatment (p<0.01. After treatment, using Seeman's method of digital compression of the larynx 48 % of patients regained satisfactory speech and voice clarity and 50% of them still presented mild dysphonia. Moderate dysphonia was registered in 2% but none of the patients had severe dysphonia. Discussion Central laryngeal palsies made 4% of our examined group, while according to the literature they make 1.2-8.7% of all laryngeal palsies. In majority of cases, paralysis of the recurrent laryngeal nerve was due to neck surgery (38%, but literature reports indicate that iatrogenic palsies are mostly due to operation of the thyroid. The well known fact that the left recurrent nerve is more frequently paralyzed, has been confirmed in

  4. An unusual case of acute wandering paralysis

    Federico Bianchi

    2016-01-01

    Full Text Available The authors reported on a 63-year-old diabetic male who developed a strange wandering hemiparesis affecting first left side and then right side, not consistent with a right parasagittal meningioma nor with ischemic stroke. The subsequent rapid worsening of clinical picture, with occurrence of paraparesis, urinary incontinence and midthoracic sensory level, together with the evidence of leucocytosis, led to the diagnosis of a T6-T7 spondylodiscitis with spinal cord compression. The authors underlied the difficulties in diagnosing this condition in the setting of general hospital practice and the importance of clinical and neurological examination.

  5. An unusual case of acute wandering paralysis

    Federico Bianchi; Quintino Giorgio D'Alessandris; Roberto Pallini; Eduardo Fernandez; Liverana Lauretti

    2016-01-01

    The authors reported on a 63-year-old diabetic male who developed a strange wandering hemiparesis affecting first left side and then right side, not consistent with a right para-sagittal meningioma nor with ischemic stroke. The subsequent rapid worsening of clinical picture, with occurrence of paraparesis, urinary incontinence and midthoracic sensory level, together with the evidence of leucocytosis, led to the diagnosis of a T6-T7 spon-dylodiscitis with spinal cord compression. The authors underlied the difficulties in diagnosing this condition in the setting of general hospital practice and the importance of clinical and neurological examination.

  6. Hypokalemic paralysis secondary to tenofovir induced fanconi syndrome

    Vishal V Ramteke; Deshpande, Rushi V.; Om Srivastava; Adinath Wagh

    2015-01-01

    Tenofovir induced fanconi syndrome (FS) presenting as hypokalemic paralysis is an extremely rare complication in patients on anti-retroviral therapy. We report a 50-year-old male with acquired immunodeficiency syndrome on tenofovir-based anti-retroviral therapy who presented with acute onset quadriparesis. On evaluation, he was found to have hypokalemia with hypophosphatemia, glucosuria and proteinuria suggesting FS. He regained normal power in limbs over next 12 h following correction of hyp...

  7. [Thyrotoxic hypokalemic periodic paralysis: report of one case].

    Frantchez, Victoria; Valiño, José; Carracelas, Analía; Dufrechou, Carlos

    2010-11-01

    Thyrotoxic hypokalemic periodic paralysis is characterized by attacks of generalized weakness associated to hypokalemia in patients with hyperthyroidism. We report a 25-year-old man with a history of spontaneously relapsing episodes of muscular weakness, who consulted for a rapidly evolving upper and lower limb paresis. Hypokalemia associated to a primary hyperthyroidism was detected. Treatment with antithyroid Drugs and potassium supplementation reverted symptoms and the episodes of acute muscular weakness did not reappear. PMID:21279257

  8. A rare case of thyrotoxic periodic paralysis precipitated by hydrocortisone

    Chakrabarti, Subrata

    2015-01-01

    Thyrotoxic periodic paralysis (TPP) is a rare, but serious condition characterized by acute paralytic attacks and hypokalemia in association with thyrotoxicosis. Although carbohydrate rich meals, strenuous exercise, alcohol, emotional stress are known precipitants of TPP, steroid treatment has rarely been reported to induce TPP. We report a case in which a patient with previously untreated Grave's disease developed TPP following administration of Intravenous hydrocortisone for control of seve...

  9. Recurrent Vocal Fold Paralysis and Parsonage-Turner Syndrome

    Marcus Vinicius Pinto; Lucia Joffily; Maurice Borges Vincent

    2013-01-01

    Background. Parsonage-Turner syndrome, or neuralgic amyotrophy (NA), is an acute brachial plexus neuritis that typically presents with unilateral shoulder pain and amyotrophy but also can affect other peripheral nerves, including the recurrent laryngeal nerve. Idiopathic vocal fold paralysis (VFP) represents approximately 12% of the VFP cases and recurrence is extremely rare. Methods and Results. We report a man with isolated recurrent unilateral right VFP and a diagnosis of NA years befo...

  10. Angiotensin converting enzyme inhibitor induced hyperkalaemic paralysis

    Dutta., D; Fischler, M; McClung, A

    2001-01-01

    Secondary hyperkalaemic paralysis is a rare condition often mimicking the Guillain-Barré syndrome. There have been a few case reports of hyperkalaemia caused by renal failure, trauma, and drugs where the presentation has been with muscle weakness. A case of hyperkalaemic paralysis caused by an angiotensin converting enzyme inhibitor is reported.


Keywords: hyperkalaemia; paralysis; ACE inhibitors

  11. Thyrotoxic periodic paralysis in a Saudi patient complicated by life-threatening arrhythmia

    Thyrotoxic periodic paralysis (TPP) is rare in non-Orientals, and sporadic case reports were reported world-wide. Eight cases were reported in Arabs, including 3 Saudis. We present an additional case of TPP in a 38-year-old Saudi man, and review the literature on TPP in Arabs. Our patient presented with complete flaccid quadriplegia, 5 weeks after he was diagnosed with Graves' disease that was treated with carbimazole and propranolol. He was hyperthyroid, and his potassium was extremely low (1.5 mmol/L). During initial evaluation in the emergency room, he developed transient asystole manifested by syncope. He was resuscitated and his hypokalemia was corrected, and he had a full recovery. This case emphasizes the notion that TPP can occur in patients of any ethnic background. The development of serious cardiac complications in our patient underscores the importance of early and correct diagnosis of this potentially life-threatening complication of hyperthyroidism. (author)

  12. [Hypokalemic periodic paralysis. A case report].

    Areta-Higuera, J D; Algaba-Montes, M; Oviedo-García, A Á

    2014-01-01

    Periodic paralysis is a rare disorder that causes episodes of severe muscle weakness that can be confused with other diseases, including epilepsy or myasthenia gravis. Hyperkalemic and hypokalemic paralysis are included within these diseases, the latter being divided into periodic paralysis (familial, thyrotoxic or sporadic) and non-periodic paralysis. In this regard, we present a case of familial hypokalemic periodic paralysis in an eighteen year-old female who was diagnosed with epilepsy in childhood, as well as a subclinical hypothyroidism (for which she received replacement therapy) months ago. The diagnosis was made by the anamnesis and the confirmation of hypokalemia. PMID:24360869

  13. 针刺配合情志护理综合干预对急性面瘫患者抑郁状态及睡眠质量的影响%Effect of Acupuncture Combined with Comprehensive Emotional Nursing Intervention on Acute Facial Paralysis Patients' Depresson and Sleep Quality

    翁子梅; 蔡南哨; 罗文舒

    2014-01-01

    目的:探讨针刺配合情志护理综合干预对急性面瘫的抑郁状态和睡眠质量的影响。方法随机选取2011年8月至2013年8月在我院接受针刺治疗的周围性面瘫患者160例,随机分为常规针刺法治疗的对照组80例,以及针刺配合情志护理综合干预的观察组80例,对比两组患者的抑郁状态、睡眠质量以及临床疗效。结果治疗4周后,观察组的抑郁评分为(42.16±5.02)分,显著低于对照组(孕<0.05);观察组的睡眠质量指数为(10.51±1.74)分,显著低于对照组(孕<0.05)。结论急性面瘫采用针刺配合情志护理综合干预的临床效果确切,能显著改善抑郁状态和睡眠质量,提高患者生活质量。%Objective To investigate the effect of acupuncture combined with comprehensive emotional nursing intervention on acute facial paralysis patients' depresson and sleep quality. Methods 160 patients with acute facial paralysis in our hospital from Aug. 2011 to Aug. 2013 were randomly divided into control group (common accupuncture treatment, n = 80) and observation group (accupuncture combined with comprehensive emotional nursing intervention, n=80). The status of depression, sleep quality and clinical curative effect were compared. Results After 4 weeks' treatment, the depression score of the observation group was (42.16±5.02), significantly lower than that of the control group (P <0.05). The sleep quality index of the observation group was (10.51±1.74), significantly lower than that of the control group (P<0.05). Conclusions Acupuncture combined with comprehensive emotional nursing intervention has exact clinical effect on acute facial paralysis, which can treat depression, enhance sleep quality significantly, and improve patients' life quality.

  14. Targeted nursing care in the treatment of 60 patients with acute facial paralysis by oral administration of traditional Chinese drugs combined with acupoint sticking therapy%中药内服联合穴位贴敷治疗急性面瘫60例针对性护理

    贾庭英

    2013-01-01

    目的:探讨中药内服联合穴位贴敷治疗急性面瘫患者的临床效果及针对性护理方法.方法:将120例急性面瘫患者随机分为观察组与对照组各60例.对照组给予常规治疗护理;观察组在此基础上给予牵正合剂内服联合穴位贴敷治疗,加强针对性护理.比较两组治疗效果、治愈时间及治疗费用.结果:观察组治疗总有效率高于对照组(P<0.05),医疗费用及治愈时间少于对照组(P<0.05).结论:中药内服联合穴位贴敷治疗急性面瘫患者的临床效果确切,针对性护理可提高治疗效率,缩短患者住院时间,减少医疗费用.%Objective:To study the efficacy of oral administration of traditional Chinese drugs combined with acupoint sticking therapy in the treatment of patients with acute facial paralysis and the targeted nursing methods.Methods:120 patients with acute facial paralysis were randomly divided into the observation group and the control group (60 cases in each group).The patients in the control group were given conventional treatment and nursing care and the patients in the observation group were treated with oral administration of Qianzheng mixture combined with acupoint sticking therapy and also given targeted nursing care based on the conventional one.The effect,time and cost of treatment were compared between the two groups.Results:The total effective rate was higher in the observation group than the control group (P < 0.05) ; the medical cost and time of cure was less and shorter in the observation group than the control group (P < 0.05).Conclusion:The clinical effect of oral administration of traditional Chinese drugs combined with acupoint sticking therapy is definite in the treatment of patients with acute facial paralysis,and targeted nursing care can improve the treatment efficiency,shorten and reduce hospitalization time and medical cost.

  15. Recurrent Hypokalemic Periodic Paralysis Unmasks Sjogren Syndrome without Sicca Symptoms.

    Hung, Yao-Min; Huang, Neng-Chyan; Wann, Shue-Ren; Chang, Yun-Te; Wang, Jyh-Seng

    2015-04-01

    Hypokalemic Periodic Paralysis (HPP) may occur as a rare complication of Sjogren Syndrome (SS) and Renal Tubular Acidosis (RTA). A 64-year male patient came with HPP, and was later diagnosed with distal RTA. The patient, who had no xerostomia and xerophthalmia, was diagnosed with primary SS from serologic and histologic findings of minor salivary gland biopsy. The patient recovered after potassium replacement therapy. Renal biopsy was also performed and revealed evidence of tubulointerstitial nephritis. Corticosteroids were administered and there was no recurrence of HPP during a 4-year follow-up period. The case highlights the significance of acute hypokalemia management in emergency department as it can unmask SS even if the SS is not associated with sicca symptoms. Hypokalemic paralysis associated with normal anion gap metabolic acidosis should prompt toward the diagnosis of SS. PMID:25933458

  16. Fatal Dysrhythmia Following Potassium Replacement for Hypokalemic Periodic Paralysis

    Ahmed, Imdad

    2010-02-01

    Full Text Available We present a case of fatal rebound hyperkalemia in a patient with thyrotoxic periodic paralysis (TPP treated with potassium supplementation. Although TPP is a rare hyperthyroidism-related endocrine disorder seen predominantly in men of Asian origin, the diagnosis should be considered in patients of non-Asian origins presenting with hypokalemia, muscle weakness or acute paralysis. The condition may present as a life threatening emergency and unfamiliarity with the disease could result in a fatal outcome. Immediate therapy with potassium chloride supplementation may foster a rapid recovery of muscle strength and prevent cardiac arrhythmias secondary to hypokalemia, but with a risk of rebound hyperkalemia. [West J Emerg Med. 2010; 11(1:57-59.

