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Sample records for laryngeal nerve palsy

  1. Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery—A meta-analysis

    Directory of Open Access Journals (Sweden)

    Shixing Zheng

    2013-08-01

    Conclusion: Based on this meta-analysis, statistically significant differences were determined in terms of the incidences of total and transient recurrent laryngeal nerve palsy after using IONM versus recurrent laryngeal nerve identification alone during thyroidectomy. However, no statistically significant differences were identified regarding the incidence of persistent recurrent laryngeal nerve palsy between groups.

  2. Recurrent Laryngeal Nerve Palsy After Cervical Spine Surgery: A Multicenter AOSpine Clinical Research Network Study

    OpenAIRE

    Gokaslan, Ziya L.; Bydon, Mohamad; De la Garza-Ramos, Rafael; Smith, Zachary A.; Hsu, Wellington K.; Qureshi, Sheeraz A.; Cho, Samuel K.; Baird, Evan O.; Mroz, Thomas E.; Fehlings, Michael; Arnold, Paul M.; Riew, K. Daniel

    2017-01-01

    Study Design: Multicenter retrospective study. Objectives: To investigate the risk of symptomatic recurrent laryngeal nerve palsy (RLNP) following cervical spine surgery, to examine risk factors for its development, and to report its treatment and outcomes. Methods: A multicenter study from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was performed. Each center screened for rare complications following cervical spine surgery, including RLNP. Patient...

  3. Intraoperative Recurrent Laryngeal Nerve Monitoring in a Patient with Contralateral Vocal Fold Palsy

    Directory of Open Access Journals (Sweden)

    Bub-Se Na

    2017-10-01

    Full Text Available Recurrent laryngeal nerve injury can develop following cervical or thoracic surgery; however, few reports have described intraoperative recurrent laryngeal nerve monitoring. Consensus regarding the use of this technique during thoracic surgery is lacking. We used intraoperative recurrent laryngeal nerve monitoring in a patient with contralateral vocal cord paralysis who was scheduled for completion pneumonectomy. This case serves as an example of intraoperative recurrent laryngeal nerve monitoring during thoracic surgery and supports this indication for its use.

  4. Unilateral Hypoglossal Nerve Palsy after Use of the Laryngeal Mask Airway Supreme

    Directory of Open Access Journals (Sweden)

    Kenichi Takahoko

    2014-01-01

    Full Text Available Purpose. Hypoglossal nerve palsy after use of the laryngeal mask airway (LMA is an exceptionally rare complication. We present the first case of unilateral hypoglossal nerve palsy after use of the LMA Supreme. Clinical Features. A healthy 67-year-old female was scheduled for a hallux valgus correction under general anesthesia combined with femoral and sciatic nerve blocks. A size 4 LMA Supreme was inserted successfully at the first attempt and the cuff was inflated with air at an intracuff pressure of 60 cmH2O using cuff pressure gauge. Anesthesia was maintained with oxygen, nitrous oxide (67%, and sevoflurane under spontaneous breathing. The surgery was uneventful and the duration of anesthesia was two hours. The LMA was removed as the patient woke and there were no immediate postoperative complications. The next morning, the patient complained of dysarthria and dysphasia. These symptoms were considered to be caused by the LMA compressing the nerve against the hyoid bone. Conservative treatment was chosen and the paralysis recovered completely after 5 months. Conclusion. Hypoglossal nerve injury may occur despite correct positioning of the LMA under the appropriate intracuff pressure. A follow-up period of at least 6 months should be taken into account for the recovery.

  5. Recurrent Laryngeal Nerve Palsy After Cervical Spine Surgery: A Multicenter AOSpine Clinical Research Network Study.

    Science.gov (United States)

    Gokaslan, Ziya L; Bydon, Mohamad; De la Garza-Ramos, Rafael; Smith, Zachary A; Hsu, Wellington K; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Mroz, Thomas E; Fehlings, Michael; Arnold, Paul M; Riew, K Daniel

    2017-04-01

    Multicenter retrospective study. To investigate the risk of symptomatic recurrent laryngeal nerve palsy (RLNP) following cervical spine surgery, to examine risk factors for its development, and to report its treatment and outcomes. A multicenter study from 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was performed. Each center screened for rare complications following cervical spine surgery, including RLNP. Patients were included if they underwent cervical spine surgery (levels from C2 to C7) between January 1, 2005 and December 31, 2011. Data were analyzed with regard to complication treatment and outcome. Cases were compared to a control group from the AOSpine CSM and CSM-I studies. Three centers reported 19 cases of RLNP from a cohort of 1345 patients. The reported incidence of RLNP ranged from 0.6% to 2.9% between these 3 centers. Fifteen patients (79%) in the RLNP group were approached from the left side. Ten patients (52.6%) required treatment for RLNP-6 required medical therapy (steroids), 1 interventional treatment (injection laryngoplasty), and 3 conservative therapy (speech therapy). When examining outcomes, 73.7% (14/19) of cases resolved completely, 15.8% (3/19) resolved with residual effects, and in 10.5% (2/19) of cases this could not be determined. In this multicenter study examining rare complications following cervical spine surgery, the risk of RLNP after cervical spine surgery ranged from 0.6% to 2.9% between centers. Though rare, it was found that 16% of patients may experience partial resolution with residual effects, and 74% resolve completely.

  6. Laryngeal and phrenic nerve involvement in a patient with hereditary neuropathy with liability to pressure palsies (HNPP).

    Science.gov (United States)

    Cortese, A; Piccolo, G; Lozza, A; Schreiber, A; Callegari, I; Moglia, A; Alfonsi, E; Pareyson, D

    2016-07-01

    Lower cranial and phrenic nerve involvement is exceptional in hereditary neuropathy with liability to pressure palsies (HNPP). Here we report the occurrence of reversible laryngeal and phrenic nerve involvement in a patient with HNPP. The patient recalled several episodes of reversible weakness and numbness of his feet and hands since the age of 30 years. His medical history was uneventful, apart from chronic obstructive pulmonary disease (COPD). At age 44, following severe weight loss, he presented with progressive dysphonia and hoarseness. EMG of cricoarytenoid and thyroarytenoid muscles and laryngeal fibroscopy confirmed vocal cord paralysis. These speech disturbances gradually regressed. Two years later, he reported rapidly worsening dyspnea. Electroneurography showed increased distal latency of the right phrenic nerve and diaphragm ultrasonography documented reduced right hemi-diaphragm excursion. Six months later and after optimization of CODP treatment, his respiratory function had improved and both phrenic nerve conduction and diaphragm excursion were completely restored. We hypothesize that chronic cough and nerve stretching in the context of CODP, together with severe weight loss, may have triggered the nerve paralysis in this patient. Our report highlights the need for optimal management of comorbidities such as CODP as well as careful control of weight in HNPP patients to avoid potentially harmful complications. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. Microvascular Cranial Nerve Palsy

    Science.gov (United States)

    ... Español Eye Health / Eye Health A-Z Microvascular Cranial Nerve Palsy Sections What Is Microvascular Cranial Nerve Palsy? ... Microvascular Cranial Nerve Palsy Treatment What Is Microvascular Cranial Nerve Palsy? Leer en Español: ¿Qué es una parálisis ...

  8. Cranial nerve palsies

    International Nuclear Information System (INIS)

    Ruggieri, P.; Adelizzi, J.; Modic, M.T.; Ross, J.S.; Tkach, J.; Masaryk, T.J.

    1990-01-01

    This paper evaluates the utility of multiplanar reconstructions (MPRs) of three-dimensional (3D) MR angiography data sets in the examination of patients with cranial nerve palsies. The authors hypothesis was that 3D data could be reformatted to highlight the intricate spatial relationships of vessels to adjacent neural tissues by taking advantage of the high vessel-parenchyma contrast in high-resolution 3D time-of-flight sequences. Twenty patients with cranial nerve palsies and 10 asymptomatic patients were examined with coronal T1-weighted and axial T2-weighted imaging plus a gadolinium-enhanced 3D MRA sequence (40/7/15 degrees, axial 60-mm volume, 0.9-mm isotropic resolution). Cranial nerves II-VIII were subsequently evaluated on axial and reformatted coronal and/or sagittal images

  9. Facial nerve palsy due to birth trauma

    Science.gov (United States)

    Seventh cranial nerve palsy due to birth trauma; Facial palsy - birth trauma; Facial palsy - neonate; Facial palsy - infant ... An infant's facial nerve is also called the seventh cranial nerve. It can be damaged just before or at the time of delivery. ...

  10. Should we routinely expose recurrent laryngeal nerve(s) during thyroid surgery

    International Nuclear Information System (INIS)

    Ahmed, M.; Aurangzeb, A.; Rashid, A.Z.; Qureshi, M.A.; Iqbal, N.; Boota, M.; Ashfaq, M.

    2013-01-01

    Objective: To compare the frequency of recurrent laryngeal nerve(s) (RLNs) palsy after various thyroid procedures with and without identification of recurrent laryngeal nerve during the operation. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Surgery, Military Hospital, Rawalpindi, from August 2008 to April 2010. Methodology: Patients undergoing indirect laryngoscopy with normal vocal cords and those with carcinoma and re-do surgery having normal vocal cord were included in the study. Patients with hoarseness of voice, abnormal vocal cord movements and with solitary nodule in the isthmus were excluded. These patients were randomly divided into 2 groups of 50 each using random number tables. RLN was identified by exposing the inferior thyroid artery and traced along its entire course in group-A. Whereas, in group-B, nerves were not identified during the operations. Immediate postoperative direct laryngoscopy was performed by a surgeon with the help of an anaesthesiologist for the assessment of vocal cords. Patients with persistent hoarseness of voice were followed-up with indirect laryngoscopy at 3 and 6 months. Results: Temporary unilateral recurrent laryngeal nerve palsies occurred in 2 (4%) patients in group-A where the voice and cord movements returned to normal in 6 months. In group-B, it occurred in 8 (16%) patients, 2 bilateral (4%) injuries requiring tracheostomy and 6 unilateral injuries (12%). Among the 2 bilateral recurrent laryngeal nerve injuries, the tracheostomy was removed in one case after 6 months with persistent hoarseness of voice but no respiratory difficulty during routine activities. Tracheostomy was permanent in the other case. Among the 6 cases of unilateral nerve injuries, the voice improved considerably in 4 cases within 6 months but in 2 cases hoarseness persisted even after 6 months. Frequency of recurrent laryngeal nerve palsies was significantly lower in group-A as compared to group-B (p = 0

  11. Isolated trochlear nerve palsy with midbrain hemorrhage

    Directory of Open Access Journals (Sweden)

    Raghavendra S

    2010-01-01

    Full Text Available Midbrain hemorrhage causing isolated fourth nerve palsy is extremely rare. Idiopathic, traumatic and congenital abnormalities are the most common causes of fourth nerve palsy. We report acute isolated fourth nerve palsy in an 18-year-old lady due to a midbrain hemorrhage probably due to a midbrain cavernoma. The case highlights the need for neuroimaging in selected cases of isolated trochlear nerve palsy.

  12. [Does intraoperative nerve monitoring reduce the rate of recurrent nerve palsies during thyroid surgery?].

    Science.gov (United States)

    Timmermann, W; Dralle, H; Hamelmann, W; Thomusch, O; Sekulla, C; Meyer, Th; Timm, S; Thiede, A

    2002-05-01

    Two different aspects of the influence of neuromonitoring on the possible reduction of post-operative recurrent laryngeal nerve palsies require critical examination: the nerve identification and the monitoring of it's functions. Due to the additional information from the EMG signals, neuromonitoring is the best method for identifying the nerves as compared to visual identification alone. There are still no randomized studies available that compare the visual and electrophysiological recurrent laryngeal nerve detection in thyroid operations with respect to the postoperative nerve palsies. Nevertheless, comparisons with historical collectives show that a constant low nerve-palsy-rate was achieved with electrophysiological detection in comparison to visual detection. The rate of nerve identification is normally very high and amounts to 99 % in our own patients. The data obtained during the "Quality assurance of benign and malignant Goiter" study show that in hemithyreoidectomy and subtotal resection, lower nerve-palsy-rates are achieved with neuromonitoring as compared to solely visual detection. Following subtotal resection, this discrepancy becomes even statistically significant. While monitoring the nerve functions with the presently used neuromonitoring technique, it is possible to observe the EMG-signal remaining constant or decreasing in volume. Assuming that a constant neuromonitoring signal represents a normal vocal cord, our evaluation shows that there is a small percentage of false negative and positive results. Looking at the permanent recurrent nerve palsy rates, this method has a specificity of 98 %, a sensitivity of 100 %, a positive prognostic value of 10 %, and a negative prognostic value of 100 %. Although an altered neuromonitoring signal can be taken as a clear indication of eventual nerve damage, an absolutely reliable statement about the postoperative vocal cord function is presently not possible with intraoperative neuromonitoring.