  17. Hypokalemic periodic paralysis; two different genes responsible for similar clinical manifestations

    Hunmin Kim

    2011-11-01

    Full Text Available Primary hypokalemic periodic paralysis (HOKPP is an autosomal dominant disorder manifesting as recurrent periodic flaccid paralysis and concomitant hypokalemia. HOKPP is divided into type 1 and type 2 based on the causative gene. Although 2 different ion channels have been identified as the molecular genetic cause of HOKPP, the clinical manifestations between the 2 groups are similar. We report the cases of 2 patients with HOKPP who both presented with typical clinical manifestations, but with mutations in 2 different genes (CACNA1S p.Arg528His and SCN4A p.Arg672His. Despite the similar clinical manifestations, there were differences in the response to acetazolamide treatment between certain genotypes of SCN4A mutations and CACNA1S mutations. We identified p.Arg672His in the SCN4A gene of patient 2 immediately after the first attack through a molecular genetic testing strategy. Molecular genetic diagnosis is important for genetic counseling and selecting preventive treatment.

  18. Hypokalemic periodic paralysis; two different genes responsible for similar clinical manifestations.

    Kim, Hunmin; Hwang, Hee; Cheong, Hae Il; Park, Hye Won

    2011-11-01

    Primary hypokalemic periodic paralysis (HOKPP) is an autosomal dominant disorder manifesting as recurrent periodic flaccid paralysis and concomitant hypokalemia. HOKPP is divided into type 1 and type 2 based on the causative gene. Although 2 different ion channels have been identified as the molecular genetic cause of HOKPP, the clinical manifestations between the 2 groups are similar. We report the cases of 2 patients with HOKPP who both presented with typical clinical manifestations, but with mutations in 2 different genes (CACNA1Sp.Arg528His and SCN4A p.Arg672His). Despite the similar clinical manifestations, there were differences in the response to acetazolamide treatment between certain genotypes of SCN4A mutations and CACNA1S mutations. We identified p.Arg672His in the SCN4A gene of patient 2 immediately after the first attack through a molecular genetic testing strategy. Molecular genetic diagnosis is important for genetic counseling and selecting preventive treatment. PMID:22253645

  19. Hypokalemic paralysis as primary presentation of Fanconi syndrome associated with Sjögren syndrome.

    Wang, Chih-Chiang; Shiang, Jeng-Chuan; Huang, Wen-Te; Lin, Shih-Hua

    2010-06-01

    Hypokalemic paralysis is a rare presentation of Fanconi syndrome (FS) caused by Sjögren Syndrome (SS). We describe a 39-year-old man who manifested flaccid paralysis of 4 limbs. Laboratory investigations showed profound hypokalemia (1.6 mmol/L) with renal K wasting, hyperchloremic metabolic acidosis with positive urine anion gap, hypophosphatemia with hyperphosphaturia, hypouricemia with hyperuricosuria, normoglycemic glycosuria, and abnormal serum creatinine concentration 2.2 mg/dL. A thorough survey for the cause of FS revealed that he had xerophthalmia and xerostomia accompanied by high anti-Ro antibody, positive Schirmer test, and delayed saliva excretion on sialoscintigraphy, confirming the diagnosis of SS. Potassium citrate, active vitamin D3, and high phosphate diet for his FS coupled with mycophenolate mofetil for SS resolved clinical symptoms and ameliorated renal function. Early recognition of HP due to the underlying SS-related FS with prompt therapy not only could terminate potentially life-threatening hypokalemia, but also improve renal outcome. PMID:20414123

  20. Hamstring transfer for quadriceps paralysis in post polio residual paralysis

    Jagadish J Patwa

    2012-01-01

    Conclusions: H to Q transfer in the presence of quadriceps paralysis with good power in hamstring is a better alternative than supracondylar osteotomy because it is a dynamic correction and it produces some degree of recurvatum with increasing stability of knee in extension while walking. While inserting hamstring over patella the periosteum is not cut in an I-shaped fashion to create a flap which gives additional strength to new insertion and also patella act as a fulcrum during the extension of knee by producing the bowstring effect.

  1. The devil is in the detail: Acute Guillain-Barré syndrome camouflaged as neurosarcoidosis in a critically ill patient admitted to an Intensive Care Unit

    Pooja Prathapan Sarada

    2016-01-01

    Full Text Available Guillain-Barré syndrome (GBS is an acute demyelinating polyneuropathy, usually evoked by antecedent infection. Sarcoidosis is a multisystem chronic granulomatous disorder with neurological involvement occurring in a minority. We present a case of a 43-year-old Caucasian man who presented with acute ascending polyradiculoneuropathy with a recent diagnosis of pulmonary sarcoidosis. The absence of acute flaccid paralysis excluded a clinical diagnosis of GBS in the first instance. Subsequently, a rapid onset of proximal weakness with multi-organ failure led to the diagnosis of GBS, which necessitated intravenous immunoglobulin and plasmapheresis to which the patient responded adequately, and he was subsequently discharged home. Neurosarcoidosis often masquerades as other disorders, leading to a diagnostic dilemma; also, the occurrence of a GBS-like clinical phenotype secondary to neurosarcoidosis may make diagnosing coexisting GBS a therapeutic challenge. This article not only serves to exemplify the rare association of neurosarcoidosis with GBS but also highlights the need for a high index of clinical suspicion for GBS and accurate history taking in any patient who may present with rapidly progressing weakness to an Intensive Care Unit.

  2. Increased vagal tone accounts for the observed immune paralysis in patients with traumatic brain injury.

    Kox, M.; Pompe, J.C.; Pickkers, P.; Hoedemaekers, C.W.E.; Vugt, A.B. van; Hoeven, J.G. van der

    2008-01-01

    Traumatic brain injury (TBI) is a leading cause of death and disability, especially in the younger population. In the acute phase after TBI, patients are more vulnerable to infection, associated with a decreased immune response in vitro. The cause of this immune paralysis is poorly understood. Apart

  3. Hemifacial paralysis in a child treated for leukemia: unusual side effect of omeprazole?

    Bauters, Tiene G M; Verlooy, Joris; Mondelaers, Veerle; Robays, Hugo; Laureys, Geneviève

    2010-06-01

    We report a hemifacial paralysis as an adverse drug reaction possibly related to the use of omeprazole in a patient with acute lymphoblastic leukemia. We believe that this case, although very rare, is clinically significant and worth mentioning, owing to the frequent use of omeprazole in the oncology setting. PMID:19617305

  4. Practical aspects in the management of hypokalemic periodic paralysis

    Levitt Jacob O

    2008-04-01

    Full Text Available Abstract Management considerations in hypokalemic periodic paralysis include accurate diagnosis, potassium dosage for acute attacks, choice of diuretic for prophylaxis, identification of triggers, creating a safe physical environment, peri-operative measures, and issues in pregnancy. A positive genetic test in the context of symptoms is the gold standard for diagnosis. Potassium chloride is the favored potassium salt given at 0.5–1.0 mEq/kg for acute attacks. The oral route is favored, but if necessary, a mannitol solvent can be used for intravenous administration. Avoidance of or potassium prophylaxis for common triggers, such as rest after exercise, high carbohydrate meals, and sodium, can prevent attacks. Chronically, acetazolamide, dichlorphenamide, or potassium-sparing diuretics decrease attack frequency and severity but are of little value acutely. Potassium, water, and a telephone should always be at a patient's bedside, regardless of the presence of weakness. Perioperatively, the patient's clinical status should be checked frequently. Firm data on the management of periodic paralysis during pregnancy is lacking. Patient support can be found at http://www.periodicparalysis.org.

  5. Recurrent Vocal Fold Paralysis and Parsonage-Turner Syndrome

    Marcus Vinicius Pinto

    2013-01-01

    Full Text Available Background. Parsonage-Turner syndrome, or neuralgic amyotrophy (NA, is an acute brachial plexus neuritis that typically presents with unilateral shoulder pain and amyotrophy but also can affect other peripheral nerves, including the recurrent laryngeal nerve. Idiopathic vocal fold paralysis (VFP represents approximately 12% of the VFP cases and recurrence is extremely rare. Methods and Results. We report a man with isolated recurrent unilateral right VFP and a diagnosis of NA years before. Conclusions. We emphasize that shoulder pain and amyotrophy should be inquired in any patient suffering from inexplicable dysphonia, and Parsonage-Turner syndrome should be considered in the differential diagnosis of idiopathic VFP.

  6. Tenofovir induced Fanconi syndrome: A rare cause of hypokalemic paralysis.

    Venkatesan, E P; Pranesh, M B; Gnanashanmugam, G; Balasubramaniam, J

    2014-03-01

    We report a 55-year-old female who presented to the emergency department with acute onset quadriparesis. She was diagnosed to have acquired immunodeficiency syndrome 7 years ago and was on tenofovir based anti-retroviral therapy for past 10 months. As the patient also had hypophosphatemia, glucosuria and proteinuria Fanconi syndrome (FS) was suspected. She improved dramatically over next 12 h to regain normal power and also her renal functions improved over next few days. Tenofovir induced FS presenting as hypokalemic paralysis is very rare complication and is the first case reported from India. PMID:24701043

  7. Hypokalemic paralysis secondary to tenofovir induced fanconi syndrome.

    Ramteke, Vishal V; Deshpande, Rushi V; Srivastava, Om; Wagh, Adinath

    2015-01-01

    Tenofovir induced fanconi syndrome (FS) presenting as hypokalemic paralysis is an extremely rare complication in patients on anti-retroviral therapy. We report a 50-year-old male with acquired immunodeficiency syndrome on tenofovir-based anti-retroviral therapy who presented with acute onset quadriparesis. On evaluation, he was found to have hypokalemia with hypophosphatemia, glucosuria and proteinuria suggesting FS. He regained normal power in limbs over next 12 h following correction of hypokalemia. Ours would be the second reported case in India. PMID:26692618

  8. Hypokalemic paralysis secondary to tenofovir induced fanconi syndrome

    Vishal V Ramteke

    2015-01-01

    Full Text Available Tenofovir induced fanconi syndrome (FS presenting as hypokalemic paralysis is an extremely rare complication in patients on anti-retroviral therapy. We report a 50-year-old male with acquired immunodeficiency syndrome on tenofovir-based anti-retroviral therapy who presented with acute onset quadriparesis. On evaluation, he was found to have hypokalemia with hypophosphatemia, glucosuria and proteinuria suggesting FS. He regained normal power in limbs over next 12 h following correction of hypokalemia. Ours would be the second reported case in India.

  9. Recurrent Vocal Fold Paralysis and Parsonage-Turner Syndrome

    Joffily, Lucia; Vincent, Maurice Borges

    2013-01-01

    Background. Parsonage-Turner syndrome, or neuralgic amyotrophy (NA), is an acute brachial plexus neuritis that typically presents with unilateral shoulder pain and amyotrophy but also can affect other peripheral nerves, including the recurrent laryngeal nerve. Idiopathic vocal fold paralysis (VFP) represents approximately 12% of the VFP cases and recurrence is extremely rare. Methods and Results. We report a man with isolated recurrent unilateral right VFP and a diagnosis of NA years before. Conclusions. We emphasize that shoulder pain and amyotrophy should be inquired in any patient suffering from inexplicable dysphonia, and Parsonage-Turner syndrome should be considered in the differential diagnosis of idiopathic VFP. PMID:24288639

  10. Recurrent vocal fold paralysis and parsonage-turner syndrome.

    Pinto, Marcus Vinicius; Joffily, Lucia; Vincent, Maurice Borges

    2013-01-01

    Background. Parsonage-Turner syndrome, or neuralgic amyotrophy (NA), is an acute brachial plexus neuritis that typically presents with unilateral shoulder pain and amyotrophy but also can affect other peripheral nerves, including the recurrent laryngeal nerve. Idiopathic vocal fold paralysis (VFP) represents approximately 12% of the VFP cases and recurrence is extremely rare. Methods and Results. We report a man with isolated recurrent unilateral right VFP and a diagnosis of NA years before. Conclusions. We emphasize that shoulder pain and amyotrophy should be inquired in any patient suffering from inexplicable dysphonia, and Parsonage-Turner syndrome should be considered in the differential diagnosis of idiopathic VFP. PMID:24288639

  11. [The history of facial paralysis].