  13. Cranial nerve palsies in Nigerian children

    African Journals Online (AJOL)

    PROF. EZECHUKWU

    2014-01-08

    Jan 8, 2014 ... Introduction. Cranial nerve palsy is a common clinical problem ... Methodology ... The two cases with three-nerve involvement were re- lated to viral encephalitis and cerebral contusion from ... RTA = road traffic accident.

  14. Multiple cranial nerve palsies complicating tympanomastoiditis: case ...

    African Journals Online (AJOL)

    Otitis media either acute or chronic, is not uncommon in childhood. Multiple cranial nerve palsies occuring as a complication of either form of otitis media is unusual. A case of a nine year old boy with chronic suppurative otitis media with associated mastoiditis complicated with ipsilateral multiple cranial nerve palsies is ...

  15. Case report of a patient with peripheral facial nerve palsy

    OpenAIRE

    Rysová, Jana

    2013-01-01

    Title of bachelor's thesis: Case report of a patient with peripheral facial nerve palsy Summary: Teoretical part of bachelor's thesis contains theoretical foundation of peripheral facial nerve palsy. Practical part of bachelor's thesis contains physiotherapeutic case report of patient with peripheral facial nerve palsy. Key words: peripheral facial nerve palsy, casuistry, rehabilitation

  16. [Acute palsy of twelfth cranial nerve].

    Science.gov (United States)

    Munoz del Castillo, F; Molina Nieto, T; De la Riva Aguilar, A; Triviño Tarradas, F; Bravo-Rodríguez, F; Ramos Jurado, A

    2005-01-01

    The hypoglossal nerve or Twelfth-nerve palsy is a rare damage with different causes: tumors or metastases in skull base, cervicals tumors, schwannoma, dissection or aneurysm carotid arteries, stroke, trauma, idiopathic cause, radiation, infections (mononucleosis) or multiple cranial neuropathy. Tumors were responsible for nearly half of the cases in different studies. We studied a female with hypoglossal nerve acute palsy. We made a differential diagnostic with others causes and a review of the literature.

  17. The Recurrent Laryngeal Nerve and Thyroid Surgery; Who to Scope ...

    African Journals Online (AJOL)

    Review with Meta Analysis of Studies Comparing. Intra-Operative Neuromonitoring of Recurrent. Laryngeal Nerves Versus Visualization Alone. During Thyroid Surgery. J Surg Res. 2014; 181(1):. 152-61. 6. Hermann M, Alk G, Roka R, et al. Laryngeal. Recurrent Nerve Injury in Surgery for Benign. Thyroid Diseases: Effect of ...

  18. Radiation-induced cranial nerve palsy: hypoglossal nerve and vocal cord palsies

    International Nuclear Information System (INIS)

    Takimoto, Toru; Saito, Yasuo; Suzuki, Masayuki; Nishimura, Toshirou

    1991-01-01

    Cranial nerve palsies are an unexpected complication of radiotherapy for head and neck tumours. We present a case of this radiation-induced cranial palsy. An 18-year-old female with nasopharyngeal carcinoma developed a right hypoglossal nerve palsy 42 months after cancericidal doses of radiotherapy. In addition, she developed a bilateral vocal cord palsy 62 months after the therapy. Follow-up over four years has demonstrated no evidence of tumour recurrence and no sign of neurological improvement. (author)

  19. Greater palatine nerve neuropraxia after laryngeal mask insertion: A rare occurrence

    Directory of Open Access Journals (Sweden)

    Jyoti Garg

    2017-01-01

    Full Text Available With the more frequent use of the laryngeal mask airway (LMA over endotracheal tubes for general anaesthesia, various cranial nerve injuries have been reported recently. We report a rare occurrence of greater palatine nerve (GPN palsy subsequent to the use of LMA Supreme™ in a young female scheduled for hand surgery. Although the exact mechanism of a nerve injury is still a matter of further research, we postulate pressure neuropraxia of GPN as a causative factor in the development of numbness over the hard palate after the removal of LMA in the post operative period.

  20. Risk factors for recurrent nerve palsy after thyroid surgery

    DEFF Research Database (Denmark)

    Godballe, Christian; Madsen, Anders Rørbæk; Sørensen, Christian Hjort

    2014-01-01

    Recurrent laryngeal nerve (RLN) injury is a well-known and serious complication to thyroid surgery. The objective was to estimate the frequency of post-thyroidectomy RLN palsy and to identify possible risk factors. Based on the Danish national thyroid surgery database, 6,859 patients treated...... predominant risk factors with a relative risk (RR) of 5.4 and 5.8, respectively. In benign cases previous performed thyroid surgery had a RR of 10.4. High volume departments with more than 150 thyroid procedures per year seem to perform significantly better. Malignant histology, neck dissection and previous...

  1. Surgical management of third nerve palsy

    Directory of Open Access Journals (Sweden)

    Anupam Singh

    2016-01-01

    Full Text Available Third nerve paralysis has been known to be associated with a wide spectrum of presentation and other associated factors such as the presence of ptosis, pupillary involvement, amblyopia, aberrant regeneration, poor bell′s phenomenon, superior oblique (SO overaction, and lateral rectus (LR contracture. Correction of strabismus due to third nerve palsy can be complex as four out of the six extraocular muscles are involved and therefore should be approached differently. Third nerve palsy can be congenital or acquired. The common causes of isolated third nerve palsy in children are congenital (43%, trauma (20%, inflammation (13%, aneurysm (7%, and ophthalmoplegic migraine. Whereas, in adult population, common etiologies are vasculopathic disorders (diabetes mellitus, hypertension, aneurysm, and trauma. Treatment can be both nonsurgical and surgical. As nonsurgical modalities are not of much help, surgery remains the main-stay of treatment. Surgical strategies are different for complete and partial third nerve palsy. Surgery for complete third nerve palsy may involve supra-maximal recession - resection of the recti. This may be combined with SO transposition and augmented by surgery on the other eye. For partial third nerve, palsy surgery is determined according to nature and extent of involvement of extraocular muscles.

  2. Surgical management of third nerve palsy

    Science.gov (United States)

    Singh, Anupam; Bahuguna, Chirag; Nagpal, Ritu; Kumar, Barun

    2016-01-01

    Third nerve paralysis has been known to be associated with a wide spectrum of presentation and other associated factors such as the presence of ptosis, pupillary involvement, amblyopia, aberrant regeneration, poor bell's phenomenon, superior oblique (SO) overaction, and lateral rectus (LR) contracture. Correction of strabismus due to third nerve palsy can be complex as four out of the six extraocular muscles are involved and therefore should be approached differently. Third nerve palsy can be congenital or acquired. The common causes of isolated third nerve palsy in children are congenital (43%), trauma (20%), inflammation (13%), aneurysm (7%), and ophthalmoplegic migraine. Whereas, in adult population, common etiologies are vasculopathic disorders (diabetes mellitus, hypertension), aneurysm, and trauma. Treatment can be both nonsurgical and surgical. As nonsurgical modalities are not of much help, surgery remains the main-stay of treatment. Surgical strategies are different for complete and partial third nerve palsy. Surgery for complete third nerve palsy may involve supra-maximal recession - resection of the recti. This may be combined with SO transposition and augmented by surgery on the other eye. For partial third nerve, palsy surgery is determined according to nature and extent of involvement of extraocular muscles. PMID:27433033

  3. VII NERVE PALSY — EVALUATION AND MANAGEMENT

    African Journals Online (AJOL)

    Enrique

    stapedial nerve — stapedius muscle in middle ear. As it exits ... facial palsy at birth. ... ticularly in the early stages of HIV and ... associated symptoms (hearing loss, ... neuron (UMN) or lower motor neuron .... gold weight implant or upper eyelid.

  4. Peripheral nerve involvement in Bell's palsy

    Directory of Open Access Journals (Sweden)

    J. A. Bueri

    1984-12-01

    Full Text Available A group of patients with Bell's palsy were studied in order to disclose the presence of subclinical peripheral nerve involvement. 20 patients, 8 male and 12 female, with recent Bell's palsy as their unique disease were examined, in all cases other causes of polyneuropathy were ruled out. Patients were investigated with CSF examination, facial nerve latencies in the affected and in the sound sides, and maximal motor nerve conduction velocities, as well as motor terminal latencies from the right median and peroneal nerves. CSF laboratory examination was normal in all cases. Facial nerve latencies were abnormal in all patients in the affected side, and they differed significantly from those of control group in the clinically sound side. Half of the patients showed abnormal values in the maximal motor nerve conduction velocities and motor terminal latencies of the right median and peroneal nerves. These results agree with previous reports which have pointed out that other cranial nerves may be affected in Bell's palsy. However, we have found a higher frequency of peripheral nerve involvement in this entity. These findings, support the hypothesis that in some patients Bell's palsy is the component of a more widespread disease, affecting other cranial and peripheral nerves.

  5. [Surgical treatment in otogenic facial nerve palsy].

    Science.gov (United States)

    Feng, Guo-Dong; Gao, Zhi-Qiang; Zhai, Meng-Yao; Lü, Wei; Qi, Fang; Jiang, Hong; Zha, Yang; Shen, Peng

    2008-06-01

    To study the character of facial nerve palsy due to four different auris diseases including chronic otitis media, Hunt syndrome, tumor and physical or chemical factors, and to discuss the principles of the surgical management of otogenic facial nerve palsy. The clinical characters of 24 patients with otogenic facial nerve palsy because of the four different auris diseases were retrospectively analyzed, all the cases were performed surgical management from October 1991 to March 2007. Facial nerve function was evaluated with House-Brackmann (HB) grading system. The 24 patients including 10 males and 14 females were analysis, of whom 12 cases due to cholesteatoma, 3 cases due to chronic otitis media, 3 cases due to Hunt syndrome, 2 cases resulted from acute otitis media, 2 cases due to physical or chemical factors and 2 cases due to tumor. All cases were treated with operations included facial nerve decompression, lesion resection with facial nerve decompression and lesion resection without facial nerve decompression, 1 patient's facial nerve was resected because of the tumor. According to HB grade system, I degree recovery was attained in 4 cases, while II degree in 10 cases, III degree in 6 cases, IV degree in 2 cases, V degree in 2 cases and VI degree in 1 case. Removing the lesions completely was the basic factor to the surgery of otogenic facial palsy, moreover, it was important to have facial nerve decompression soon after lesion removal.

  6. Prevention of Recurrent Laryngeal Nerve Injury in ThyroidSurgery ...

    African Journals Online (AJOL)

    Meticulous dissection and exploration of the nerve was the main technique in our study. Results: The nerve was identified in 97% of cases, Temporary RLN palsy was found in 6 patients and permanent palsy was found in 1 case. No neuromonitoring techniques were used. Discussion: Our results and the literature review ...

  7. Inferior alveolar nerve injury with laryngeal mask airway: a case report.

    LENUS (Irish Health Repository)

    Hanumanthaiah, Deepak

    2011-01-01

    The incidence of damage to the individual cranial nerves and their branches associated with laryngeal mask airway use is low; there have been case reports of damage to the lingual nerve, hypoglossal nerve and recurrent laryngeal nerve. To the best of our knowledge we present the first reported case of inferior alveolar nerve injury associated with laryngeal mask airway use.