    Glicenstein, J

    2015-10-01

    Facial paralysis has been a recognized condition since Antiquity, and was mentionned by Hippocratus. In the 17th century, in 1687, the Dutch physician Stalpart Van der Wiel rendered a detailed observation. It was, however, Charles Bell who, in 1821, provided the description that specified the role of the facial nerve. Facial nerve surgery began at the end of the 19th century. Three different techniques were used successively: nerve anastomosis, (XI-VII Balance 1895, XII-VII, Korte 1903), myoplasties (Lexer 1908), and suspensions (Stein 1913). Bunnell successfully accomplished the first direct facial nerve repair in the temporal bone, in 1927, and in 1932 Balance and Duel experimented with nerve grafts. Thanks to progress in microsurgical techniques, the first faciofacial anastomosis was realized in 1970 (Smith, Scaramella), and an account of the first microneurovascular muscle transfer published in 1976 by Harii. Treatment of the eyelid paralysis was at the origin of numerous operations beginning in the 1960s; including palpebral spring (Morel Fatio 1962) silicone sling (Arion 1972), upperlid loading with gold plate (Illig 1968), magnets (Muhlbauer 1973) and transfacial nerve grafts (Anderl 1973). By the end of the 20th century, surgeons had at their disposal a wide range of valid techniques for facial nerve surgery, including modernized versions of older techniques. PMID:26088742

  12. Unilateral traumatic oculomotor nerve paralysis

    The present authors report a case of unilateral traumatic oculomotor nerve paralysis which shows interesting CT findings which suggest its mechanism. A 60-year-old woman was admitted to our hospital with a cerebral concussion soon after a traffic accident. A CT scan was performed soon after admission. A high-density spot was noted at the medial aspect of the left cerebral peduncle, where the oculomotor nerve emerged from the midbrain, and an irregular, slender, high-density area was delineated in the right dorsolateral surface of the midbrain. Although the right hemiparesis had already improved by the next morning, the function of the left oculomotor nerve has been completely disturbed for the three months since the injury. In our case, it is speculated that an avulsion of the left oculomotor nerve rootlet occurred at the time of impact as the mechanism of the oculomotor nerve paralysis. A CT taken soon after the head injury showed a high-density spot; this was considered to be a hemorrhage occurring because of the avulsion of the nerve rootlet at the medial surface of the cerebral peduncle. (J.P.N.)

  13. An unusual case of dengue infection presenting with hypokalemic paralysis with hypomagnesemia.

    Jain, Rajendra Singh; Gupta, Pankaj Kumar; Agrawal, Rakesh; Kumar, Sunil; Khandelwal, Kapil

    2015-08-01

    Neurological manifestations are unusual in dengue fever and can be due to neurotropic effect, systemic complications of dengue infection, or immune mediated. Acute hypokalemic paralysis is a rare systemic complication of dengue infection; however, hypokalemia along with hypomagnesemia has not been reported earlier. We herein report an extremely unusual and probably the first case of dengue infection in a 30-year-old male who presented to us with hypokalemic paralysis along with hypomagnesemia. This case report highlights that hypomagnesemia may be a significant complication in dengue infection. Correction of hypomagnesemia is of paramount importance to avoid refractory hypokalemia leading to severe consequences. PMID:26209406

  14. An unusual case of hypokalemic paralysis associated with primary Sjogren's syndrome.

    Toy, Walton C; Jasin, Hugo E

    2008-06-01

    43-year-old Caucasian female presented with progressive weakness and dyspnea. She was diagnosed with hypokalemic paralysis from a severe distal renal tubular acidosis (RTA). Immunologic work-up showed a strongly positive ANA of 1:640 and positive antibodies to SSA and SSB. Schirmer's test was normal. Renal involvement in Sjogren's syndrome (SS) is not uncommon and may precede sicca complaints. The pathology in most cases is a tubulointerstitial nephritis causing among other things, distal RTA, and, rarely, hypokalemic paralysis. Treatment consists of potassium repletion, alkali therapy and corticosteroids. Primary SS should be a differential in premenopausal women with acute weakness and hypokalemia. PMID:18564466

  15. Granulocytic Sarcoma Presenting as Atypical Mastoiditis with Facial Paralysis: Description of a Case

    M. Crovetto

    2011-01-01

    Full Text Available We describe a case of temporal granulocytic sarcoma in a 26-year-old patient after apparent molecular remission of an acute myeloid leukaemia. He complained of otodynia with hearing loss and facial paralysis on the right side. He was treated with chemotherapy and self-transplant haematopoietic stem cells. He was cured clinically, molecular remission of the haematological processes was achieved, and he remained asymptomatic for three years. Facial paralysis and hearing loss associated with temporal GS should be treated with chemotherapy. Aggressive surgery may complicate the clinical course of the disease and it should be avoided.

  16. "A Study of the Characteristrics of Hypokalemic Paralysis in Patient Hospitalized in Shahid Beheshti Hospital During 1990 –2000"

    SA Masoud

    2001-09-01

    Full Text Available Hypokalemic disease is a disorder in which the amount of serum’ s potassium declines and the patient faces limbs weakness. In this disease, eye muscle and respiratory muscles rarely become involved and death may follow due to respiratory paralysis and heart conducting disturbances. Since this disease is treatable and progressive weakness can be prevented, therefore in the study conducted we attempted to compare between the causes and epidemiological characteristics and start of clinical manifestation and the characteristics of this diseases with what had been presented in classical text and foreign sources in order to take effective measure for timely diagnosis. This was a descriptive prospective study. The records of hypocalemically paralyzed patients hospitalized in shahid Beheshti Hospital of Kashan during 1990 to 2000 were used to collect the data such as general condition of the patient, systematic and neurologic examination, serum potasium level, ABG, and paramedical measures like ECG were extracted and used for analysis. 27 patients were identified as Hypokalemic afflicted to paralysis and all were sporadic cases. The starting age for weakness attack was mostly in the second to fourth decade of life. The mean age for attack was 29 years . 96.3 percent were male and the rest were female. The level of potasium in serum of these patients during the weakness attack was mostly within 1 to 3.5 meq/L and the most changes in ECG was related to decrease in height at T and appearance of U- waves. 11 patients have more than 3 attacks (40.7 percent , 10 patients faced all-attacks (37.3 percent and 6 patients experienced 2 times attack (22 percent.Considering that hypokalemic paralysis disorder is a treatable disease and immediate diagnosis and treatment reduces cardiac and muscular problems, it is necessary for the physican who treat patients referring with flaccid paralysis to keep in mind four limbs of this disease and use diagnostic measures.

  17. Comparative study of thyrotoxic periodic paralysis from idiopathic hypokalemic periodic paralysis: An experience from India

    Kalita, J; G Goyal; Bhoi, S. K.; Chandra, S.; Misra, U K

    2012-01-01

    Objective: There is paucity of reports on thyrotoxic periodic paralysis (TPP) from India. We report the patients with TPP and compare them with idiopathic hypokalemic periodic paralysis (IHPP). Materials and Methods: Patients with hypokalemic periodic paralysis (HPP) treated during the past 11 years were evaluated retrospectively. Their demographic parameters, family history, clinical features, precipitating factors, severity of weakness, laboratory parameters and rapidity of recovery were re...

  18. The diagnostic value of nerve conduction in children with acute flabby paralysis%神经传导功能在小儿急性驰缓性瘫痪中的诊断价值

    王莉; 詹学; 冯成功; 兰兴会

    2002-01-01

    目的:探讨神经传导功能在小儿急性驰缓性瘫痪(acuteflabby paralysis,AFP)中表现特征和诊断价值.方法:167例AFP患儿进行周围神经运动、感觉传导功能检查和结果分析.结果:(1)格林-巴利综合征45.9%神经运动肌肉复合电位(CMAP)消失,54.1%波幅显著降低,其中29.7%运动传导速度(MCV)异常延迟;F波异常89.2%;(2)注射性神经损伤患侧CMAP消失和波幅显著下降分别是68.9%和20%,MCV延迟2.2%;(3)灰髓炎综合征27.9%患侧CMAP波幅轻度降低.(4)肌病和急性脊髓炎MCV、SCV正常,但后者F波均异常.(5)肱骨骨折桡神经CMAP消失92.3%.结论:(1)周围神经传导功能检查结果,能明确病变部位和性质,有助于小儿AFP鉴别诊断.

  19. Voltage Sensors in Hypokalemic Periodic Paralysis

    J Gordon Millichap

    2009-06-01

    Full Text Available Researchers at the National Hospital, Queen Square, London, UK, conducted automated DNA sequencing of the S4 regions of CACNA1S and SCN4A in 83 patients with hypokalemic periodic paralysis (HypoPP.

  20. An unusual cause of bilateral diaphragmatic paralysis.

    Pandit, A; Kalra, S.; Woodcock, A

    1992-01-01

    In a patient who had a sudden onset of bilateral diaphragmatic paralysis after forceful neck manipulation complete, though gradual, recovery in lung function and transdiaphragmatic pressures was seen over three years. This is a previously unrecognised risk of neck osteopathy.

  1. Clinical and diagnostic characteristics of patients with suspected polyneuropathy

    Mikhailova Е.V.; Zaitseva I.A.; Karalsky S.A.; Karalskaya Zh.Zh.; Kaschaev B.A.

    2013-01-01

    Objective: to study the causes and clinical manifestations of disease in children referred for hospitalization in children infectious diseases hospital in Saratov with a diagnosis of «acute flaccid paralysis». Material and methods: 157 children with the diagnosis on admission of the guide «acute flaccid paralysis». Conducted clinical examination and laboratory tests included a general analysis of cerebrospinal fluid, urine, virological examination of nasal swabs and faeces, with the definitio...

  2. Thyrotoxic periodic paralysis in Caucasian patients: a diagnostic challenge.

    Pichon, Bertrand; Lidove, Olivier; Delbot, Thierry; Aslangul, Elisabeth; Hausfater, Pierre; Papo, Thomas

    2005-09-01

    Secondary hypokalemic periodic paralysis is rare. However, when it occurs, it is usually associated with Graves' disease and it is mostly diagnosed in Asiatic male patients. In this report, we analyze the diagnostic procedure in three cases of hypokalemic periodic paralysis associated with Graves' disease, diagnosed in three different emergency care units over the last 3 years. Three Caucasian men (26, 30, and 39 years of age) came to the emergency care unit for acute tetraparesia. One of them had suffered 15 stereotypical episodes of tetraparesia during the last 2 years. Goiter was present in each case. Kalemia was 1.8, 2.1, and 3 mmol/l, respectively. Triggering events such as considerable sugar intake and physical exercise were present in two cases. In all cases, low TSH levels, high FT4 levels, and anti-TSH receptor antibodies led to the diagnosis of Graves' disease. All patients were treated with potassium supplementation and neomercazole. Outcome was good with a follow-up of 6, 9, and 24 months, respectively. Emergency care practitioners should be aware of this diagnosis, which may affect Caucasian patients presenting with transient tetraparesia in a primary care unit. PMID:16137557

  3. Hypokalemic paralysis in a professional bodybuilder.

    Mayr, Florian B; Domanovits, Hans; Laggner, Anton N

    2012-09-01

    Severe hypokalemia is a potentially life-threatening disorder and is associated with variable degrees of skeletal muscle weakness, even to the point of paralysis. On rare occasions, diaphragmatic paralysis from hypokalemia can lead to respiratory arrest. There may also be decreased motility of smooth muscle, manifesting with ileus or urinary retention. Rarely, severe hypokalemia may result in rhabdomyolysis. Other manifestations of severe hypokalemia include alteration of cardiac tissue excitability and conduction. Hypokalemia can produce electrocardiographic changes such as U waves, T-wave flattening, and arrhythmias, especially if the patient is taking digoxin. Common causes of hypokalemia include extrarenal potassium losses (vomiting and diarrhea) and renal potassium losses (eg, hyperaldosteronism, renal tubular acidosis, severe hyperglycemia, potassium-depleting diuretics) as well as hypokalemia due to potassium shifts (eg, insulin administration, catecholamine excess, familial periodic hypokalemic paralysis, thyrotoxic hypokalemic paralysis). Although the extent of diuretic misuse in professional bodybuilding is unknown, it may be regarded as substantial. Hence, diuretics must always be considered as a cause of hypokalemic paralysis in bodybuilders. PMID:21871759

  4. [Hypokalemic periodic paralysis provoked by "Ambene"].

    Wessel, K; Schumm, F; Peiffer, J; Schlote, W

    1985-12-01

    The case of a 42-year-old man is reported, who on four occasions developed a hypokalaemic periodic paralysis after an intramuscular injection of "Ambene". The detailed examination of this patient shows, that it is the primary, autosomal dominant inherited form of hypokalaemic periodic paralysis, and not the secondary form, which is caused by a renal or gastrointestinal loss of potassium. Clinical and electrophysiological, as well as histopathological and electron microscopic findings are presented, showing the typical vacuolar myopathy with submicroscopic tubular structures. In the literature there is evidence for an increased sensitivity of the muscle membrane to insulin with an increased potassium-shift inside the cell in hypokalaemic periodic paralysis. "Ambene" is a combination, which contains amongst other substances dexamethasone and the local anaesthetic drug lidocain. In the present case the paresis was possibly caused by a combined effect of dexamethasone with a consequent hyperglycaemia and lidocain with a change in the excitability of the muscle membrane. The pathophysiological mechanism of hypokalaemic periodic paralysis is discussed in terms of the release by the combination of these two drugs. It has not previously been reported that "Ambene" can provoke a hypokalaemic periodic paralysis. This is a severe side effect because of the resulting cardiac and respiratory problems. PMID:2936967

  5. Radiation-induced brachial plexus paralysis

    Fifteen patients with radiation-induced brachial plexus paralysis were studied. Thirteen women had been treated for breast cancer. Two men developed symptoms and signs following radiation therapy for lung cancer. The brachial plexus paralysis initially was not static and progressed, but spontaneous arrest with permanent residual paralysis was seen in three patients. Three were noted to have intractable pain, but the major complaint of the remaining 12 was the inability to use their hands. The ten patients on whom an earlier operation directed at the brachial plexus had been performed were not relieved. Two of these were later considered excellent candidates for a tendon transfer in the hand. One did not desire surgery. The other underwent operation and showed marked improvement of her grasp and general hand function

  6. Thyrotoxicosis, myasthenia gravis and periodic paralysis in a Chinese man.

    Lee, K. O.; Guan, R.; Ee, B.; Cheah, J. S.

    1985-01-01

    The association of myasthenia gravis and periodic paralysis in thyrotoxicosis has not been reported before. We describe a Chinese man with thyrotoxicosis and myasthenia gravis, who subsequently developed periodic paralysis. The possible aetiological links are discussed.

  7. Periodic paralysis: clinical evaluation in 20 patients

    Célia Harumi Tengan

    1994-12-01

    Full Text Available Twenty patients with periodic paralysis were evaluated and the aspects studied included epidemiological data, clinical manifestations, ancillary tests, treatment and evolution. Sixteen patients had the hypokalemic form (5 familiar, 5 sporadic, 5 thyrotoxic and 1 secondary. No patient with the normokalemic form was detected. Predominance of men was found (14 patients, especially in the cases with hyperthyroidism (5 patients. No thyrotoxic patient was of oriental origin. Only 4 patients had the hyperkalemic form (3 familiar, 1 sporadic. Attacks of paralysis began during the first decade in the hyperkalemic form and up to the third decade in the hypokalemic. In both forms the attacks occurred preferentially in the morning with rest after exercise being the most important precipitating factor. Seventy five percent of the hyperkalemic patients referred brief attacks (<12 hours. Longer attacks were referred by 43% of the hypokalemic patients. The majority of the attacks manifested with a generalized weakness mainly in legs, and its frequency was variable. Creatinokinase was evaluated in 10 patients and 8 of them had levels that varied from 1,1 to 5 times normal. Electromyography was done in 6 patients and myotonic phenomenon was the only abnormality detected in 2 patients. Carbonic anhydrase inhibitors, especially acetazolamide, were used for prophylactic treatment in 9 pacients with good results in all. Although periodic paralysis may be considered a benign disease we found respiratory distress in 5 patients, permanent myopathy in 1, electrocardiographic abnormalities during crises in 4; death during paralysis occurred in 2. Therefore correct diagnosis and immediate treatment are crucial. This study shows that hyperthyroidism is an important cause of periodic paralysis in our country, even in non oriental patients. Hence endocrine investigation is mandatory since this kind of periodic paralysis will only be abated after return to the euthyroid state.

  8. A 32-year-old Man with Normokalemic Thyrotoxic Periodic Paralysis

    Valizadeh, Neda; Zarrin, Sahar

    2013-01-01

    Thyrotoxic Periodic Paralysis (TPP) is a rare and life threatening condition commonly occurring in young Asian males. It is characterized by acute paralytic attacks and hypokalemia in association with thyrotoxicosis. Serum potassium levels may be normal in rare cases of TPP. The diagnosis of normokalemic TPP may be overlooked and/or delayed in most cases. Here, we describe a 32-year-old Iranian man with normokalemic TPP misdiagnosed as somatization disorder with the correct diagnosis made one...

  9. Increased vagal tone accounts for the observed immune paralysis in patients with traumatic brain injury.

    Kox, M; Pompe, J.C.; Pickkers, P; Hoedemaekers, C.W.E.; van Vugt, A. B.; van der Hoeven, J. G.

    2008-01-01

    Traumatic brain injury (TBI) is a leading cause of death and disability, especially in the younger population. In the acute phase after TBI, patients are more vulnerable to infection, associated with a decreased immune response in vitro. The cause of this immune paralysis is poorly understood. Apart from other neurologic dysfunction, TBI also results in an increase in vagal activity. Recently, the vagus nerve has been demonstrated to exert an anti-inflammatory effect, termed the cholinergic a...

  10. Corticosteroid Induced Hypokalemic Periodic Paralysis: A Case Report

    Kaçan, Turgut; BALOĞLU, Selen KAÇAN; ÇUBUKÇUOĞLU, Tarık

    2013-01-01

    Hypokalemic periodic paralysis (HPP) is a rare disease characterized by reversible attacks of muscle weakness due to hypokalemia. The attacks may occur everyday, weak, month or once a year and may last for a few hours to several days. The serum potassium level is low during the attack. However, the serum potassium levels are normal between two attacks. The most common causes of HPP are familial periodic paralysis (FPP), thyrotoxic periodic paralysis (TPP) and sporadic periodic paralysis (S...

  11. Vocal Cord Paralysis and its Etiologies: A Prospective Study

    Seyed Javad Seyed Toutounchi; Mahmood Eydi; Samad EJ Golzari; Mohammad Reza Ghaffari; Nashmil Parvizian

    2014-01-01

    Introduction: Vocal cord paralysis is a common symptom of numerous diseases and it may be due to neurogenic or mechanical fixation of the cords. Paralysis of the vocal cords is just a symptom of underlying disease in some cases; so, clinical diagnosis of the underlying cause leading to paralysis of the vocal cords is important. This study evaluates the causes of vocal cord paralysis. Methods: In a prospective study, 45 patients with paralyzed vocal cord diagnosis were examined by tests such a...

  12. Hyperkalaemic paralysis--a bizarre presentation of renal failure.

    Cumberbatch, G L; Hampton, T J

    1999-05-01

    Paralysis due to hyperkalaemia is rare and the diagnosis may be overlooked in the first instance. However it is rapidly reversible and so long as electro-cardiography and serum potassium measurement are urgently done in all patients presenting with paralysis, it will not be missed. A case of hyperkalaemic paralysis is described and a review of the emergency management discussed. PMID:10353058

  13. Hyperkalaemic paralysis--a bizarre presentation of renal failure.

    Cumberbatch, G L; Hampton, T. J.

    1999-01-01

    Paralysis due to hyperkalaemia is rare and the diagnosis may be overlooked in the first instance. However it is rapidly reversible and so long as electro-cardiography and serum potassium measurement are urgently done in all patients presenting with paralysis, it will not be missed. A case of hyperkalaemic paralysis is described and a review of the emergency management discussed.

  14. 运动想象疗法对急性脑梗死患者上肢瘫痪的效果及脑功能MRI的改变%Effects and changes of brain functional MRI of motor imagery therapy on acute cerebral infarction patients with upper limb paralysis

    冉茂胜; 叶建军; 马东兵; 张莉; 胡杰杰; 杨旭君; 乔小民; 姜晓萍

    2013-01-01

    Objective To investigate the effects and changes of brain functional MRI (fMRI) of motor imagery therapy on acute cerebral infarction ( ACI) patients with upper limb paralysis. Methods Seventy cases of ACI patients with hemiplegia were randomly divided into the control group (drug therapy + exercise) and motor imagery therapy group, each group had 35 cases. The treatment of motor imagery therapy group was on the basis of control group, add into motor imagery therapy, 2 times a day, for 30 d. Before and 30 d after treatment, the patients were scored by Fugl-Meyer scale (FMA) and functional independence measure scale (FIM) , the active range of motion ( AROM) of ipsilateral wrist was measured by a protractor, and the brain movement activation range was measured by blood oxygen level dependent fMRI. Results After treatment, the FMA, FIM scores of paralysis upper extremity, the AROM and range of brain activation were significantly higher or bigger than before treatment in the two groups (P<0. 05 -0.01). And these indicators of motor imagery therapy group were significantly higher or bigger than those in the control group (P<0. 05 —0.01). Conclusions Motor imagery therapy can promote the recovery of the upper limb motor function in acute cerebral infarction patients with hemiplegia, and expand the brain movement activation range on fMRI.%目的 研究运动想象疗法对急性脑梗死患者上肢瘫痪的效果及脑功能MRI(fMRI)的改变.方法 70例脑梗死偏瘫患者,随机分为对照组(药物治疗+运动)和运动想象治疗组,每组35例.运动想象治疗组在对照组的治疗基础上,进行运动想象疗法,每天2次,连续30 d.在治疗前和治疗后30 d,给患者进行Fugl-Meyer量表(FMA)、功能独立性评定量表(FIM)评分,用量角器测定患侧手腕主动活动范围(AROM);用血氧水平依赖性fMRI测定脑运动激活区范围.结果 两组患者治疗后瘫痪上肢的FMA、FIM评分、AROM及脑激活区的范围均明

  15. Abdominal muscle paralysis associated with herpes zoster.

    Gottschau, P; Trojaborg, W

    1991-10-01

    We describe a 77-year-old women with cutaneous herpes zoster in the area of the right T9-T11 dermatomes complicated by abdominal muscle paralysis. Four months after onset of paralysis, stimulation of appropriate intercostal nerves failed to evoke responses from the corresponding segments of the rectus abdominis muscle. Three months later EMG of these muscle segments revealed profuse denervation activity and spontaneous long-lasting burst of high frequency discharges. Magnetic stimulation applied transcranially and peripherally at T10 evoked responses from the left, but not from the right paralytic rectus abdominis muscle. Electric stimulation of right T10 elicited a markedly delayed, prolonged and polyphasic response in the transverse abdominis muscle and EMG revealed polyphasia and increased motor unit potential duration in muscle segments underlying herpes zoster eruption. One and a half years after onset, the paralysis of the rectus abdominis muscle was still present. A survey of the literature concerning this rare type of zoster paralysis is presented. PMID:1837649

  16. GOLD WEIGHTS IN FACIAL PARALYSIS (REVISITED)

    ZECHA, PJ; ROBINSON, PH; VANOORT, RP; COENRAADS, PJ

    1994-01-01

    A retrospective study of 11 patients with facial paralysis was undertaken. Correction of lagophthalmos was accomplished by inserting a dental gold weight into the upper eyelid. All weights were assessed and adjusted to fit the patient's individual need. The primary objective was to achieve adequate

  17. Molecular basis for hyperkalemic periodic paralysis.

    Brown, R H

    At least one form of periodic paralysis is a direct consequence of a mutation in a skeletal muscle, voltage-sensitive sodium channel--it was observed that many individual with this disease developed low serum potassium levels during paralytic episodes. Some families had hyperkalemic paralysis with serum potassium levels of 6 or 7 mEg/L during paralytic crises. In both hypokalemic and hyperkalemic paralysis one of the precipitants is a period of rest after exertion. In hypokalemic periodic paralysis carbohydrates may initiate weakness. In both hyper- and hypokalemic forms, the disorder is inherited as an autosomal dominant trait. During hypokalemic and hyperkalemic paralysis, one might respectively anticipate muscle hyperpolarization or depolarization. Has been observed a potassium-related abnormality of sodium conductance in the pathogenesis at least of the hyperkalemic form of periodic paralysis. The fact that TTX reverses the physiological defect suggested the hypothesis that the primary problem might be a mutation in a TTX-sensitive sodium channel. The protein consists of some 2000 amino acids with characteristic intracytoplasmic and extracellular domains as well a four remarkably conserved membrane spanning domains, each composed of six transmembrane of a polymorphism of the human sodium channel with hyperkalemic paralysis. When multipoint analysis was used to test for coinheritance of the disease with both Na-2 and growth hormone polymorphisms, a lod score of 7 was obtained. That is, the ratio of the probability of linkage to non-linkage is 10 million to one. When extracellular potassium is increased to 10 mM, the affected myotubes demonstrate strikingly abnormal channel behavior characterized by prolonged open times or repetitive opens throughout the voltage step. Potassium implicate as a primary factor triggering an abnormal sodium channel gating mode and, as a result, aberrant sodium current behavior. It was estimated that, for the normal channel, the