  8. Risk factors for recurrent laryngeal nerve neuropraxia postthyroidectomy.

    LENUS (Irish Health Repository)

    Sheahan, Patrick

    2012-06-01

    Despite preservation of the recurrent laryngeal nerve (RLN), transient vocal cord paralysis (VCP) occurs after 1.2% to 10.9% of thyroidectomies. The objective of this study was to study risk factors for transient VCP after thyroidectomy.

  9. Hypoglossal Nerve Palsy After Cervical Spine Surgery

    OpenAIRE

    Ames, Christopher P.; Clark, Aaron J.; Kanter, Adam S.; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.; Riew, K. Daniel

    2017-01-01

    Study Design: Multi-institutional retrospective study. Objective: The goal of the current study is to quantify the incidence of 2 extremely rare complications of cervical spine surgery; hypoglossal and glossopharyngeal nerve palsies. Methods: A total of 8887 patients who underwent cervical spine surgery from 2005 to 2011 were included in the study from 21 institutions. Results: No glossopharyngeal nerve injuries were reported. One hypoglossal nerve injury was reported after a C3-7 laminectomy...

  10. Management of peripheral facial nerve palsy

    OpenAIRE

    Finsterer, Josef

    2008-01-01

    Peripheral facial nerve palsy (FNP) may (secondary FNP) or may not have a detectable cause (Bell?s palsy). Three quarters of peripheral FNP are primary and one quarter secondary. The most prevalent causes of secondary FNP are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immunological disorders, or drugs. The diagnosis of FNP relies upon the presence of typical symptoms and signs, blood chemical investigations, cerebro-spinal-fluid-investigations, X-ray of the...

  11. Delayed facial nerve decompression for Bell's palsy.

    Science.gov (United States)

    Kim, Sang Hoon; Jung, Junyang; Lee, Jong Ha; Byun, Jae Yong; Park, Moon Suh; Yeo, Seung Geun

    2016-07-01

    Incomplete recovery of facial motor function continues to be long-term sequelae in some patients with Bell's palsy. The purpose of this study was to investigate the efficacy of transmastoid facial nerve decompression after steroid and antiviral treatment in patients with late stage Bell's palsy. Twelve patients underwent surgical decompression for Bell's palsy 21-70 days after onset, whereas 22 patients were followed up after steroid and antiviral therapy without decompression. Surgical criteria included greater than 90 % degeneration on electroneuronography and no voluntary electromyography potentials. This study was a retrospective study of electrodiagnostic data and medical chart review between 2006 and 2013. Recovery from facial palsy was assessed using the House-Brackmann grading system. Final recovery rate did not differ significantly in the two groups; however, all patients in the decompression group recovered to at least House-Brackmann grade III at final follow-up. Although postoperative hearing threshold was increased in both groups, there was no significant between group difference in hearing threshold. Transmastoid decompression of the facial nerve in patients with severe late stage Bell's palsy at risk for a poor facial nerve outcome reduced severe complications of facial palsy with minimal morbidity.

  12. Radiation-induced cranial nerve palsy

    International Nuclear Information System (INIS)

    Berger, P.S.; Bataini, J.P.

    1977-01-01

    Twenty-five patients with 35 cranial nerve palsies were seen at the Fondation Curie during follow-up after radical radiotherapy for head and neck tumors. The twelfth nerve was involved in 19 cases, the tenth in nine, and the eleventh in five; the fifth and second nerves were involved once each and in the same patient. The twelfth nerve was involved alone in 16 patients and the tenth nerve alone in three, with multiple nerves involved in the remaining six patients. The palsy was noted from 12 to 145 months after diagnosis of the tumor. The latency period could be correlated with dose so that the least square fit equation representing NSD vs delay is NSD = 2598--Delay (in months) x 4.6, with a correlation coefficient of -0.58. The distinction between tumor recurrence and radiation-induced nerve palsy is critical. It can often be inferred from the latency period but must be confirmed by observation over a period of time

  13. The prognostic value of concurrent phrenic nerve palsy in newborn babies with neonatal brachial plexus palsy.

    Science.gov (United States)

    Yoshida, Kiyoshi; Kawabata, Hidehiko

    2015-06-01

    To investigate the prognostic value of concurrent phrenic nerve palsy for predicting spontaneous motor recovery in neonatal brachial plexus palsy. We reviewed the records of 366 neonates with brachial plexus palsy. The clinical and follow-up data of patients with and without phrenic nerve palsy were compared. Of 366 newborn babies with neonatal brachial plexus palsy, 21 (6%) had concurrent phrenic nerve palsy. Sixteen of these neonates had upper-type palsy and 5 had total-type palsy. Poor spontaneous motor recovery was observed in 13 neonates with concurrent phrenic nerve palsy (62%) and in 129 without concurrent phrenic nerve palsy (39%). Among neonates born via vertex delivery, poor motor recovery was observed in 7 of 9 (78%) neonates with concurrent phrenic nerve palsy and 115 of 296 (39%) without concurrent phrenic nerve palsy. Concurrent phrenic nerve palsy in neonates with brachial plexus palsy has prognostic value in predicting poor spontaneous motor recovery of the brachial plexus, particularly after vertex delivery. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  14. Facial nerve problems and Bell's palsy

    OpenAIRE

    Sala, DV; Venter, C; Valenas, O

    2015-01-01

    Bell's palsy is paralysis or weakness of muscle at the hemifacial level, a form of temporary facial paralysis, probable a virus infection or trauma, to one or two facial nerves. Damage to the facial nerve innervating the muscles on one side of the face result in a flabby appearance, fell the respective hemiface. Nerve damage can also affect the sense of taste and salivary and lacrimal secretion. This condition begins suddenly, often overnight, and usually gets better on its own within a few w...

  15. The CT features of recurrent laryngeal nerve paralysis

    International Nuclear Information System (INIS)

    Wu Bin; Peng Weijun; Gu Yajia; Yang Tianxi; Wang Hongshi

    2006-01-01

    Objective: To describe the CT appearance of recurrent laryngeal nerve paralysis, discuss the anatomic and pathologic basis of this paralysis, and evaluate CT diagnosis. Methods: 32 cases of recurrent laryngeal nerve paralysis clinical confirmed were analyzed retrospectively. All of these patients had the CT scans from the level of hyoid bone to the upper thorax, the slice and interval are 5 mm. Results: CT findings of recurrent laryngeal nerve paralysis included: oblique of aryepiglottic fold, dislocation of arytenoid cartilage and cricoarytenoid joint, dilation and relaxation of piriform sinus for 27 cases (84.4%); wide and asymmetrical ventricle of larynx for 16 cases (50.0%); asymmetrical and fix of vocal fold for 11 cases (34.4%) et al. Conclusion: The recurrent laryngeal nerve innervate all the intrinsic muscles of the larynx except cricothyroid muscle, paralysis of the nerve leads to atrophy of related muscles. CT scan demonstrate the larynx morphologic changes of recurrent nerve paralysis and is helpful to identify the etiology. (authors)

  16. Transient Femoral Nerve Palsy Following Ilioinguinal Nerve Block ...

    African Journals Online (AJOL)

    2018-04-20

    Apr 20, 2018 ... a 3‑year period under ilioinguinal nerve block only were assessed for evidence of TFNP. All patients ... loss over the anterior aspect of the thigh, weakness of extension at the knee joint, .... and may result in falls with fractures which carry severe ... recovery of the palsy and subsequently discharged same.

  17. Hypoglossal Nerve Palsy After Cervical Spine Surgery.

    Science.gov (United States)

    Ames, Christopher P; Clark, Aaron J; Kanter, Adam S; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Multi-institutional retrospective study. The goal of the current study is to quantify the incidence of 2 extremely rare complications of cervical spine surgery; hypoglossal and glossopharyngeal nerve palsies. A total of 8887 patients who underwent cervical spine surgery from 2005 to 2011 were included in the study from 21 institutions. No glossopharyngeal nerve injuries were reported. One hypoglossal nerve injury was reported after a C3-7 laminectomy (0.01%). This deficit resolved with conservative management. The rate by institution ranged from 0% to 1.28%. Although not directly injured by the surgical procedure, the transient nerve injury might have been related to patient positioning as has been described previously in the literature. Hypoglossal nerve injury during cervical spine surgery is an extremely rare complication. Institutional rates may vary. Care should be taken during posterior cervical surgery to avoid hyperflexion of the neck and endotracheal tube malposition.

  18. NEONATAL NERVE PALSIES: A CONTEMPORARY OBSTETRIC PERSPECTIVE

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    Daren J. Roberts

    2014-05-01

    Full Text Available Background:Birth trauma and its often incorrect inference of iatrogenic causation has led to unfortunate implications for the affected child, the parents, the obstetrician and the midwife due to unwarranted medico-legal attention in our current litigious society.A more discerning evaluation of neonatal nerve palsies following labour and delivery has led to a better understanding of their aetiology with potentially more appropriate outcomes for all parties involved.

  19. Schwannoma of the Recurrent Laryngeal Nerve : A Rare Entity

    NARCIS (Netherlands)

    de Heer, Linda M; Teding van Berkhout, F; Priesterbach, Loudy; Buijsrogge, Marc P

    Neurogenic tumors are the most common posterior mediastinal tumors in adults. Schwannomas originating from the recurrent laryngeal nerve are rare. The present study describes a 46-year-old man with a tumor in the left superior mediastinum. Because of the narrow relationship with the aorta and the

  20. Relationship between the internal laryngeal nerve and the triticeal cartilage: a potentially unrecognized compression site during anterior cervical spine and carotid endarterectomy operations.

    Science.gov (United States)

    Tubbs, R Shane; Dixon, Joshua F; Loukas, Marios; Shoja, Mohammadali M; Cohen-Gadol, Aaron A

    2010-06-01

    The triticeal cartilage has received scant attention in the literature. To date, its relationship to the nearby internal laryngeal nerve has not been studied. Therefore, to elucidate further this anatomic relationship and its potential surgical implications, this study was performed. Eighty-six adult cadaveric sides underwent dissection of the internal laryngeal nerve near its penetration of the thyrohyoid membrane. The relationship of this nerve to the triticeal cartilage was documented. Measurements and histological analysis were performed on all cartilage specimens. We identified triticeal cartilage in 51% of the specimens and found it to be hyaline in nature. The triticeal cartilage was located in the upper, middle, and lower thirds of the thyrohyoid membrane in 14%, 66%, and 20% of sides, respectively. Regardless of the position of the triticeal cartilage within the thyrohyoid membrane, the internal laryngeal nerve crossed directly over the triticeal cartilage on 59% of sides. When present, the internal laryngeal nerve will cross over the triticeal cartilage in the majority of individuals. This relationship should be borne in mind during surgical manipulation in this area and when placing retractors during anterior neck operations including cervical discectomy/fusion and carotid endarterectomy. Compression of the internal laryngeal nerve against the solid triticeal cartilage can cause laryngeal nerve palsy and increase the risk of resultant postoperative aspiration.

  1. Isolated abducens nerve palsy with hyperhomocysteinemia: Association and outcomes

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    Virender Sachdeva

    2013-01-01

    Full Text Available Ischemic abducens nerve palsy usually presents as isolated cranial nerve palsy in the middle aged and elderly patients with known risk factors such as diabetes mellitus, hypertension, dyslipidemia, carotid artery disease, etc., In this report, we describe four patients with isolated abducens nerve palsy who presented with an acute onset diplopia whose detailed history and examination were suggestive of an ischemic etiology. Detailed systemic and laboratory evaluation revealed hyperhomocysteinemia as the only potential risk factor. To the best of our knowledge this is the first report of association of hyperhomocysteinemia and isolated abducens nerve palsy.