  18. Normokalemic thyrotoxic periodic paralysis with preserved reflexes- a unique case report.

    Chakrabarti, Subrata

    2015-02-01

    Although serum potassium levels are usually subnormal in Thyrotoxic Periodic Paralysis (TPP), but in exceptionally rare circumstances, it may be normal leading to the entity called normokalemic TPP. The diagnosis of normokalemic TPP is more often overlooked and/or delayed due to lack of awareness among the physicians and associated mild symptoms of hyperthyroidism. Here, the author describes the case of a 27-year-old male with newly diagnosed but untreated Grave's disease and TPP who was normokalemic during the acute phase of paralysis. Hypokalemia was documented only after resolution of paralytic attacks during subsequent days of admission. The importance of the case report is to highlight upon the fact that TPP should always be considered in an "previously asymptomatic" young Asian individual with acute paralysis with or without hypokalemia , and thyroid function and serial potassium values should be evaluated for diagnosing the usual hypokalemic type or the more rarer variant normokalemic TPP. This case report also deserves mention as the patient of TPP had a notable feature of having preserved reflexes in the face of hypokalemia. PMID:25859483

  19. Clinic-Radiological Study of facial paralysis

    We have gathered 159 cases of facial paralysis from recent records in our hospital, including paralyses of central as well as peripheral origin, and presenting as the only symptom or as one of several major symptoms of the discomfort of each patient. Sixty-four percent of them were studied by CT scan and/or MR, confirming the existence of alterations in the pathway of nerve pair VII in 50% of the patients who underwent radiological study. Idiopathic facial paralysis was the most common type (42% of the total); while tumors and post-traumatic findings were the most constant radiological findings. From the analysis of the data, the importance of the clinical criteria for selection of the patients in the study and the protocol for radiological diagnosis employed can be deduced. (author)

  20. Thyrotoxic Hypokalemic Periodic Paralysis: A Case Report

    Murat Atmaca

    2012-12-01

    Full Text Available Thyrotoxic hypokalemic periodic paralysis is a rare complication of thyrotoxicosis. This clinic condition is often encountered in Asian populations and male gender while thyrotoxicosis is frequently seen in women. The escape of potassium into cell is the mechanism responsible for this disease and its etiology is not completely known. Thyroid hormones, carbohydrate rich diet, alcohol consumption and excessive exercise are regarded as the precipitating factors. This clinical picture is generally difficult to define at first attack. Here, we report a forty-two-year-old male patient with Basedow-Graves disease who was diagnosed as having thyrotoxic hypokalemic periodic paralysis during the first paralytic attack. His symptoms improved after potassium replacement and treatment with beta-blocker and antithyroid drugs. The permanent cure was achieved with radioactive iodine ablation therapy. Turk Jem 2012; 16: 69-71

  1. Paralysie musculaire secondaire à une polymyosite

    Ennafiri, Meryem; Elotmani, Wafae; Awab, Almahdi; El Moussaoui, Rachid; El Hijri, Ahmed; Alilou, Mustapha; Azzouzi, Abderrahim

    2015-01-01

    Les polymyosites sont des maladies inflammatoires des muscles striés, d’étiologie inconnue. Le déficit musculaire, qui se résume généralement à une fatigabilité, évolue de façon bilatérale, symétrique et non sélective avec prédominance sur les muscles proximaux. L'intensité de la faiblesse musculaire est variable d'un sujet à un autre, de la simple gêne fonctionnelle à un état grabataire. Nous rapportons l'observation d'un cas de polymyosite particulièrement sévère avec paralysie musculaire complète, touchant tous les muscles de l'organisme, d’évolution favorable sous immunoglobulines intraveineuses et nous discutons les facteurs favorisant la paralysie musculaire. PMID:26185559

  2. Vocal cord paralysis caused by stingray.

    Kwon, Oh Jin; Park, Jung Je; Kim, Jin Pyeong; Woo, Seung Hoon

    2013-11-01

    Foreign bodies in the oral cavity and pharynx are commonly encountered in the emergency room and outpatient departments, and the most frequently observed of these foreign bodies are fish bones. Among the possible complications resulting from a pharyngeal foreign body, vocal cord fixation is extremely rare, with only three cases previously reported in the English literature. The mechanisms of vocal cord fixation can be classified into mechanical articular fixation, direct injury of the recurrent laryngeal nerve, or recurrent laryngeal nerve paralysis secondary to inflammation. The case discussed here is different from previous cases. We report a rare case of vocal cord paralysis caused by the venom of a stingray tail in the hypopharynx. PMID:24077868

  3. Hypokalemic periodic paralysis in Sjogren's syndrome secondary to distal renal tubular acidosis.

    Yılmaz, Hakkı; Kaya, Mustafa; Özbek, Mustafa; ÜUreten, Kemal; Safa Yıldırım, İ

    2013-07-01

    We report a 53-year-old Turkish female presented with progressive weakness and mild dyspnea. Laboratory results demonstrated severe hypokalemia with hyperchloremic metabolic acidosis. The urinary anion gap was positive in the presence of acidemia, thus she was diagnosed with hypokalemic paralysis from a severe distal renal tubular acidosis (RTA). Immunologic work-up showed a strongly positive ANA of 1:3,200 and positive antibodies to SSA and SSB. Schirmer's test was abnormal. Autoimmune and other tests revealed Sjögren syndrome as the underlying cause of the distal renal tubular acidosis. Renal involvement in Sjogren's syndrome (SS) is not uncommon and may precede sicca complaints. The pathology in most cases is a tubulointerstitial nephritis causing among other things, distal RTA, and, rarely, hypokalemic paralysis. Treatment consists of potassium repletion, alkali therapy, and corticosteroids. Primary SS could be a differential in women with acute weakness and hypokalemia. PMID:22212410

  4. A Case Of Infectious Mononucleosis With Acute Inflammatory Demyelinating Polyradiculoneuropathy

    Somani S K

    2003-01-01

    Full Text Available We report a case of Acute inflammatory demyelinating polyradiculo neuropathy (AIDP, following infectious mononucleosis. A 12 year old girl presented with acute flaccid quadriplegia with bilateral cervical lymphadenopathy and enlarged tonsils six weeks after a febrile illness. Cerebrospinal fluid revealed albuminocytological dissociation and electrophysiology showed evidence of axonal-demyelinating polyradiculoneuropathy. Heterophile antibody test was positive and lymph node biopsy showed non -specific reactive hyperplasia. She was managed conservatively with good outcome.

  5. Thyrotoxic Hypokalemic Periodic Paralysis: A Case Report

    Murat Atmaca; Işılay Kalan; Saliha Yıldız; Mehmet Fatih Özbay; Murat Kaçmaz

    2012-01-01

    Thyrotoxic hypokalemic periodic paralysis is a rare complication of thyrotoxicosis. This clinic condition is often encountered in Asian populations and male gender while thyrotoxicosis is frequently seen in women. The escape of potassium into cell is the mechanism responsible for this disease and its etiology is not completely known. Thyroid hormones, carbohydrate rich diet, alcohol consumption and excessive exercise are regarded as the precipitating factors. This clinical picture is generall...

  6. Familial Hypokalemic Periodic Paralysis: A Case Report

    Semih KORKUT, Hayati KANDİŞ, Harun GÜNEŞ, Esin KORKUT

    2010-01-01

    Familial hypokalemic periodic paralysis is an autosomal dominantly inherited congenital diseasecharacterized by intermittent attacks of muscle weakness lasting for a few hours to a few daysand occurring a few times a year or once a day. Due to the shift of potassium into muscle cells,serum potassium level is decreased during attacks and it is in the normal range between twoattacks. A 21 year old male patient seen in the emergency department due to a hypokalemicparalysis attack occurring witho...

  7. Periodic paralysis: clinical evaluation in 20 patients

    Célia Harumi Tengan; Acary S. Bulle de Oliveira; Alberto Alain Gabbai

    1994-01-01

    Twenty patients with periodic paralysis were evaluated and the aspects studied included epidemiological data, clinical manifestations, ancillary tests, treatment and evolution. Sixteen patients had the hypokalemic form (5 familiar, 5 sporadic, 5 thyrotoxic and 1 secondary). No patient with the normokalemic form was detected. Predominance of men was found (14 patients), especially in the cases with hyperthyroidism (5 patients). No thyrotoxic patient was of oriental origin. Only 4 patients had ...

  8. Imaging evaluation of vocal cord paralysis

    Garcia, Marcelo de Mattos; Magalhaes, Fabiana Pizanni; Dadalto, Gabriela Bijos; Moura, Marina Vimieiro Timponi de [Axial Centro de Imagem, Belo Horizonte, MG (Brazil)], e-mail: marcelomgarcia@superig.com.br, e-mail: ce@axialmg.com.br

    2009-09-15

    Vocal cord paralysis is a common cause of hoarseness. It may be secondary to many types of lesions along the cranial nerve X pathway and its branches, particularly the laryngeal recurrent nerves. Despite the idiopathic nature of a great number of cases, imaging methods play a very significant role in the investigation of etiologic factors, such as thyroid and esophagus neoplasias with secondary invasion of the laryngeal recurrent nerves. Other conditions such as aortic and right subclavian artery aneurysms also may be found. The knowledge of local anatomy and related diseases is of great importance for the radiologist, so that he can tailor the examination properly to allow an appropriate diagnosis and therapy planning. Additionally, considering that up to 35% of patients with vocal cord paralysis are asymptomatic, the recognition of radiological findings indicative of this condition is essential for the radiologist who must warn the referring physician on the imaging findings. In the present study, the authors review the anatomy and main diseases related to vocal cord paralysis, demonstrating them through typical cases evaluated by computed tomography and magnetic resonance imaging, besides describing radiological findings of laryngeal abnormalities indicative of this condition. (author)

  9. Laryngeal paralysis in dogs: An update on recent knowledge

    Kitshoff, Adriaan M.; Bart Van Goethem; Ludo Stegen; Peter Vandekerckhov; Hilde de Rooster

    2013-01-01

    Laryngeal paralysis is the effect of an inability to abduct the arytenoid cartilages during inspiration, resulting in respiratory signs consistent with partial airway obstruction. The aetiology of the disease can be congenital (hereditary laryngeal paralysis or congenital polyneuropathy), or acquired (trauma, neoplasia, polyneuropathy, endocrinopathy). The most common form of acquired laryngeal paralysis (LP) is typically seen in old, large breed dogs and is a clinical manifestation of a gene...

  10. Hypokalemic periodic paralysis as first sign of thyrotoxicosis

    Trifanescu, RA; Danciulescu Miulescu, R; Carsote, M; Poiana, C

    2013-01-01

    Background: periodic paralysis related to hypokalemia is seldom reported in thyrotoxicosis, and it usually occurs in Asian males. Patients and methods: Two Romanian (Caucasian) young patients presented with hypokalemic paralysis. TSH, FT4, TT3 was measured by immunochemiluminescence. Case report 1. Patient O.R, aged 19, presented marked asthenia and lower limbs paralysis, following high carbohydrate meal. He declared 10 kg weight loss on hypocaloric diet and mild sweating. Biochemical data re...

  11. HYPOKALEMIC PERIODIC PARALYSIS: AGE OF ONSET IN A RETROSPECTIVE STUDY

    Harirchian, M.H.; M. Ghaffarpour M. H. Shahbazi

    2003-01-01

    Primary hypokalemic periodic paralysis is a familial channelopathy inherited as an autosomal dominant trait. The first attack of paralysis may be evolved at any age, but has been reported to be most common in the second decade, so that some authorities believe that an episodic weakness beginning after age 25 is almost never due to primary periodic paralysis. In this retrospective study, we reviewed 50 patients admitted in two hospitals of Tehran University of Medical Sciences during 1992-2001...

  12. Vocal Cord Paralysis and its Etiologies: A Prospective Study

    Seyed Javad Seyed Toutounchi

    2014-03-01

    Full Text Available Introduction: Vocal cord paralysis is a common symptom of numerous diseases and it may be due to neurogenic or mechanical fixation of the cords. Paralysis of the vocal cords is just a symptom of underlying disease in some cases; so, clinical diagnosis of the underlying cause leading to paralysis of the vocal cords is important. This study evaluates the causes of vocal cord paralysis.Methods: In a prospective study, 45 patients with paralyzed vocal cord diagnosis were examined by tests such as examination of the pharynx, larynx, esophagus, thyroid, cervical, lung, and mediastinum, brain and heart by diagnostic imaging to investigate the cause vocal cord paralysis. The study was ended by diagnosing the reason of vocal cord paralysis at each stage of the examination and the clinical studies.Results: The mean duration of symptoms was 18.95±6.50 months. The reason for referral was phonation changes (97.8% and aspiration (37.8% in the subjects. There was bilateral paralysis in 6.82%, left paralysis in 56.82% and right in 63.36% of subjects. The type of vocal cord placement was midline in 52.8%, paramedian in 44.4% and lateral in 2.8% of the subjects. The causes of vocal cords paralysis were idiopathic paralysis (31.11%, tumors (31.11%, surgery (28.89%, trauma, brain problems, systemic disease and other causes (2.2%.Conclusion: An integrated diagnostic and treatment program is necessary for patients with vocal cord paralysis. Possibility of malignancy should be excluded before marking idiopathic reason to vocal cord paralysis.

  13. Familial Hypokalemic Periodic Paralysis: A Case Report

    Semih KORKUT, Hayati KANDİŞ, Harun GÜNEŞ, Esin KORKUT

    2010-11-01

    Full Text Available Familial hypokalemic periodic paralysis is an autosomal dominantly inherited congenital diseasecharacterized by intermittent attacks of muscle weakness lasting for a few hours to a few daysand occurring a few times a year or once a day. Due to the shift of potassium into muscle cells,serum potassium level is decreased during attacks and it is in the normal range between twoattacks. A 21 year old male patient seen in the emergency department due to a hypokalemicparalysis attack occurring without any obvious triggering factor was presented in this article.

  14. Rifampin-associated tubulointersititial nephritis and Fanconi syndrome presenting as hypokalemic paralysis

    Min Hong Ki

    2013-01-01

    Full Text Available Abstract Background Rifampin is one of the most important drugs in first-line therapies for tuberculosis. The renal toxicity of rifampin has been reported sporadically and acute tubulointerstitial nephritis (ATIN is a frequent histological finding. We describe for the first time a case of ATIN and Fanconi syndrome presenting as hypokalemic paralysis, associated with the use of rifampin. Case presentation A 42-year-old man was admitted with sudden-onset lower extremity paralysis and mild renal insufficiency. He had been treated for pulmonary tuberculosis with isoniazid, rifampin, and ethambutol for 2 months. Laboratory tests revealed proteinuria, profound hypokalemia, hyperchloremic metabolic acidosis with a normal anion gap, positive urine anion gap, hypophosphatemia with hyperphosphaturia, hypouricemia with hyperuricosuria, glycosuria with normal serum glucose level, generalized aminoaciduria, and β2-microglobulinuria. A kidney biopsy revealed findings typical of ATIN and focal granular deposits of immunoglubulin A and complement 3 in the glomeruli and tubules. Electron microscopy showed epithelial foot process effacement and electron-dense deposits in the subendothelial and mesangial spaces. Cessation of rifampin resolved the patient’s clinical presentation of Fanconi syndrome, and improved his renal function and proteinuria. Conclusion This case demonstrates that rifampin therapy can be associated with Fanconi syndrome presenting as hypokalemic paralysis, which is a manifestation of ATIN. Kidney function and the markers of proximal tubular injury should be carefully monitored in patients receiving rifampin.

  15. Hypokalaemia with paralysis: don’t forget the thyroid

    Catalano, Concetta; Caridi, Graziella; Postorino, Maria Concetta; Enia, Giuseppe

    2011-01-01

    The authors report the case of a 33-year-old Italian man who had three episodes of hypokalaemia with paralysis linked to hyperthyroidism. Because of its low prevalence in western populations, the diagnosis of thyrotoxic hypokalaemic periodic paralysis can be easily missed in non-Asian countries.

  16. Like a Deer in the Headlights: The Paralysis of Stuckness

    Anderson-Nathe, Ben

    2008-01-01

    When describing how they experience moments of not-knowing, youth workers often talk about a sense of paralysis, as though their uncertainty becomes physically constraining. This chapter describes the first of five themes associated with youth workers' experiences of not knowing what to do: the paralysis of stuckness. In addition to describing and…

  17. Facial Nerve Paralysis seen in Pseudomonas sepsis with ecthyma gangrenosum

    Suleyman Ozdemir

    2013-02-01

    Full Text Available Ecthyma gangrenosum is a skin lesion which is created by pseudomonas auriginosa. Peripheral facial paralysis and mastoiditis as a rare complication of otitis media induced by pseudomonas auriginosa.In this study, 4 months child who has ecthyma gangrenosum and facial nerve paralysis was reported. [Cukurova Med J 2013; 38(1.000: 126-130

  18. Acute Disseminated Encephalomyelitis

    Kambiz Sotoudeh

    Full Text Available Acute disseminated encephalomyelitis (ADEM is an acute, inflammatory, monophasic, demyelinating and immune-mediated disorder of central nervous system; occurs mostly in children after systemic viral infections or vaccinations. Acute polysymptomatic neurologic signs such as encephalopathy, paralysis of limbs, cranial nerve involvement, ataxia and optic neuritis are common manifestations. Brain magnetic resonance imaging study is essential for diagnosis and enabling prompt diagnosis and treatment. Evidence of multifocal lesions of demyelination in subcortical white matter are seen. They are usually bilateral and asymmetrical. Treatment optins have included steroids, immunoglobulins, and plasmapheresis. ADEM is treatable and prognosis is good.

  19. Thyrotoxic Periodic Paralysis and Polymorphisms of the ADRB2, AR, and GABRA3 Genes in Men with Graves Disease

    Park, Suyeon; Kim, Tae Yong; Sim, Soyoung; Lim, Seonhee; Kim, Mijin; Kwon, Hyemi; Jeon, Min Ji; Kim, Won Gu; Shong, Young Kee; Kim, Won Bae

    2016-01-01

    Background Thyrotoxic periodic paralysis (TPP) is a rare complication of thyrotoxicosis characterized by acute attacks of muscle weakness and hypokalemia. Recently, variation in several genes was suggested to be associated with TPP. This study evaluated the genetic predisposition to TPP in terms of the β2-adrenergic receptor (ADRB2), androgen receptor (AR), and γ-aminobutyric acid receptor α3 subunit (GABRA3) genes. Methods This study enrolled 48 men with Graves disease (GD) and TPP, and 48 G...

  20. Isolated sleep paralysis elicited by sleep interruption.

    Takeuchi, T; Miyasita, A; Sasaki, Y; Inugami, M; Fukuda, K

    1992-06-01

    We elicited isolated sleep paralysis (ISP) from normal subjects by a nocturnal sleep interruption schedule. On four experimental nights, 16 subjects had their sleep interrupted for 60 minutes by forced awakening at the time when 40 minutes of nonrapid eye movement (NREM) sleep had elapsed from the termination of rapid eye movement (REM) sleep in the first or third sleep cycle. This schedule produced a sleep onset REM period (SOREMP) after the interruption at a high rate of 71.9%. We succeeded in eliciting six episodes of ISP in the sleep interruptions performed (9.4%). All episodes of ISP except one occurred from SOREMP, indicating a close correlation between ISP and SOREMP. We recorded verbal reports about ISP experiences and recorded the polysomnogram (PSG) during ISP. All of the subjects with ISP experienced inability to move and were simultaneously aware of lying in the laboratory. All but one reported auditory/visual hallucinations and unpleasant emotions. PSG recordings during ISP were characterized by a REM/W stage dissociated state, i.e. abundant alpha electroencephalographs and persistence of muscle atonia shown by the tonic electromyogram. Judging from the PSG recordings, ISP differs from other dissociated states such as lucid dreaming, nocturnal panic attacks and REM sleep behavior disorders. We compare some of the sleep variables between ISP and non-ISP nights. We also discuss the similarities and differences between ISP and sleep paralysis in narcolepsy. PMID:1621022

  1. Cerebral hemorrhage without manifest motor paralysis

    Before the introduction of computerized tomography (CT) there were some cases of intracerebral bleeding who were wrongly diagnosed as hypertensive encephalopathy or senile psychosis. We here report 5 cases who did not show any sign of motor paralysis. The clinical aspects of these cases were nausea and vomiting with dizziness (case 1), nausea and vomiting with slight headache (case 2), agnosia of left side with several kinds of disorientation (case 3), nausea and vomiting (case 4), and visual disturbance of right, lower quadrant (case 5). All of these cases showed no motor paralysis or abnormal reflex activities. By examination with CT each of them exhibited a high density area in the subcortical area of the right parietal lobe, the subcortical area of the right occipital lobe, the right temporal and parietal lobe, rather small portion of the left putamen and external capsule, and the subcortical area of left occipital lobe, respectively. Patients of cerebral hemorrhage without motor or sensory disturbances might often be taken for some psychic abnormality. We here have emphasized the importance of CT in such a group of patients. But for this technique, most of them would not be given adequate treatment and might be exposed to lifethreatening situations. (author)

  2. Sjögren's syndrome presenting as hypokalemic periodic paralysis.

    Dowd, J E; Lipsky, P E

    1993-12-01

    We describe a 21-year-old Hispanic woman who presented with hypokalemic paralysis as the initial manifestation of Sjögren's syndrome (SS). Our review of the English literature revealed 12 previously reported cases of SS and renal tubular acidosis (RTA). Paralysis often preceded the sicca complex in those patients. Renal function in the patients with hypokalemic paralysis was reduced compared with that in patients who had primary SS and RTA but no history of hypokalemic paralysis (P Hypokalemic periodic paralysis is a rare manifestation of SS. It is seen more often in patients with primary SS, may precede the classic sicca complex, and may serve as a clinical marker for more severe renal disease in patients who have primary SS and RTA. PMID:8250993

  3. Pseudobulbar Paralysis Treated by Acupuncture - Clinical Observation in 36 Cases

    杜琳

    2001-01-01

    @@Pseudobulbar paralysis is a kind of common clinical syndromes of cerebral vascular diseases, which is manifested as dyslalia, dysphagia and choking. By several-year clinical observations, 36 cases were treated with satisfactory therapeutic effects as reported in the following. Clinical Data Of 36 in-patients, there were 24 males and 12 females, aged from 44 to 81 years, averaging 64.92 years. Of 36 cases, 24 were at the acute stage and 12 at the recovery stage. All the cases were diagnosed as cerebral vascular diseases by cranial CT scan and MRI, of which, 4 were cerebral infarction, 26 lacunar cerebral infarction, 5 cerebral hemorrhage and 1 mixed type. Of 36 cases, 15 were the first attack of wind-stroke, 15 the second attack, 5 the third attack and 1 the forth attack. There were 26 patients with hypertension among 36 cases, of which, 8 patients suffered from hypertension within 10 years, 6 for more than 10 years, 9 for more than 20 years and 3 for more than 30 years. All the 36 cases were associated with dysphagia and agreeable to Standard on Diagnosis and Evaluation of Therapeutic Effects of Wind-stroke issued by the State Scientific Committee 85-919-01-01, 1995.

  4. La Sorveglianza attiva delle paralisi flaccide acute (AFP)in Sardegna nell'obiettivo della eradicazione della poliomielite

    Castiglia, Paolo Giuseppino; Mura, Ida Iolanda; Solinas, Maria Giuliana; Scanu, Rita; Maida, Alessandro

    2000-01-01

    Nella storia della salute pubblica, l’umanità sta per raggiungere un importante obiettivo nel controllo delle malattie infettive, obiettivo fino ad ora conquistato solo per il vaiolo. Nel 1988 l’Assemblea Mondiale della Sanità si è infatti proposta di perseguire, tra i suoi obiettivi, la eradicazione della poliomielite attraverso una strategia di base imperneata su a) garanzia di alti livelli di copertura nella popolazione al di sotto dei 5 anni di età con vaccinazi...

  5. Comparative study of thyrotoxic periodic paralysis from idiopathic hypokalemic periodic paralysis: An experience from India

    J Kalita

    2012-01-01

    Full Text Available Objective: There is paucity of reports on thyrotoxic periodic paralysis (TPP from India. We report the patients with TPP and compare them with idiopathic hypokalemic periodic paralysis (IHPP. Materials and Methods: Patients with hypokalemic periodic paralysis (HPP treated during the past 11 years were evaluated retrospectively. Their demographic parameters, family history, clinical features, precipitating factors, severity of weakness, laboratory parameters and rapidity of recovery were recorded. The demographic, clinical and laboratory parameters of TPP and IHPP were compared. Results: During the study period, we managed 52 patients with HPP; nine (17.3% of whom had TPP and 27 (52% had IHPP. The demographic, precipitating factors, number of attacks and severity of limb weakness were similar between the TPP and IHPP groups, except in the IHPP group, bulbar weakness was present in four and respiratory paralysis in six, needing artificial ventilation in two patients. Serum potassium was significantly lower in TPP (2.21 ± 0.49 compared with IHPP (2.67 ± 0.59, P = 0.04. Four patients with TPP had subclinical thyrotoxicosis and two had subclinical hyperthyroidism. Rebound hyperkalemia occurred in both TPP and IHPP (three versus eight patients. The recovery was faster in IHPP (26.7 ± 15.4 h compared with TPP (34.0 ± 14.0 h, but was statistically insignificant. Conclusion: TPP constitutes 17.3% of HPP, and absence of clinical features of thyrotoxicosis and subclinical hyperthyroidism in TPP is not uncommon. Clinical features, demographic profile and rebound hyperkalemia are similar in both TPP and IHPP. The serum potassium level is significantly low in the TPP compared with the IHPP group.