  2. The First Experience of Triple Nerve Transfer in Proximal Radial Nerve Palsy.

    Science.gov (United States)

    Emamhadi, Mohammadreza; Andalib, Sasan

    2018-01-01

    Injury to distal portion of posterior cord of brachial plexus leads to palsy of radial and axillary nerves. Symptoms are usually motor deficits of the deltoid muscle; triceps brachii muscle; and extensor muscles of the wrist, thumb, and fingers. Tendon transfers, nerve grafts, and nerve transfers are options for surgical treatment of proximal radial nerve palsy to restore some motor functions. Tendon transfer is painful, requires a long immobilization, and decreases donor muscle strength; nevertheless, nerve transfer produces promising outcomes. We present a patient with proximal radial nerve palsy following a blunt injury undergoing triple nerve transfer. The patient was involved in a motorcycle accident with complete palsy of the radial and axillary nerves. After 6 months, on admission, he showed spontaneous recovery of axillary nerve palsy, but radial nerve palsy remained. We performed triple nerve transfer, fascicle of ulnar nerve to long head of the triceps branch of radial nerve, flexor digitorum superficialis branch of median nerve to extensor carpi radialis brevis branch of radial nerve, and flexor carpi radialis branch of median nerve to posterior interosseous nerve, for restoration of elbow, wrist, and finger extensions, respectively. Our experience confirmed functional elbow, wrist, and finger extensions in the patient. Triple nerve transfer restores functions of the upper limb in patients with debilitating radial nerve palsy after blunt injuries. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. External laryngeal nerve in thyroid surgery: is the nerve stimulator necessary?

    Science.gov (United States)

    Aina, E N; Hisham, A N

    2001-09-01

    To find out the incidence and type of external laryngeal nerves during operations on the thyroid, and to assess the role of a nerve stimulator in detecting them. Prospective, non-randomised study. Teaching hospital, Malaysia. 317 patients who had 447 dissections between early January 1998 and late November 1999. Number and type of nerves crossing the cricothyroid space, and the usefulness of the nerve stimulator in finding them. The nerve stimulator was used in 206/447 dissections (46%). 392 external laryngeal nerves were seen (88%), of which 196/206 (95%) were detected with the stimulator. However, without the stimulator 196 nerves were detected out of 241 dissections (81%). The stimulator detected 47 (23%) Type I nerves (nerve > 1 cm from the upper edge of superior pole); 86 (42%) Type IIa nerves (nerve edge of superior pole); and 63 (31%) Type IIb nerves (nerve below upper edge of superior pole). 10 nerves were not detected. When the stimulator was not used the corresponding figures were 32 (13%), 113 (47%), and 51 (21%), and 45 nerves were not seen. If the nerve cannot be found we recommend dissection of capsule close to the medial border of the upper pole of the thyroid to avoid injury to the nerve. Although the use of the nerve stimulator seems desirable, it confers no added advantage in finding the nerve. In the event of uncertainty about whether a structure is the nerve, the stimulator may help to confirm it. However, exposure of the cricothyroid space is most important for good exposure in searching for the external laryngeal nerve.

  4. Correction: Inferior alveolar nerve injury with laryngeal mask airway: a case report.

    LENUS (Irish Health Repository)

    Hanumanthaiah, Deepak

    2011-11-30

    ABSTRACT: Following the publication of our article [Inferior alveolar nerve injury with laryngeal mask airway: a case report. Journal of Medical Case Reports 2011, 5:122] it was brought to our attention that we inadvertently used the registered trademark of the Laryngeal Mask Company Limited (LMA) as the abbreviation for laryngeal mask airway. A Portex(R) Soft Seal(R) Laryngeal Mask was used and not a device manufactured by the Laryngeal Mask Company.

  5. SELECTIVE LARYNGEAL ABDUCTOR REINNERVATION IN CATS USING A PHRENIC-NERVE TRANSFER AND ORG-2766

    NARCIS (Netherlands)

    MAHIEU, HF; VANLITHBIJL, JT; GROENHOUT, C; TONNAER, JADM; DEWILDE, P

    Reinnervation of the recurrent laryngeal nerve following nerve injury often leads to laryngeal synkinesis. Selective reinnervation of adductor and abductor muscles might be able to avoid synkinesis. This study presents the results of selective abductor reinnervation in cats, using a phrenic nerve

  6. Herpes Zoster ophthalmicus with occulomotor nerve palsy

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    Hayati Kandiş

    2010-09-01

    Full Text Available Dear Editor;A 79-year-old male patient was admitted to our emergency department with a complaining of eruption over his face for 10 days and inability to open his eyes for a few days. The patient had hypertension and diabetes mellitus. He had no history of smoking, alcohol. On examination, there was vesicular cutaneous eruption, erosions and crusts, as well as ptosis, in some areas in the ophthalmic division of the trigeminal nerve on the left side of his face (Figure 1. The patient did not have extraocular muscle palsy. Patient was cachectic and dehydrated appearance. Other systemic examinations were unremarkable. Laboratory investigations showed total white cell count of 16500 (neutrophil: 15000, N: 5200–12400, and CRP: 15 mg/dL (N: 0.1–0.5. A clinical diagnosis of ophthalmic zoster with occulomotor nerve palsy was made and the valasiclovir 3g/d was given to patient, wet dressing with an aluminum acetate solution 0,5%. The patient’s lesions had markedly improved within 10 days.

  7. Traumatic facial nerve neuroma with facial palsy presenting in infancy.

    Science.gov (United States)

    Clark, James H; Burger, Peter C; Boahene, Derek Kofi; Niparko, John K

    2010-07-01

    To describe the management of traumatic neuroma of the facial nerve in a child and literature review. Sixteen-month-old male subject. Radiological imaging and surgery. Facial nerve function. The patient presented at 16 months with a right facial palsy and was found to have a right facial nerve traumatic neuroma. A transmastoid, middle fossa resection of the right facial nerve lesion was undertaken with a successful facial nerve-to-hypoglossal nerve anastomosis. The facial palsy improved postoperatively. A traumatic neuroma should be considered in an infant who presents with facial palsy, even in the absence of an obvious history of trauma. The treatment of such lesion is complex in any age group but especially in young children. Symptoms, age, lesion size, growth rate, and facial nerve function determine the appropriate management.

  8. [Isolated palsy of the hypoglossal nerve complicating infectious mononucleosis].

    Science.gov (United States)

    Carra-Dallière, C; Mernes, R; Juntas-Morales, R

    2011-01-01

    Neurological complications of infectious mononucleosis are rare. Various disorders have been described: meningitis, encephalitis, peripheral neuropathy. Isolated cranial nerve palsy has rarely been reported. A 16-year-old man was admitted for isolated and unilateral hypoglossal nerve palsy, four weeks after infectious mononucleosis. Cerebral MRI, cerebrospinal fluid study and electromyography were normal. IgM anti-VCA were positive. Two months later, without treatment, the tongue had almost fully recovered. To the best of our knowledge, only seven cases of isolated palsy of the hypoglossal nerve complicating infectious mononucleosis have been previously reported. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

  9. Involvement of hypoglossal and recurrent laryngeal nerves on swallowing pressure.

    Science.gov (United States)

    Tsujimura, Takanori; Suzuki, Taku; Yoshihara, Midori; Sakai, Shogo; Koshi, Naomi; Ashiga, Hirokazu; Shiraishi, Naru; Tsuji, Kojun; Magara, Jin; Inoue, Makoto

    2018-05-01

    Swallowing pressure generation is important to ensure safe transport of an ingested bolus without aspiration or leaving residue in the pharynx. To clarify the mechanism, we measured swallowing pressure at the oropharynx (OP), upper esophageal sphincter (UES), and cervical esophagus (CE) using a specially designed manometric catheter in anesthetized rats. A swallow, evoked by punctate mechanical stimulation to the larynx, was identified by recording activation of the suprahyoid and thyrohyoid muscles using electromyography (EMG). Areas under the curve of the swallowing pressure at the OP, UES, and CE from two trials indicated high intrasubject reproducibility. Effects of transecting the hypoglossal nerve (12N) and recurrent laryngeal nerve (RLN) on swallowing were investigated. Following bilateral hypoglossal nerve transection (Bi-12Nx), OP pressure was significantly decreased, and time intervals between peaks of thyrohyoid EMG bursts and OP pressure were significantly shorter. Decreased OP pressure and shortened times between peaks of thyrohyoid EMG bursts and OP pressure following Bi-12Nx were significantly increased and longer, respectively, after covering the hard and soft palates with acrylic material. UES pressure was significantly decreased after bilateral RLN transection compared with that before transection. These results suggest that the 12N and RLN play crucial roles in OP and UES pressure during swallowing, respectively. We speculate that covering the palates with a palatal augmentation prosthesis may reverse the reduced swallowing pressure in patients with 12N or tongue damage by the changes of the sensory information and of the contact between the tongue and a palates. NEW & NOTEWORTHY Hypoglossal nerve transection reduced swallowing pressure at the oropharynx. Covering the hard and soft palates with acrylic material may reverse the reduced swallowing function caused by hypoglossal nerve damage. Recurrent laryngeal nerve transection reduced upper

  10. Bilateral sixth cranial nerve palsy in infectious mononucleosis.

    Science.gov (United States)

    Neuberger, J.; Bone, I.

    1979-01-01

    A 15-year-old girl who presented with a bilateral sixth nerve palsy caused by infectious mononucleosis is described. The neurological presentation of infectious mononucleosis is discussed. PMID:225738

  11. Intraneural metastasis of gastric carcinoma leads to sciatic nerve palsy

    International Nuclear Information System (INIS)

    Ichikawa, Jiro; Matsumoto, Seiichi; Shimoji, Takashi; Tanizawa, Taisuke; Gokita, Tabu; Hayakawa, Keiko; Aoki, Kaoru; Ina, Saori; Kanda, Hiroaki

    2012-01-01

    Soft tissue metastases, in particular intraneural metastasis, from any carcinomas seldom occur. To our knowledge, no case of sciatic nerve palsy due to intraneural metastasis of gastric carcinoma is reported in the literature. A case is reported of a 82-year old woman with sciatic nerve palsy with intraneural metastasis of gastric carcinoma. Although she had undergone partial gastrectomy with T2b, N0, M0 two years ago and primary site was cured, she developed sciatic nerve palsy from the carcinoma metastasis directly to the nerve. Operative resection and Histological examination revealed poorly differentiated adenocarcinoma, the same as her primary site adenocarcinoma. Sciatica is usually caused by a herniated disc or spinal canal stenosis. Sciatic nerve palsy may be caused by nondiscogenic etiologies that may be either intrapelvic or extrapelvic. It is important to image the entire course of the nerve to distinguish these etiologies quickly. The longer the nerve compression the less likely a palsy will recover. Surgery is a good intervention that simultaneously obtains a tissue diagnosis and decompresses the nerve

  12. Reversing Age Related Changes of the Laryngeal Muscles by Chronic Electrostimulation of the Recurrent Laryngeal Nerve.

    Directory of Open Access Journals (Sweden)

    Michael Karbiener

    Full Text Available Age related atrophy of the laryngeal muscles -mainly the thyroarytenoid muscle (TAM- leads to a glottal gap and consequently to a hoarse and dysphonic voice that significantly affects quality of life. The aim of our study was to reverse this atrophy by inducing muscular hypertrophy by unilateral functional electrical stimulation (FES of the recurrent laryngeal nerve (RLN in a large animal model using aged sheep (n = 5. Suitable stimulation parameters were determined by fatiguing experiments of the thyroarytenoid muscle in an acute trial. For the chronic trial an electrode was placed around the right RLN and stimulation was delivered once daily for 29 days. We chose a very conservative stimulation pattern, total stimulation time was two minutes per day, or 0.14% of total time. Overall, the mean muscle fiber diameter of the stimulated right TAM was significantly larger than the non-stimulated left TAM (30μm±1.1μm vs. 28μm±1.1 μm, p<0.001. There was no significant shift in fiber type distribution as judged by immunohistochemistry. The changes of fiber diameter could not be observed in the posterior cricoarytenoid muscle (PCAM. FES is a possible new treatment option for reversing the effects of age related laryngeal muscle atrophy.

  13. Facial nerve palsy: Evaluation by contrast-enhanced MR imaging

    International Nuclear Information System (INIS)

    Kinoshita, T.; Ishii, K.; Okitsu, T.; Okudera, T.; Ogawa, T.

    2001-01-01

    AIM: The purpose of this study was to investigate the value of contrast-enhanced magnetic resonance (MR) imaging in patients with peripheral facial nerve palsy. MATERIALS AND METHODS: MR imaging was performed in 147 patients with facial nerve palsy, using a 1.0 T unit. All of 147 patients were evaluated by contrast-enhanced MR imaging and the pattern of enhancement was compared with that in 300 control subjects evaluated for suspected acoustic neurinoma. RESULTS: The intrameatal and labyrinthine segments of the normal facial nerve did not show enhancement, whereas enhancement of the distal intrameatal segment and the labyrinthine segment was respectively found in 67% and 43% of patients with Bell's palsy. The geniculate ganglion or the tympanic-mastoid segment was enhanced in 21% of normal controls versus 91% of patients with Bell's palsy. Abnormal enhancement of the non-paralyzed facial nerve was found in a patient with bilateral temporal bone fracture. CONCLUSION: Enhancement of the distal intrameatal and labyrinthine segments is specific for facial nerve palsy. Contrast-enhanced MR imaging can reveal inflammatory facial nerve lesions and traumatic nerve injury, including clinically silent damage in trauma. Kinoshita T. et al. (2001)

  14. Facial nerve palsy: Evaluation by contrast-enhanced MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kinoshita, T.; Ishii, K.; Okitsu, T.; Okudera, T.; Ogawa, T

    2001-11-01

    AIM: The purpose of this study was to investigate the value of contrast-enhanced magnetic resonance (MR) imaging in patients with peripheral facial nerve palsy. MATERIALS AND METHODS: MR imaging was performed in 147 patients with facial nerve palsy, using a 1.0 T unit. All of 147 patients were evaluated by contrast-enhanced MR imaging and the pattern of enhancement was compared with that in 300 control subjects evaluated for suspected acoustic neurinoma. RESULTS: The intrameatal and labyrinthine segments of the normal facial nerve did not show enhancement, whereas enhancement of the distal intrameatal segment and the labyrinthine segment was respectively found in 67% and 43% of patients with Bell's palsy. The geniculate ganglion or the tympanic-mastoid segment was enhanced in 21% of normal controls versus 91% of patients with Bell's palsy. Abnormal enhancement of the non-paralyzed facial nerve was found in a patient with bilateral temporal bone fracture. CONCLUSION: Enhancement of the distal intrameatal and labyrinthine segments is specific for facial nerve palsy. Contrast-enhanced MR imaging can reveal inflammatory facial nerve lesions and traumatic nerve injury, including clinically silent damage in trauma. Kinoshita T. et al. (2001)

  15. Recurrent unilateral facial nerve palsy in a child with dehiscent facial nerve canal

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    Christopher Liu

    2016-12-01

    Full Text Available Objective: The dehiscent facial nerve canal has been well documented in histopathological studies of temporal bones as well as in clinical setting. We describe clinical and radiologic features of a child with recurrent facial nerve palsy and dehiscent facial nerve canal. Methods: Retrospective chart review. Results: A 5-year-old male was referred to the otolaryngology clinic for evaluation of recurrent acute otitis media and hearing loss. He also developed recurrent left peripheral FN palsy associated with episodes of bilateral acute otitis media. High resolution computed tomography of the temporal bones revealed incomplete bony coverage of the tympanic segment of the left facial nerve. Conclusions: Recurrent peripheral FN palsy may occur in children with recurrent acute otitis media in the presence of a dehiscent facial nerve canal. Facial nerve canal dehiscence should be considered in the differential diagnosis of children with recurrent peripheral FN palsy.

  16. Facial nerve palsy as a primary presentation of advanced carcinoma ...

    African Journals Online (AJOL)

    Introduction: Cranial nerve neuropathy is a rare presentation of advanced cancer of the prostate. Observation: We report a case of 65-year-old man who presented with right lower motor neuron (LMN) facial nerve palsy. The prostate had malignant features on digital rectal examination (DRE) and the prostate specific antigen ...

  17. A case of laryngeal palsy and persistent aspiration pneumonia following radiotherapy for laryngeal carcinoma

    International Nuclear Information System (INIS)

    Nakao, Kazunari; Tayama, Niro; Mizuno, Masahiro; Niimi, Seiji.

    1997-01-01

    A 80-year-old man developed impairment in his laryngeal movement, vocal fold fixation and severe misdeglutition after radiotherapy for laryngeal carcinoma. Despite of several surgical treatments for aspiration pneumonia, the misdeglutition did not cease because of the stiffness in his larynx until a laryngectomy was finally performed. The resected larynx showed marked fibrosis, and it was considered as a late complication of radiotherapy. The treatment course in this difficult case is discussed. (author)

  18. Multiple Cranial Nerve Palsy Due to Cerebral Venous Thrombosis

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    Esra Eruyar

    2017-04-01

    Full Text Available Cerebral venous thrombosis (CVT is a rare clinical condition between cerebrovasculer diases. The most common findings are headache, seizure and focal neurological deficit. Multiple cranial nerve palsy due to CVT is rarely seen and it is not clear pathology. A pathology that could explain the lack of cranial nerve imaging is carrying suspected diagnosis but the disease is known to provide early diagnosis and treatment. We want to emphasize with this case multipl cranial nerve palsy due to CVT is seen rarely and good response to treatment.

  19. The diagnostic yield of neuroimaging in sixth nerve palsy - Sankara Nethralaya Abducens Palsy Study (SNAPS: Report 1

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    Akshay Gopinathan Nair

    2014-01-01

    Full Text Available Aims: The aim was to assess the etiology of sixth nerve palsy and on the basis of our data, to formulate a diagnostic algorithm for the management in sixth nerve palsy. Design: Retrospective chart review. Results: Of the 104 neurologically isolated cases, 9 cases were attributable to trauma, and 95 (86.36% cases were classified as nontraumatic, neurologically isolated cases. Of the 95 nontraumatic, isolated cases of sixth nerve palsy, 52 cases were associated with vasculopathic risk factors, namely diabetes and hypertension and were classified as vasculopathic sixth nerve palsy (54.7%, and those with a history of sixth nerve palsy from birth (6 cases were classified as congenital sixth nerve palsy (6.3%. Of the rest, neuroimaging alone yielded a cause in 18 of the 37 cases (48.64%. Of the other 19 cases where neuroimaging did not yield a cause, 6 cases were attributed to preceding history of infection (3 upper respiratory tract infection and 3 viral illnesses, 2 cases of sixth nerve palsy were found to be a false localizing sign in idiopathic intracranial hypertension and in 11 cases, the cause was undetermined. In these idiopathic cases of isolated sixth nerve palsy, neuroimaging yielded no positive findings. Conclusions: In the absence of risk factors, a suggestive history, or positive laboratory and clinical findings, neuroimaging can serve as a useful diagnostic tool in identifying the exact cause of sixth nerve palsy. Furthermore, we recommend an algorithm to assess the need for neuroimaging in sixth nerve palsy.

  20. Restoration of diaphragmatic function after diaphragm reinnervation by inferior laryngeal nerve; experimental study in rabbits

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    de Barros Angelique

    2006-01-01

    Full Text Available Abstract Objectives To assess the possibilities of reinnervation in a paralyzed hemidiaphragm via an anastomosis between phrenic nerve and inferior laryngeal nerve in rabbits. Reinnervation of a paralyzed diaphragm could be an alternative to treat patients with ventilatory insufficiency due to upper cervical spine injuries. Material and method Rabbits were divided into five groups of seven rabbits each. Groups I and II were respectively the healthy and the denervated control groups. The 3 other groups were all reinnervated using three different surgical procedures. In groups III and IV, phrenic nerve was respectively anastomosed with the abductor branch of the inferior laryngeal nerve and with the trunk of the inferior laryngeal nerve. In group V, the fifth and fourth cervical roots were respectively anastomosed with the abductor branch of the inferior laryngeal nerve and with the nerve of the sternothyroid muscle (originating from the hypoglossal nerve. Animals were evaluated 4 months later using electromyography, transdiaphragmatic pressure measurements, sonomicrometry and histological examination. Results A poor inspiratory activity was found in quiet breathing in the reinnervated groups, with an increasing pattern of activity during effort. In the reinnervated groups, transdiaphragmatic pressure measurements and sonomicrometry were higher in group III with no significant differencewith groups IV and V. Conclusion Inspiratory contractility of an hemidiaphragm could be restored with immediate anastomosis after phrenic nerve section between phrenic nerve and inferior laryngeal nerve.

  1. Does intraoperative neuromonitoring of recurrent nerves have an impact on the postoperative palsy rate? Results of a prospective multicenter study.

    Science.gov (United States)

    Mirallié, Éric; Caillard, Cécile; Pattou, François; Brunaud, Laurent; Hamy, Antoine; Dahan, Marcel; Prades, Michel; Mathonnet, Muriel; Landecy, Gérard; Dernis, Henri-Pierre; Lifante, Jean-Christophe; Sebag, Frederic; Jegoux, Franck; Babin, Emmanuel; Bizon, Alain; Espitalier, Florent; Durand-Zaleski, Isabelle; Volteau, Christelle; Blanchard, Claire

    2018-01-01

    The impact of intraoperative neuromonitoring on recurrent laryngeal nerve palsy remains debated. Our aim was to evaluate the potential protective effect of intraoperative neuromonitoring on recurrent laryngeal nerve during total thyroidectomy. This was a prospective, multicenter French national study. The use of intraoperative neuromonitoring was left at the surgeons' choice. Postoperative laryngoscopy was performed systematically at day 1 to 2 after operation and at 6 months in case of postoperative recurrent laryngeal nerve palsy. Univariate and multivariate analyses and propensity score (sensitivity analysis) were performed to compare recurrent laryngeal nerve palsy rates between patients operated with or without intraoperative neuromonitoring. Among 1,328 patients included (females 79.9%, median age 51.2 years, median body mass index 25.6 kg/m 2 ), 807 (60.8%) underwent intraoperative neuromonitoring. Postoperative abnormal vocal cord mobility was diagnosed in 131 patients (9.92%), including 69 (8.6%) and 62 (12.1%) in the intraoperative neuromonitoring and nonintraoperative neuromonitoring groups, respectively. Intraoperative neuromonitoring was associated with a lesser rate of recurrent laryngeal nerve palsy in univariate analysis (odds ratio = 0.68, 95% confidence interval, 0.47; 0.98, P = .04) but not in multivariate analysis (oddsratio = 0.74, 95% confidence interval, 0.47; 1.17, P = .19), or when using a propensity score (odds ratio = 0.76, 95% confidence interval, 0.53; 1.07, P = .11). There was no difference in the rates of definitive recurrent laryngeal nerve palsy (0.8% and 1.3% in intraoperative neuromonitoring and non-intraoperative neuromonitoring groups respectively, P = .39). The sensitivity, specificity, and positive and negative predictive values of intraoperative neuromonitoring for detecting abnormal postoperative vocal cord mobility were 29%, 98%, 61%, and 94%, respectively. The use of intraoperative

  2. Phrenic Nerve Palsy as Initial Presentation of Large Retrosternal Goitre.

    Science.gov (United States)

    Hakeem, Arsheed Hussain; Hakeem, Imtiyaz Hussain; Wani, Fozia Jeelani

    2016-12-01

    Unilateral phrenic nerve palsy as initial presentation of the retrosternal goitre is extremely rare event. This is a case report of a 57-year-old woman with history of cough and breathlessness of 3 months duration, unaware of the thyroid mass. She had large cervico-mediastinal goiter and chest radiograph revealed raised left sided hemidiaphragm. Chest CT scan did not reveal any lung parenchymal or mediastinal pathology. The patient underwent a total thyroidectomy through a cervical approach. The final pathology was in favor of multinodular goitre. Even after 1 year of follow up, phrenic nerve palsy did not improve indicating permanent damage. Phrenic nerve palsy as initial presentation of the retrosternal goitre is unusual event. This case is reported not only because of the rare nature of presentation, but also to make clinicians aware of the entity so that early intervention may prevent attendant morbidity.