  6. Chronic Bee Paralysis Virus in Honeybee Queens

    Amiri, Esmaeil; Meixner, Marina; Büchler, Ralph;

    2014-01-01

    Chronic bee paralysis virus (CBPV) is known as a disease of worker honey bees. To investigate pathogenesis of the CBPV on the queen, the sole reproductive individual in a colony, we conducted experiments regarding the susceptibility of queens to CBPV. Results from susceptibility experiment showed a...... similar disease progress in the queens compared to worker bees after infection. Infected queens exhibit symptoms by Day 6 post infection and virus levels reach 1011 copies per head. In a transmission experiment we showed that social interactions may affect the disease progression. Queens with forced...... contact to symptomatic worker bees acquired an overt infection with up to 1011 virus copies per head in six days. In contrast, queens in contact with symptomatic worker bees, but with a chance to receive food from healthy bees outside the cage appeared healthy. The virus loads did not exceed 107 in the...

  7. Paralysis recovery in humans and model systems

    Edgerton, V. Reggie; Roy, Roland R.

    2002-01-01

    Considerable evidence now demonstrates that extensive functional and anatomical reorganization following spinal cord injury occurs in centers of the brain that have some input into spinal motor pools. This is very encouraging, given the accumulating evidence that new connections formed across spinal lesions may not be initially functionally useful. The second area of advancement in the field of paralysis recovery is in the development of effective interventions to counter axonal growth inhibition. A third area of significant progress is the development of robotic devices to quantify the performance level of motor tasks following spinal cord injury and to 'teach' the spinal cord to step and stand. Advances are being made with robotic devices for mice, rats and humans.

  8. A 10-Month-Old With Intermittent Hypotonia and Paralysis.

    Beinvogl, Beate C; Rosman, N Paul; Baumer, Fiona M; Rodan, Lance H; Forster, Catherine S; Kwon, Albert H; Berry, Gerard T

    2016-07-01

    A 10-month-old boy presented with a 1-day history of flaccid quadriplegia and dysconjugate gaze. His history was remarkable for stereotyped episodes of flaccid quadriplegia or hemiplegia, oculomotor abnormalities, and limb or neck posturing, beginning in the first days of life and becoming more frequent and more prolonged over time. The patient was healthy and developmentally normal between episodes. Results of extensive laboratory evaluations, including EEG and brain imaging studies, were negative. The patient's history, diagnostic evaluation, and final diagnosis are reviewed. This case illustrates the importance of a fundamental understanding of neurologic localization in pediatric care and a focused diagnostic approach to an infant with paroxysmal neurologic signs. PMID:27252036

  9. Laryngeal paralysis in dogs: An update on recent knowledge

    Adriaan M. Kitshoff

    2013-02-01

    Full Text Available Laryngeal paralysis is the effect of an inability to abduct the arytenoid cartilages duringinspiration, resulting in respiratory signs consistent with partial airway obstruction. Theaetiology of the disease can be congenital (hereditary laryngeal paralysis or congenitalpolyneuropathy, or acquired (trauma, neoplasia, polyneuropathy, endocrinopathy. Themost common form of acquired laryngeal paralysis (LP is typically seen in old, large breeddogs and is a clinical manifestation of a generalised peripheral polyneuropathy recentlyreferred to as geriatric onset laryngeal paralysis polyneuropathy. Diagnosing LP based onclinical signs, breed and history has a very high sensitivity (90% and can be confirmed bylaryngeal inspection. Prognosis after surgical correction depends on the aetiology: traumaticcases have a good prognosis, whereas tumour-induced or polyneuropathy-induced LP has aguarded prognosis. Acquired idiopathic LP is a slow progressive disease, with dogs reachingmedian survival times of 3–5 years after surgical correction.

  10. Neonatal bilateral diaphragmatic paralysis caused by brain stem haemorrhage.

    Blazer, S; Hemli, J A; Sujov, P O; Braun, J

    1989-01-01

    We describe a neonate with severe bilateral diaphragmatic paralysis caused by haemorrhage in the lower brain stem. To our knowledge this association has not been previously reported in the English medical literature.

  11. Laryngeal paralysis in dogs: An update on recent knowledge

    Adriaan M. Kitshoff

    2013-04-01

    Full Text Available Laryngeal paralysis is the effect of an inability to abduct the arytenoid cartilages during inspiration, resulting in respiratory signs consistent with partial airway obstruction. The aetiology of the disease can be congenital (hereditary laryngeal paralysis or congenital polyneuropathy, or acquired (trauma, neoplasia, polyneuropathy, endocrinopathy. The most common form of acquired laryngeal paralysis (LP is typically seen in old, large breed dogs and is a clinical manifestation of a generalised peripheral polyneuropathy recently referred to as geriatric onset laryngeal paralysis polyneuropathy. Diagnosing LP based on clinical signs, breed and history has a very high sensitivity (90% and can be confirmed by laryngeal inspection. Prognosis after surgical correction depends on the aetiology: traumatic cases have a good prognosis, whereas tumour-induced or polyneuropathy-induced LP has a guarded prognosis. Acquired idiopathic LP is a slow progressive disease, with dogs reaching median survival times of 3–5 years after surgical correction.

  12. A young man presenting with paralysis after vigorous exercise

    Gubran, Christopher; Narain, Rajay; Malik, Luqmaan; Saeed, Saad Aldeen

    2012-01-01

    Thyrotoxic periodic paralysis (TPP) is a rare metabolic disorder characterised by muscular weakness and paralysis in predisposed thyrotoxic patients. Although patients with TPP are almost uniformly men of Asian descent, cases have been reported in Caucasian and other ethnic populations. The rapid increase in ethnic diversity in Western and European nations has led to increase in TPP reports, where it was once considered exceedingly rare. Correcting the hypokalaemic and hyperthyroid state tend...

  13. Interictal conduction slowing in muscle fibers in hypokalemic periodic paralysis.

    Troni, W; Doriguzzi, C; Mongini, T

    1983-11-01

    Conduction velocity in muscle fibers of the short head of biceps brachii was reduced between attacks in all the affected members of a family suffering from hypokalemic periodic paralysis. This finding represents a further evidence of a primary alteration of sarcolemmal function in this disease. Interictal conduction slowing in muscle fibers is consistent with the prevailing pathophysiologic hypothesis, which considers an increased membrane permeability to sodium ions as the fundamental defect underlying all forms of familial periodic paralysis. PMID:6685247

  14. Neonatal peripheral facial paralysis' evaluation with photogrammetry: A case report.

    da Fonseca Filho, Gentil Gomes; de Medeiros Cirne, Gabriele Natane; Cacho, Roberta Oliveira; de Souza, Jane Carla; Nagem, Danilo; Cacho, Enio Walker Azevedo; Moran, Cristiane Aparecida; Abreu, Bruna; Pereira, Silvana Alves

    2015-12-01

    Facial paralysis in newborns can leave functional sequelae. Determining the evolution and amount of functional losses requires consistent evaluation methods that measure, quantitatively, the evolution of clinical functionality. This paper reports an innovative method of facial assessment for the case of a child 28 days of age with unilateral facial paralysis. The child had difficulty breast feeding, and quickly responded to the physical therapy treatment. PMID:26607566

  15. Anaesthetic management of a patient with familial normokalaemic periodic paralysis.

    Walsh, F

    2012-02-03

    PURPOSE: We describe the anaesthetic management of a patient with the autosomal dominant inherited disease, normokalaemic periodic paralysis. The disease results in intermittent bouts of limb and respiratory muscular weakness in association with hypothermia, stress, prolonged fasting or exercise. Unlike hypokalaemic and hyperkalaemic periodic paralysis, the more common variants of the disease, normokalaemic periodic paralysis is not accompanied by alterations in the plasma potassium concentration. CLINICAL FEATURES: A five-year-old boy presented for emergency scrotal exploration. He had a family history of periodic paralysis and had experienced previous episodes of weakness, two of which had required hospitalization for respiratory distress. On admission there was no evidence of weakness and serum potassium concentration was 4.2 mMol.L-1. A spinal anaesthetic was performed and the procedure was uncomplicated by muscle paralysis above the level of the spinal block. CONCLUSION: Avoidance of known precipitating factors and judicious use of neuromuscular blocking drugs has been advocated in patients with this disorder presenting for surgery. In appropriate circumstances, spinal anaesthesia represents a useful option in patients with normokalaemic periodic paralysis.

  16. Sleep paralysis, sexual abuse, and space alien abduction.

    McNally, Richard J; Clancy, Susan A

    2005-03-01

    Sleep paralysis accompanied by hypnopompic ('upon awakening') hallucinations is an often-frightening manifestation of discordance between the cognitive/perceptual and motor aspects of rapid eye movement (REM) sleep. Awakening sleepers become aware of an inability to move, and sometimes experience intrusion of dream mentation into waking consciousness (e.g. seeing intruders in the bedroom). In this article, we summarize two studies. In the first study, we assessed 10 individuals who reported abduction by space aliens and whose claims were linked to apparent episodes of sleep paralysis during which hypnopompic hallucinations were interpreted as alien beings. In the second study, adults reporting repressed, recovered, or continuous memories of childhood sexual abuse more often reported sleep paralysis than did a control group. Among the 31 reporting sleep paralysis, only one person linked it to abuse memories. This person was among the six recovered memory participants who reported sleep paralysis (i.e. 17% rate of interpreting it as abuse-related). People rely on personally plausible cultural narratives to interpret these otherwise baffling sleep paralysis episodes. PMID:15881271

  17. MRI findings in an infant with vaccine-associated paralytic poliomyelitis

    Lopes Ferraz-Filho, Jose Roberto [Sao Jose do Rio Preto Medical School, Department of Radiology, Hospital de Base, Sao Paulo, State (Brazil); Sao Jose do Rio Preto Medical School, Department of Radiology, Sao Jose do Rio Preto, Sao Paulo State (Brazil); Santos Torres, Ulysses dos; Portela de Oliveira, Eduardo; Soares Souza, Antonio [Sao Jose do Rio Preto Medical School, Department of Radiology, Hospital de Base, Sao Paulo, State (Brazil)

    2010-12-15

    Although acute flaccid paralysis is a manifestation observed in several neurologic and muscular disorders, vaccine-associated paralytic poliomyelitis (VAPP) is an exceedingly rare etiology. In the clinical setting of acute flaccid paralysis, MRI is useful in differentiating between VAPP and other conditions. Additionally, MRI can assess the extent of lesions. However, reports on MRI findings in VAPP are scarce in the pediatric radiology literature. We report a Brazilian infant who developed VAPP 40 days after receiving the first dose of oral polio vaccine (OPV). MR images of the cervical and thoracic spinal cord showed lesions involving the anterior horn cell, with increased signal intensity on T2-weighted sequences. We would like to emphasize the importance of considering VAPP as a differential diagnosis in patients with acute flaccid paralysis and an MRI showing involvement of medulla oblongata or spinal cord, particularly in countries where OPV is extensively administered. (orig.)

  18. MRI findings in an infant with vaccine-associated paralytic poliomyelitis

    Although acute flaccid paralysis is a manifestation observed in several neurologic and muscular disorders, vaccine-associated paralytic poliomyelitis (VAPP) is an exceedingly rare etiology. In the clinical setting of acute flaccid paralysis, MRI is useful in differentiating between VAPP and other conditions. Additionally, MRI can assess the extent of lesions. However, reports on MRI findings in VAPP are scarce in the pediatric radiology literature. We report a Brazilian infant who developed VAPP 40 days after receiving the first dose of oral polio vaccine (OPV). MR images of the cervical and thoracic spinal cord showed lesions involving the anterior horn cell, with increased signal intensity on T2-weighted sequences. We would like to emphasize the importance of considering VAPP as a differential diagnosis in patients with acute flaccid paralysis and an MRI showing involvement of medulla oblongata or spinal cord, particularly in countries where OPV is extensively administered. (orig.)