  3. Cranial nerve palsies in childhood parameningeal rhabdomyosarcoma.

    Science.gov (United States)

    Zorzi, Alexandra P; Grant, Ronald; Gupta, Abha A; Hodgson, David C; Nathan, Paul C

    2012-12-15

    Children with parameningeal rhabdomyosarcoma (PM RMS) and cranial nerve palsy (CNP) are at risk for permanent neurologic dysfunction. Clinicians often consider the use of emergent therapies such as expedited radiation and/or corticosteroids; however, there is a paucity of information describing the natural history of CNP in PM RMS. We sought to describe the clinical features of patients with PM RMS plus associated CNP and to evaluate the patient, disease, and treatment-related factors that impacted neurologic recovery. We conducted a retrospective review of PM RMS cases treated at the Hospital for Sick Children between 1985 and 2010. Thirty-five children were treated for PM RMS, 19 (54%) of whom presented with CNP. Children with CNP were nine times more likely to have other high-risk features (cranial base bony erosion and/or intracranial extension) at the time of presentation than children without CNP (OR 9.6, 95% CI 1.69, 54.79, P = 0.013). In addition to commencing chemotherapy, 13 patients (68%) received expedited RT and corticosteroids, four (21%) corticosteroids alone, and two (11%) received only standard chemotherapy and RT. At last follow up of the 11 survivors, neurologic recovery was complete in five (45%), partial in five (45%), and absent in one (9%). In our cohort, recovery of PM RMS associated CNP was often incomplete despite multi-modal therapy. A larger cohort of patients is required to determine the utility of emergent initiation of radiation or corticosteroids. This study will facilitate the counseling of future families on the long-term neurologic recovery CNP in PM RMS. Copyright © 2012 Wiley Periodicals, Inc.

  4. Post traumatic facial nerve palsy without temporal bone fracture

    International Nuclear Information System (INIS)

    Scuotto, A.; Cappabianca, S.; Capasso, R.; Porto, A.; D'Oria, S.; Rotondo, M.

    2016-01-01

    Facial nerve injury following head trauma is a frequent event with or without temporal bone fractures. Computed tomography is the imaging modality of choice for assessing the possible bone disruption of the facial nerve canal. Magnetic resonance is helpful in presence of a facial nerve paralysis, unexplained by computed tomography findings. We present a case of delayed post-traumatic facial nerve palsy without radiological evidence of temporal bone fractures, in which magnetic resonance was crucial for diagnosing the nerve impairment. Radiological findings in accordance both with electrodiagnostic tests and clinical presentation suggested the successful conservative management. - Highlights: • Facial nerve is more prone to damage than any other cranial nerve after trauma. • Facial nerve trauma is usually associated with temporal bone fractures. • MRI is mandatory in case of no evidence of bone disruption at CT.

  5. Acute sixth nerve palsy in a young man, beware of the 'red herring'.

    LENUS (Irish Health Repository)

    O'Neill, E C

    2012-02-01

    BACKGROUND: Cranial nerve palsies has several etiologies including vascular insufficiency, neoplasm, trauma and inflammation. Isolated sixth nerve palsy is an extremely rare presenting feature of leukemia. AIM: We describe an unusual ocular presentation of a bilateral progressive sixth nerve palsy in a young male with a preceding head injury. CONCLUSION: Acquired sixth nerve palsies in young adults may be due to trauma but in the absence of a definitive history other systemic processes must be outruled. We describe a case of bilateral sixth nerve palsy in a patient with ALL with no obvious CNS involvement. Potential etiological mechanisms are discussed.

  6. Inferior alveolar nerve injury with laryngeal mask airway: a case report

    Directory of Open Access Journals (Sweden)

    Masud Sarmad

    2011-03-01

    Full Text Available Abstract Introduction The incidence of damage to the individual cranial nerves and their branches associated with laryngeal mask airway use is low; there have been case reports of damage to the lingual nerve, hypoglossal nerve and recurrent laryngeal nerve. To the best of our knowledge we present the first reported case of inferior alveolar nerve injury associated with laryngeal mask airway use. Case presentation A 35-year-old Caucasian man presented to our facility for elective anterior cruciate ligament repair. He had no background history of any significant medical problems. He opted for general anesthesia over a regional technique. He was induced with fentanyl and propofol and a size 4 laryngeal mask airway was inserted without any problems. His head was in a neutral position during the surgery. After surgery in the recovery room, he complained of numbness in his lower lip. He also developed extensive scabbing of the lower lip on the second day after surgery. The numbness and scabbing started improving after a week, with complete recovery after two weeks. Conclusion We report the first case of vascular occlusion and injury to the inferior alveolar nerve, causing scabbing and numbness of the lower lip, resulting from laryngeal mask airway use. This is an original case report mostly of interest for anesthetists who use the laryngeal mask airway in day-to-day practice. Excessive inflation of the laryngeal mask airway cuff could have led to this complication. Despite the low incidence of cranial nerve injury associated with the use of the laryngeal mask airway, vigilant adherence to evidence-based medicine techniques and recommendations from the manufacturer's instructions can prevent such complications.

  7. Ocular cranial nerve palsies secondary to sphenoid sinusitis

    Institute of Scientific and Technical Information of China (English)

    Aiman El Mograbi; Ethan Soudry

    2017-01-01

    Objective:The clinical presentation of sphenoid sinusitis can be highly variable.Rarely,sphenoid sinusitis may present with cranial nerve complications due to the proximity of these structures to the sphenoid sinus.Method:A case series from Rabin Medical Center and all cases of cranial nerves palsies secondary to sphenoid sinusitis that have been reported in the literature were reviewed.Results:Seventeen patients were identified.The abducent nerve was the most common cranial nerve affected (76%),followed by the oculomotor nerve (18%).One patient had combined oculomotor,trochlear and abducent palsies.The most common pathology was isolated purulent sphenoid sinusitis in 64% followed by allergic fungal sinusitis (AFS) in 18%,and fungal infection in 18%.94% had an acute presentation.The majority (85%) received a combined intravenous antibiotics and surgical treatment.The remainder received conservative treatment alone.Complete recovery of cranial nerve palsy was noted in 82% during follow up.Conclusion:Sphenoid sinusitis presenting as diplopia and headaches is rare.A neoplastic process must be ruled out and early surgical intervention with intravenous antimicrobial therapy carry an excellent outcome with complete resolution of symptoms.

  8. Changes in the frequency of swallowing during electrical stimulation of superior laryngeal nerve in rats.

    Science.gov (United States)

    Tsuji, Kojun; Tsujimura, Takanori; Magara, Jin; Sakai, Shogo; Nakamura, Yuki; Inoue, Makoto

    2015-02-01

    The aim of the present study was to investigate the adaptation of the swallowing reflex in terms of reduced swallowing reflex initiation following continuous superior laryngeal nerve stimulation. Forty-four male Sprague Dawley rats were anesthetized with urethane. To identify swallowing, electromyographic activity of the left mylohyoid and thyrohyoid muscles was recorded. To evoke the swallowing response, the superior laryngeal nerve (SLN), recurrent laryngeal nerve, or cortical swallowing area was electrically stimulated. Repetitive swallowing evoked by continuous SLN stimulation was gradually reduced, and this reduction was dependent on the resting time duration between stimulations. Prior SLN stimulation also suppressed subsequent swallowing initiation. The reduction in evoked swallows induced by recurrent laryngeal nerve or cortical swallowing area stimulation was less than that following superior laryngeal nerve stimulation. Decerebration had no effect on the reduction in evoked swallows. Prior subthreshold stimulation reduced subsequent initiation of swallowing, suggesting that there was no relationship between swallowing movement evoked by prior stimulation and the subsequent reduction in swallowing initiation. Overall, these data suggest that reduced sensory afferent nerve firing and/or trans-synaptic responses, as well as part of the brainstem central pattern generator, are involved in adaptation of the swallowing reflex following continuous stimulation of swallow-inducing peripheral nerves and cortical areas. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Sciatic nerve palsy associated with intramuscular quinine injections ...

    African Journals Online (AJOL)

    Sct?ior ikfeclical O[ficcr. Department of Orthopaeclics, Mulago Hospital, Makerere University, Kampala, Uganda. Key Words: Sciatic nerve palsy, intramuscular injections, children, quinine dil~ydrochloride. The purpose of this paper is to show that, in children, gluteal injection of quinine dihydrochloride (QDH) may result in ...

  10. Developmental Changes in the Connective Tissues of the Porcine Recurrent Laryngeal Nerve

    OpenAIRE

    Campbell, Ellen O.; Samlan, Robin A.; McMullen, Nathaniel T.; Cook, Sarah; Smiley-Jewell, Suzette; Barkmeier-Kraemer, Julie

    2013-01-01

    The recurrent laryngeal nerve (RLN) branches from the vagus cranial nerve to innervate structures important for voicing and swallowing. Damage to this nerve, commonly associated with surgery or idiopathic etiologies that largely occur with aging, results in impaired voicing and swallowing. Sunderland proposed a model of peripheral nerve damage whereby a nerve’s ability to resist damage from stretch and compression is determined by the quantity and composition of its epineurial connective tiss...

  11. A Multicenter Review of Superior Laryngeal Nerve Injury Following Anterior Cervical Spine Surgery.

    Science.gov (United States)

    Tempel, Zachary J; Smith, Justin S; Shaffrey, Christopher; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel; Kanter, Adam S

    2017-04-01

    A retrospective multicenter case-series study; case report and review of the literature. The anatomy and function of the superior laryngeal nerve (SLN) are well described; however, the consequences of SLN injury remain variable and poorly defined. The prevalence of SLN injury as a consequence of cervical spine surgery is difficult to discern as its clinical manifestations are often inconstant and frequently of a subclinical degree. A multicenter study was performed to better delineate the risk factors, prevalence, and outcomes of SLN injury. A retrospective multicenter case-series study involving 21 high-volume surgical centers from the AO Spine North America Clinical Research Network. Medical records for 17 625 patients who received subaxial cervical spine surgery from 2005 to 2011 were reviewed to identify occurrence of 21 predefined treatment complications. Descriptive statistics were provided for baseline patient characteristics. A retrospective review of the neurosurgical literature on SLN injury was also performed. A total of 8887 patients who underwent anterior cervical spine surgery at the participating institutions were screened, and 1 case of SLN palsy was identified. The prevalence ranged from 0% to 1.25% across all centers. The patient identified underwent a C4 corpectomy. The SLN injury was identified after the patient demonstrated difficulty swallowing postoperatively. He underwent placement of a percutaneous gastrostomy tube and his SLN palsy resolved by 6 weeks. This multicenter study demonstrates that identification of SLN injury occurs very infrequently. Symptomatic SLN injury is an exceedingly rare complication of anterior cervical spine surgery. The SLN is particularly vulnerable when exposing the more rostral levels of the cervical spine. Careful dissection and retraction of the longus coli may decrease the risk of SLN injury during anterior cervical surgery.

  12. [Cranial nerve palsy caused by tumours of the head and neck

    NARCIS (Netherlands)

    Delsing, C.P.; Verbist, B.M.; Hoogen, F.J.A. van den

    2013-01-01

    Cranial nerve palsy is a diagnostic guiding symptom, but often goes unrecognized. The differential diagnosis includes a variety of diseases, including malignant tumours of the head and neck. Here we describe three cases of cranial nerve palsy. In two of the cases the palsy was recognized following

  13. Traumatic facial nerve palsy: CT patterns of facial nerve canal fracture and correlation with clinical severity

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jae Cheol; Kim, Sang Joon; Park, Hyun Min; Lee, Young Suk; Lee, Jee Young [College of Medicine, Dankook Univ., Chonan (Korea, Republic of)

    2002-07-01

    To analyse the patterns of facial nerve canal injury seen at temporal bone computed tomography (CT) in patients with traumatic facial nerve palsy and to correlate these with clinical manifestations and outcome. Thirty cases of temporal bone CT in 29 patients with traumatic facial nerve palsy were analyzed with regard to the patterns of facial nerve canal involvement. The patterns were correlated with clinical grade, the electroneurographic (ENoG) findings, and clinical outcome. For clinical grading, the House-Brackmann scale was used, as follows:grade I-IV, partial palsy group; grade V-VI, complete palsy group. The electroneuronographic findings were categorized as mild to moderate (below 90%) or severe (90% and over) degeneration. In 25 cases, the bony wall of the facial nerve canals was involved directly (direct finding): discontinuity of the bony wall was onted in 22 cases, bony spicules in ten, and bony wall displacement in five. Indirect findings were canal widening in nine cases and adjacent bone fracture in two. In one case, there were no direct or indirect findings. All cases in which there was complete palsy (n=8) showed one or more direct findings including spicules in six, while in the incomplete palsy group (n=22), 17 cases showed direct findings. In the severe degeneration group (n=13), on ENog, 12 cases demonstrated direct findings, including spicules in nine cases. In 24 patients, symptoms of facial palsy showed improvement at follow up evaluation. Four of the five patients in whom symptoms did not improve had spicules. Among ten patients with spicules, five underwent surgery and symptoms improved in four of these; among the five patients not operated on , symptoms did not improve in three. In most patients with facial palsy after temporal bone injury, temporal bone CT revealed direct or indirect facial nerve canal involvement, and in complete palsy or severe degeneration groups, there were direct findings in most cases. We believe that meticulous

  14. Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia.

    Science.gov (United States)

    Kaneko, Mami; Hitomi, Takefumi; Takekawa, Takashi; Tsuji, Takuya; Kishimoto, Yo; Hirano, Shigeru

    2017-09-26

    Injury to the superior laryngeal nerve can result in dysphonia, and in particular, loss of vocal range. It can be an especially difficult problem to address with either voice therapy or surgical intervention. Some clinicians and scientists suggest that combining vocal exercises with adjunctive neuromuscular electrical stimulation may enhance the positive effects of voice therapy for superior laryngeal nerve paresis (SLNP). However, the effects of voice therapy without neuromuscular electrical stimulation are unknown. The purpose of this retrospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating chronic SLNP dysphonia in two subjects, using interspike interval (ISI) variability of laryngeal motor units by laryngeal electromyography (LEMG). Both patients underwent LEMG and were diagnosed with having 70% recruitment of the cricothyroid muscle, and 70% recruitment of the cricothyroid and thyroarytenoid muscles, respectively. Both patients received voice therapy for 3 months. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 were performed before and after voice therapy. Mean ISI variability during steady phonation was also assessed. After voice therapy, both patients showed improvement in vocal assessments by acoustic, aerodynamic, GRBAS, and Voice Handicap Index-10 analysis. LEMG indicated shortened ISIs in both cases. This study suggests that voice therapy for chronic SLNP dysphonia can be useful for improving SLNP and voice quality. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  15. [Treatment of idiopathic peripheral facial nerve paralysis (Bell's palsy)].

    Science.gov (United States)

    Meyer, Martin Willy; Hahn, Christoffer Holst

    2013-01-28

    Bell's palsy is defined as an idiopathic peripheral facial nerve paralysis of sudden onset. It affects 11-40 persons per 100,000 per annum. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement. The aim of this study was to make an overview of which pharmacological treatments have been used to improve outcomes. The available evidence from randomized controlled trials shows significant benefit from treating Bell's palsy with corticosteroids but shows no benefit from antivirals.

  16. Neuro-ophthalmological approach to facial nerve palsy.

    Science.gov (United States)

    Portelinha, Joana; Passarinho, Maria Picoto; Costa, João Marques

    2015-01-01

    Facial nerve palsy is associated with significant morbidity and can have different etiologies. The most common causes are Bell's palsy, Ramsay-Hunt syndrome and trauma, including surgical trauma. Incidence varies between 17 and 35 cases per 100,000. Initial evaluation should include accurate clinical history, followed by a comprehensive investigation of the head and neck, including ophthalmological, otological, oral and neurological examination, to exclude secondary causes. Routine laboratory testing and diagnostic imaging is not indicated in patients with new-onset Bell's palsy, but should be performed in patients with risk factors, atypical cases or in any case without resolution within 4 months. Many factors are involved in determining the appropriate treatment of these patients: the underlying cause, expected duration of nerve dysfunction, anatomical manifestations, severity of symptoms and objective clinical findings. Systemic steroids should be offered to patients with new-onset Bell's palsy to increase the chance of facial nerve recovery and reduce synkinesis. Ophthalmologists play a pivotal role in the multidisciplinary team involved in the evaluation and rehabilitation of these patients. In the acute phase, the main priority should be to ensure adequate corneal protection. Treatment depends on the degree of nerve lesion and on the risk of the corneal damage based on the amount of lagophthalmos, the quality of Bell's phenomenon, the presence or absence of corneal sensitivity and the degree of lid retraction. The main therapy is intensive lubrication. Other treatments include: taping the eyelid overnight, botulinum toxin injection, tarsorrhaphy, eyelid weight implants, scleral contact lenses and palpebral spring. Once the cornea is protected, longer term planning for eyelid and facial rehabilitation may take place. Spontaneous complete recovery of Bell's palsy occurs in up to 70% of cases. Long-term complications include aberrant regeneration with

  17. High-intensity facial nerve lesions on T2-weighted images in chronic persistent facial nerve palsy

    Energy Technology Data Exchange (ETDEWEB)

    Kinoshita, T. [Dept. of Radiology, Sendai City Hospital, Sendai (Japan); Dept. of Radiology, Tottori Univ. (Japan); Ishii, K. [Dept. of Radiology, Sendai City Hospital, Sendai (Japan); Okitsu, T. [Dept. of Otolaryngology, Sendai City Hospital (Japan); Ogawa, T. [Dept. of Radiology, Tottori Univ. (Japan); Okudera, T. [Dept. of Radiology, Research Inst. of Brain and Blood Vessels-Akita, Akita (Japan)

    2001-05-01

    Our aim was to estimate the value of MRI in detecting irreversibly paralysed facial nerves. We examined 95 consecutive patients with a facial nerve palsy (14 with a persistent palsy, and 81 with good recovery), using a 1.0 T unit, with T2-weighted and contrast-enhanced T1-weighted images. The geniculate ganglion and tympanic segment had gave high signal on T2-weighted images in the chronic stage of persistent palsy, but not in acute palsy. The enhancement pattern of the facial nerve in the chronic persistent facial nerve palsy is similar to that in the acute palsy with good recovery. These findings suggest that T2-weighted MRI can be used to show severely damaged facial nerves. (orig.)

  18. Complete Spinal Accessory Nerve Palsy From Carrying Climbing Gear.

    Science.gov (United States)

    Coulter, Jess M; Warme, Winston J

    2015-09-01

    We report an unusual case of spinal accessory nerve palsy sustained while transporting climbing gear. Spinal accessory nerve injury is commonly a result of iatrogenic surgical trauma during lymph node excision. This particular nerve is less frequently injured by blunt trauma. The case reported here results from compression of the spinal accessory nerve for a sustained period-that is, carrying a load over the shoulder using a single nylon rope for 2.5 hours. This highlights the importance of using proper load-carrying equipment to distribute weight over a greater surface area to avoid nerve compression in the posterior triangle of the neck. The signs and symptoms of spinal accessory nerve palsy and its etiology are discussed. This report is particularly relevant to individuals involved in mountaineering and rock climbing but can be extended to anyone carrying a load with a strap over one shoulder and across the body. Copyright © 2015 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  19. Recurrent Isolated Oculomotor Nerve Palsy after Radiation of a Mesencephalic Metastasis. Case Report and Mini Review

    Science.gov (United States)

    Grabau, Olga; Leonhardi, Jochen; Reimers, Carl D.

    2014-01-01

    Introduction: Recurrent oculomotor nerve palsies are extremely rare clinical conditions. Case report: Here, we report on a unique case of a short-lasting recurrent unilateral incomplete external and complete internal oculomotor nerve palsy. The episodic palsies were probably caused by an ipsilateral mesencephalic metastasis of a breast carcinoma and occurred after successful brain radiation therapy. Discussion: While the pathogenic mechanism remains unclear, the recurrent sudden onset and disappearance of the palsies and their decreasing frequency after antiepileptic treatment suggest the occurrence of epilepsy-like brainstem seizures. A review of case reports of spontaneous reversible oculomotor nerve palsies is presented. PMID:25104947

  20. Transient delayed facial nerve palsy after inferior alveolar nerve block anesthesia.

    Science.gov (United States)

    Tzermpos, Fotios H; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

    2012-01-01

    Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution.

  1. Case study of physiotherapeutic treatment of patient with diagnosis facial nerve peripheral palsy

    OpenAIRE

    Zahrádková, Tereza

    2015-01-01

    Title of Bachelorʼs thesis: Case study of physiotherapeutic treatment of patient with diagnosis facial nerve peripheral palsy. Aim of thesis: Summary of theoretical findings of patientʼs diagnosis, study metodology of physiotherapeutic care, treatment design, monitoring of treatment, and evaluate the effect of patient with diagnosis facial nerve peripheral palsy. Summary: This thesis comprehensively summarizes the findings of of peripheral facial nerve palsy and it's treatment with physiotera...

  2. Facial nerve palsy associated with a cystic lesion of the temporal bone.

    Science.gov (United States)

    Kim, Na Hyun; Shin, Seung-Ho

    2014-03-01

    Facial nerve palsy results in the loss of facial expression and is most commonly caused by a benign, self-limiting inflammatory condition known as Bell palsy. However, there are other conditions that may cause facial paralysis, such as neoplastic conditions of the facial nerve, traumatic nerve injury, and temporal bone lesions. We present a case of facial nerve palsy concurrent with a benign cystic lesion of the temporal bone, adjacent to the tympanic segment of the facial nerve. The patient's symptoms subsided after facial nerve decompression via a transmastoid approach.

  3. Transient femoral nerve palsy following ilioinguinal nerve block for ...

    African Journals Online (AJOL)

    Nigerian Journal of Surgery ... Background: Elective inguinal hernia repair in young fit patients is preferably done under ilioinguinal nerve block anesthesia in the ambulatory setting to improve ... Conclusion: TFNP is a rare complication of ilioinguinal nerve block which delays patient discharge postambulatory hernioplasty.

  4. A non-recurrent inferior laryngeal nerve in a man undergoing thyroidectomy: a case report

    Directory of Open Access Journals (Sweden)

    Sousa Daniel

    2010-11-01

    Full Text Available Abstract Introduction A non-recurrent variant of the inferior laryngeal nerve has been seldom reported. These reports are mostly based on cadaveric dissection studies or large chart review studies in which the emphasis is placed on the determination of the frequency of the variation, and not on the clinical appearance of this variant. We graphically describe the intraoperative identification of a non-recurrent inferior laryngeal nerve. Case Presentation A 44-year old Caucasian man was referred to the Head and Neck Surgery Outpatient Clinic with the diagnosis of a nodular mass in his left thyroid lobe that had been growing for one year. A fine needle aspiration puncture was compatible with thyroid papillary cancer. It was decided that the patient should undergo total thyroidectomy. During surgery, a non-recurrent right inferior laryngeal nerve was noted. This nerve emanated from the right vagus nerve, entering the larynx 3 cm after its origin. The nerve did not show a recurrent course. The nerve on the left side had a normal configuration. The surgery and post-operative period were uneventful, and the patient had no change in his voice. Conclusion This paper allows those interested to become acquainted with the normal intraoperative appearance of a non-recurrent inferior laryngeal nerve. This will undoubtedly be of significance for all of those performing invasive diagnostic and surgical procedures in the neck and upper thoracic regions, in order to minimize the risk of iatrogenic injury to this nerve. This is of extreme importance, since a unilateral lesion of this nerve may result in permanent hoarseness, and a bilateral lesion may lead to aphonia and life-threatening dyspnea.