  19. Dihydropyridine receptor mutations cause hypokalemic periodic paralysis

    Ptacek, L.J.; Leppert, M.F. [Univ. of Utah, Salt Lake City, UT (United States); Tawil, R. [Univ. of Rochester, MN (United States)] [and others

    1994-09-01

    Hypokalemic periodic paralysis (hypoKPP) is an autosomal dominant skeletal muscle disorder manifested by episodic weakness associated with low serum potassium. Genetic linkage analysis has localized the hypoKPP gene to chromosome 1q31-q32 near a dihydropyridine receptor (DHP) gene. This receptor functions as a voltage-gated calcium channel and is also critical for excitation-contraction coupling in a voltage-sensitive and calcium-independent manner. We have characterized patient-specific DHP receptor mutations in 11 probands of 33 independent hypoKPP kindreds that occur at one of two adjacent nucleotides within the same codon and predict substitution of a highly conserved arginine in the S4 segment of domain 4 with either histidine or glycine. In one kindred, the mutation arose de novo. Taken together, these data establish the DHP receptor as the hypoKPP gene. We are unaware of any other human diseases presently known to result from DHP receptor mutations.

  20. Provocative poliomyelitis causing postpolio residual paralysis among select communities of two remote villages of North Karnataka in India: A community survey

    Amitesh Narayan

    2011-01-01

    Full Text Available Intramuscular injections can provoke muscular paralysis especially, if the child has had exposure to polio virus. The purpose of the study was to determine the association with known risk factors for motor disabilities in two remote villages of North Karnataka (India, where an increased number of disabled people among select communities had been reported. A community based survey was conducted. The selection of study subjects was done through screening, history related with occurrence of musculoskeletal disability, screening and general examination of the affected joints and muscles. Data analysis was done by estimation of percentages. Among the physical disabilities identified, the most common was post-polio residual paralysis. 35.65% (n = 41 subjects had developed paralysis following the administration of an intramuscular injection when they had acute viremia in childhood, indicating that (probably muscle paralysis would have been provoked by intramuscular injections, resulting in provocative poliomyelitis. Unnecessary injection must be avoided in children during acute viremia state and use of oral polio vaccine should be encouraged.

  1. Peripheral and Central Venous Blood Glucose Concentrations in Dogs and Cats with Acute Arterial Thromboembolism

    S. Klainbart; Kelmer, E.; Vidmayer, B.; Bdolah‐Abram, T.; Segev, G.; Aroch, I.

    2014-01-01

    Background Acute limb paralysis because of arterial thromboembolism (ATE) occurs in cats and less commonly in dogs. ATE is diagnosed based on physical examination findings and, occasionally, advanced imaging. Hypothesis/Objectives Peripheral, affected limb venous glucose concentration is decreased in ATE, whereas its systemic concentration is within or above reference interval. Animals Client‐owned cats and dogs were divided into 3 respective groups: acute limb paralysis because of ATE (22 ca...

  2. Timing of spontaneous sleep-paralysis episodes.

    Girard, Todd A; Cheyne, J Allan

    2006-06-01

    The objective of this prospective naturalistic field study was to determine the distribution of naturally occurring sleep-paralysis (SP) episodes over the course of nocturnal sleep and their relation to bedtimes. Regular SP experiencers (N = 348) who had previously filled out a screening assessment for SP as well as a general sleep survey were recruited. Participants reported, online over the World Wide Web, using a standard reporting form, bedtimes and subsequent latencies of spontaneous episodes of SP occurring in their homes shortly after their occurrence. The distribution of SP episodes over nights was skewed to the first 2 h following bedtime. Just over one quarter of SP episodes occurred within 1 h of bedtime, although episodes were reported throughout the night with a minor mode around the time of normal waking. SP latencies following bedtimes were moderately consistent across episodes and independent of bedtimes. Additionally, profiles of SP latencies validated self-reported hypnagogic, hypnomesic, and hypnopompic SP categories, as occurring near the beginning, middle, and end of the night/sleep period respectively. Results are consistent with the hypothesis that SP timing is controlled by mechanisms initiated at or following sleep onset. These results also suggest that SP, rather than uniquely reflecting anomalous sleep-onset rapid eye movement (REM) periods, may result from failure to maintain sleep during REM periods at any point during the sleep period. On this view, SP may sometimes reflect the maintenance of REM consciousness when waking and SP hallucinations the continuation of dream experiences into waking life. PMID:16704578

  3. A clinician's guide to recurrent isolated sleep paralysis.

    Sharpless, Brian A

    2016-01-01

    This review summarizes the empirical and clinical literature on sleep paralysis most relevant to practitioners. During episodes of sleep paralysis, the sufferer awakens to rapid eye movement sleep-based atonia combined with conscious awareness. This is usually a frightening event often accompanied by vivid, waking dreams (ie, hallucinations). When sleep paralysis occurs independently of narcolepsy and other medical conditions, it is termed "isolated" sleep paralysis. Although the more specific diagnostic syndrome of "recurrent isolated sleep paralysis" is a recognized sleep-wake disorder, it is not widely known to nonsleep specialists. This is likely due to the unusual nature of the condition, patient reluctance to disclose episodes for fear of embarrassment, and a lack of training during medical residencies and graduate education. In fact, a growing literature base has accrued on the prevalence, risk factors, and clinical impact of this condition, and a number of assessment instruments are currently available in both self-report and interview formats. After discussing these and providing suggestions for accurate diagnosis, differential diagnosis, and patient selection, the available treatment options are discussed. These consist of both pharmacological and psychotherapeutic interventions which, although promising, require more empirical support and larger, well-controlled trials. PMID:27486325

  4. Radiology findings in adult patients with vocal fold paralysis

    Robinson, S. [Helsinki Medical Imaging Centre, University of Helsinki, Haartmaninkatu, Helsinki (Finland)]. E-mail: s.robinson@dzu.at; Pitkaeranta, A. [Department of Otorhinolaryngology, Haartmaninkatu, Helsinki (Finland)

    2006-10-15

    Aim: To compile imaging findings in patients with vocal fold paralysis. Materials and methods: A retrospective analysis of the medical charts of 100 consecutive patients, admitted to our department with vocal fold paralysis was undertaken. After laryngoscopy, patients were referred for radiological work-up depending on their clinical history and clinical findings. Ultrasound of the neck and/or contrast-enhanced spiral computed tomography (CT) of the neck and mediastinum was performed, extending to include the whole chest if necessary. In one patient, CT of the brain and in two patients, magnetic resonance angiography was undertaken. Analysis of the clinical and radiological data was performed to assess the most frequent causes for vocal fold paralysis. Results: In 66% of patients, the paralysis was related to previous surgery. Thirty-four percent of cases were labelled idiopathic after clinical examination. After imaging and follow-up, only 8% remained unexplained. Nine patients suffered from neoplasms, four from vascular disease, and 12 from infections. One patient developed encephalomyelitis disseminata on follow-up. Conclusion: Thorough radiological work-up helps to reduce the amount of idiopathic cases of vocal fold paralysis and guides appropriate therapy.

  5. Radiology findings in adult patients with vocal fold paralysis

    Aim: To compile imaging findings in patients with vocal fold paralysis. Materials and methods: A retrospective analysis of the medical charts of 100 consecutive patients, admitted to our department with vocal fold paralysis was undertaken. After laryngoscopy, patients were referred for radiological work-up depending on their clinical history and clinical findings. Ultrasound of the neck and/or contrast-enhanced spiral computed tomography (CT) of the neck and mediastinum was performed, extending to include the whole chest if necessary. In one patient, CT of the brain and in two patients, magnetic resonance angiography was undertaken. Analysis of the clinical and radiological data was performed to assess the most frequent causes for vocal fold paralysis. Results: In 66% of patients, the paralysis was related to previous surgery. Thirty-four percent of cases were labelled idiopathic after clinical examination. After imaging and follow-up, only 8% remained unexplained. Nine patients suffered from neoplasms, four from vascular disease, and 12 from infections. One patient developed encephalomyelitis disseminata on follow-up. Conclusion: Thorough radiological work-up helps to reduce the amount of idiopathic cases of vocal fold paralysis and guides appropriate therapy

  6. Intratypic differentiation of polioviruses isolated from suspected cases of poliomyelitis in Brazil during the period of 1990 to 1993

    A. M. B. de Filippis

    1994-12-01

    Full Text Available This study analyzed 3129 fecal samples derived from 1626 patients with sudden onset acute flaccid paralysis clinically compatible with poliomyelitis. The samples were collected in the period ranging from January 1990 to September 1993 in all regions of Brazil. Among the 1626 cases studied, 196 had isolation of poliovirus. Nevertheless, it was observed that some factors influenced the isolation rate and the intratypic characterization of these polioviruses. No cases of acute flaccid paralysis has been found to be etiologically related with wild polioviruses.

  7. Molecular Identification of Chronic Bee Paralysis Virus Infection in Apis mellifera Colonies in Japan

    Tomomi Morimoto

    2012-06-01

    Full Text Available Chronic bee paralysis virus (CBPV infection causes chronic paralysis and loss of workers in honey bee colonies around the world. Although CBPV shows a worldwide distribution, it had not been molecularly detected in Japan. Our investigation of Apis mellifera and Apis cerana japonica colonies with RT-PCR has revealed CBPV infection in A. mellifera but not A. c. japonica colonies in Japan. The prevalence of CBPV is low compared with that of other viruses: deformed wing virus (DWV, black queen cell virus (BQCV, Israel acute paralysis virus (IAPV, and sac brood virus (SBV, previously reported in Japan. Because of its low prevalence (5.6% in A. mellifera colonies, the incidence of colony losses by CBPV infection must be sporadic in Japan. The presence of the (− strand RNA in dying workers suggests that CBPV infection and replication may contribute to their symptoms. Phylogenetic analysis demonstrates a geographic separation of Japanese isolates from European, Uruguayan, and mainland US isolates. The lack of major exchange of honey bees between Europe/mainland US and Japan for the recent 26 years (1985–2010 may have resulted in the geographic separation of Japanese CBPV isolates.

  8. Hypokalemic Paralysis Complicated by Concurrent Hyperthyroidism and Chronic Alcoholism

    Tsai, Ming-Hsien; Lin, Shih-Hua; Leu, Jyh-Gang; Fang, Yu-Wei

    2015-01-01

    Abstract Thyrotoxic periodic paralysis (TPP) is characterized by the presence of muscle paralysis, hypokalemia, and hyperthyroidism. We report the case of a young man with paralysis of the lower extremities, severe hypokalemia, and concurrent hyperthyroidism. TPP was suspected; therefore, treatment consisting of judicious potassium (K+) repletion and β-blocker administration was initiated. However, urinary K+ excretion rate, as well as refractoriness to treatment, was inconsistent with TPP. Chronic alcoholism was considered as an alternative cause of hypokalemia, and serum K+ was restored through vigorous K+ repletion and the addition of K+-sparing diuretics. The presence of thyrotoxicosis and hypokalemia does not always indicate a diagnosis of TPP. Exclusion of TPP can be accomplished by immediate evaluation of urinary K+ excretion, acid-base status, and the amount of potassium chloride required to correct hypokalemia at presentation. PMID:26426670

  9. Periodic paralysis and the sodium-potassium pump.

    Layzer, R B

    1982-06-01

    Analysis of the pathophysiology of hypokalemic paralysis, as it occurs in barium poisoning, chronic potassium deficiency, and thyrotoxicosis, suggests that these disorders may have a similar mechanism. An increased ratio of muscle sodium permeability to potassium permeability reduces the ionic diffusion potential, while the resting membrane potential is sustained by an increase of Na-K pump electrogenesis. The result is that potassium entry (the sum of active and passive influx) exceeds potassium efflux; this causes a large shift of extracellular potassium into muscle until the Na-K pump turns off, leading to depolarization and paralysis. The primary defect in familial hypokalemic periodic paralysis, as in the example of barium poisoning, may be a marked reduction of muscle permeability to potassium. PMID:6287910

  10. An instance of sleep paralysis in Moby-Dick.

    Herman, J

    1997-07-01

    It is suggested that picturesque medical conditions can, at times, be encountered in literary works composed prior to their clinical delineation. This is true of sleep paralysis, of which the first scientific description was given by Silas Weir Mitchell in 1876. A quarter of a century earlier, Herman Melville, in Moby-Dick, gave a precise account of a case, including the predisposing factors and sexual connotations, all in accord with modern theory. The details of Ishmael's attack of sleep paralysis, the stresses leading up to it, and the associations causing him to recall the experience are given here. PMID:9322274