  5. Myelography for nerve root avulsion in birth palsy

    Energy Technology Data Exchange (ETDEWEB)

    Hashimoto, Tsutomu; Mitomo, Masanori; Hirabuki, Norio; Miura, Takashi; Kawai, Ryuji; Imakita, Satoshi; Harada, Koshi; Nakamura, Hironobu; Kozuka, Takahiro (Osaka Univ. (Japan). Faculty of Medicine)

    1990-04-01

    Myelography and CT myelography (CMT) were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. Root-somatosensory evoked potential (root-SEP) was also reviewed for myelographic evaluation of the nerve root avolusion in birth palsy. Root-SEP is not induced in case of avulsed nerve roots, but is induced in case of both normal and incompletely avulsed roots. Myelography demonstrated 58 abnormal nerve roots in 18 cases (19 limbs); 45 (78%) complete and 13 (22%) incomplete nerve root avulsions. Each of complete and incomplete avulsions was defined as total absence and partial presence of rootlets on myelography, respectively. Traumatic meningoceles were detected at 46 roots (79%) on myelography and/or CTM; 35 roots on myelography and 45 roots on CTM. CTM could not detect only a very small meningocele at one root. At 11 roots CTM was superior to myelography in delineating a meningocele because CTM is sensitive to a poorly enhanced meningocele. CTM, however, could not diagnose nerve root avulsions so accurately as myelography, since myelography detected 12 (7 completely and 5 incompletely) avulsed roots without meningocele, whereas CTM could not delineate the nerve roots clearly. Thus, myelography is indispensable to evaluate nerve root avulsions without meningocele. Root-SEP was examined in 9 patients who underwent branchial plexus exploration. SEP was negative at 22/25 roots with complete avulsion and was positive at 7/7 roots with myelographically incomplete avulsion, regardless of presence or absence of any traumatic meningocele. Myelography and root-SEP correlated well at 29 (92%) out of 32 roots in evaluating complete and incomplete avulsion injuries. Myelography and root-SEP were not considered in 3 roots. Though myelography demonstrated complete avulsions with traumatic meningocele, SEP was positive in these three roots, which were interpreted as partially avulsed roots. (J.P.N.).

  6. Myelography for nerve root avulsion in birth palsy

    International Nuclear Information System (INIS)

    Hashimoto, Tsutomu; Mitomo, Masanori; Hirabuki, Norio; Miura, Takashi; Kawai, Ryuji; Imakita, Satoshi; Harada, Koshi; Nakamura, Hironobu; Kozuka, Takahiro

    1990-01-01

    Myelography and CT myelography (CMT) were reviewed in 18 cases of birth palsy with clinically suspected avulsion injury. Root-somatosensory evoked potential (root-SEP) was also reviewed for myelographic evaluation of the nerve root avolusion in birth palsy. Root-SEP is not induced in case of avulsed nerve roots, but is induced in case of both normal and incompletely avulsed roots. Myelography demonstrated 58 abnormal nerve roots in 18 cases (19 limbs); 45 (78%) complete and 13 (22%) incomplete nerve root avulsions. Each of complete and incomplete avulsions was defined as total absence and partial presence of rootlets on myelography, respectively. Traumatic meningoceles were detected at 46 roots (79%) on myelography and/or CTM; 35 roots on myelography and 45 roots on CTM. CTM could not detect only a very small meningocele at one root. At 11 roots CTM was superior to myelography in delineating a meningocele because CTM is sensitive to a poorly enhanced meningocele. CTM, however, could not diagnose nerve root avulsions so accurately as myelography, since myelography detected 12 (7 completely and 5 incompletely) avulsed roots without meningocele, whereas CTM could not delineate the nerve roots clearly. Thus, myelography is indispensable to evaluate nerve root avulsions without meningocele. Root-SEP was examined in 9 patients who underwent branchial plexus exploration. SEP was negative at 22/25 roots with complete avulsion and was positive at 7/7 roots with myelographically incomplete avulsion, regardless of presence or absence of any traumatic meningocele. Myelography and root-SEP correlated well at 29 (92%) out of 32 roots in evaluating complete and incomplete avulsion injuries. Myelography and root-SEP were not considered in 3 roots. Though myelography demonstrated complete avulsions with traumatic meningocele, SEP was positive in these three roots, which were interpreted as partially avulsed roots. (J.P.N.)

  7. Case of Cytomegalovirus Infection Causing Isolated Oculomotor Nerve Palsy

    Directory of Open Access Journals (Sweden)

    Halil Sen

    2014-06-01

    Full Text Available The third cranial nerve is called the oculomotor nerve. The pathology is revealed by limitation of eye movement inward-up-down, mydriasis, loss of light reflex and ptosis. Oculomotor nerve pathologies are frequently seen in neurology practice and are situations that may be very difficult for differential diagnosis. Differential diagnosis first involves disqualifying intracranial etiologies by imaging because these intracranial etiologies may be situations that can result in death and should be primarily evaluated. If intracranial events are ruled out, generally rarer etiologic reasons with generally difficult differentiation should be researched. Viral infections are among the rare etiological reasons causing 3rd cranial nerve involvement. Our case was a 71-year old female with etiological research due to 3rd cranial nerve palsy. The patient with diabetes-linked immune deficiency was found to have cranial nerve involvement developed secondary to cytomegalovirus (CMV infection. We report this case as 3rd cranial nerve involvement is rarely observed developing linked to CMV infection.

  8. Neurological complications in thyroid surgery: a surgical point of view on laryngeal nerves.

    Directory of Open Access Journals (Sweden)

    EMANUELA eVARALDO

    2014-07-01

    Full Text Available The cervical branches of the vagus nerve that are pertinent to endocrine surgery are the superior and the inferior laryngeal nerves: their anatomical course in the neck places them at risk during thyroid surgery. The external branch of the superior laryngeal nerve (EB is at risk during thyroid surgery because of its close anatomical relationship with the superior thyroid vessels and the superior thyroid pole region. The rate of EB injury (which leads to the paralysis of the cricothyroid muscle varies from 0 to 58%. The identification of the EB during surgery helps avoiding both an accidental transection and an excessive stretching. When the nerve is not identified,the ligation of superior thyroid artery branches close to the thyroid gland is suggested, as well as the abstention from an indiscriminate use of energy-based devices that might damage it. The inferior laryngeal nerve (RLN runs in the tracheoesophageal groove toward the larynx, close to the posterior aspect of the thyroid. It is the main motor nerve of the intrinsic laryngeal muscles, and also provides sensory innervation to the larynx. Its injury finally causes the paralysis of the omolateral vocal cord and various sensory alterations: the symptoms range from mild to severe hoarseness, to acute airway obstruction and swallowing impairment. Permanent lesions of the RNL occur from 0.3 to 7% of cases, according to different factors. The surgeon must be aware of the possible anatomical variations of the nerve which should be actively searched for and identified. Visual control and gentle dissection of RLN are imperative. The use of intraoperative nerve monitoring has been safely applied but, at the moment, its impact in the incidence of RLN injuries has not been clarified. In conclusion, despite a thorough surgical technique and the use of intraoperative neuromonitoring, the incidence of neurological complications after thyroid surgery cannot be suppressed, but should be maintained in a

  9. MRI of the facial nerve in idiopathic facial palsy

    International Nuclear Information System (INIS)

    Saatci, I.; Sahintuerk, F.; Sennaroglu, L.; Boyvat, F.; Guersel, B.; Besim, A.

    1996-01-01

    The purpose of this prospective study was to define the enhancement pattern of the facial nerve in idiopathic facial paralysis (Bell's palsy) on magnetic resonance (MR) imaging with routine doses of gadolinium-DTPA (0.1 mmol/kg). Using 0.5 T imager, 24 patients were examined with a mean interval time of 13.7 days between the onset of symptoms and the MR examination. Contralateral asymptomatic facial nerves constituted the control group and five of the normal facial nerves (20.8%) showed enhancement confined to the geniculate ganglion. Hence, contrast enhancement limited to the geniculate ganglion in the abnormal facial nerve (3 of 24) was referred to a equivocal. Not encountered in any of the normal facial nerves, enhancement of other segments alone or associated with geniculate ganglion enhancement was considered to be abnormal and noted in 70.8% of the symptomatic facial nerves. The most frequently enhancing segments were the geniculate ganglion and the distal intracanalicular segment. (orig.)

  10. MRI of the facial nerve in idiopathic facial palsy

    Energy Technology Data Exchange (ETDEWEB)

    Saatci, I. [Dept. of Radiology, Hacettepe Univ., Hospital Sihhiye, Ankara (Turkey); Sahintuerk, F. [Dept. of Radiology, Hacettepe Univ., Hospital Sihhiye, Ankara (Turkey); Sennaroglu, L. [Dept. of Otolaryngology, Head and Neck Surgery, Hacettepe Univ., Hospital Sihhiye, Ankara (Turkey); Boyvat, F. [Dept. of Radiology, Hacettepe Univ., Hospital Sihhiye, Ankara (Turkey); Guersel, B. [Dept. of Otolaryngology, Head and Neck Surgery, Hacettepe Univ., Hospital Sihhiye, Ankara (Turkey); Besim, A. [Dept. of Radiology, Hacettepe Univ., Hospital Sihhiye, Ankara (Turkey)

    1996-10-01

    The purpose of this prospective study was to define the enhancement pattern of the facial nerve in idiopathic facial paralysis (Bell`s palsy) on magnetic resonance (MR) imaging with routine doses of gadolinium-DTPA (0.1 mmol/kg). Using 0.5 T imager, 24 patients were examined with a mean interval time of 13.7 days between the onset of symptoms and the MR examination. Contralateral asymptomatic facial nerves constituted the control group and five of the normal facial nerves (20.8%) showed enhancement confined to the geniculate ganglion. Hence, contrast enhancement limited to the geniculate ganglion in the abnormal facial nerve (3 of 24) was referred to a equivocal. Not encountered in any of the normal facial nerves, enhancement of other segments alone or associated with geniculate ganglion enhancement was considered to be abnormal and noted in 70.8% of the symptomatic facial nerves. The most frequently enhancing segments were the geniculate ganglion and the distal intracanalicular segment. (orig.)

  11. Surgical and Clinical Decision Making in Isolated Long Thoracic Nerve Palsy.

    Science.gov (United States)

    Noland, Shelley S; Krauss, Emily M; Felder, John M; Mackinnon, Susan E

    2017-10-01

    Isolated long thoracic nerve palsy results in scapular winging and destabilization. In this study, we review the surgical management of isolated long thoracic nerve palsy and suggest a surgical technique and treatment algorithm to simplify management. In total, 19 patients who required surgery for an isolated long thoracic nerve palsy were reviewed retrospectively. Preoperative demographics, electromyography (EMG), and physical examinations were reviewed. Intraoperative nerve stimulation, surgical decision making, and postoperative outcomes were reviewed. In total, 19 patients with an average age of 32 were included in the study. All patients had an isolated long thoracic nerve palsy caused by either an injury (58%), Parsonage-Turner syndrome (32%), or shoulder surgery (10%); 18 patients (95%) underwent preoperative EMG; 10 with evidence of denervation (56%); and 13 patients had motor unit potentials in the serratus anterior (72%). The preoperative EMG did not correlate with intraoperative nerve stimulation in 13 patients (72%) and did correlate in 5 patients (28%); 3 patients had a nerve transfer (3 thoracodorsal to long thoracic at lateral chest, 1 pec to long thoracic at supraclavicular incision). In the 3 patients who had a nerve transfer, there was return of full forward flexion of the shoulder at an average of 2.5 months. A treatment algorithm based on intraoperative nerve stimulation will help guide surgeons in their clinical decision making in patients with isolated long thoracic nerve palsy. Intraoperative nerve stimulation is the gold standard in the management of isolated long thoracic nerve palsy.

  12. Transient facial nerve palsy after occipital nerve block: a case report.

    Science.gov (United States)

    Strauss, Lauren; Loder, Elizabeth; Rizzoli, Paul

    2014-01-01

    Occipital nerve blocks are commonly performed to treat a variety of headache syndromes and are generally believed to be safe and well tolerated. We report the case of an otherwise healthy 24-year-old woman with left side-locked occipital, parietal, and temporal pain who was diagnosed with probable occipital neuralgia. She developed complete left facial nerve palsy within minutes of blockade of the left greater and lesser occipital nerves with a solution of bupivicaine and triamcinolone. Magnetic resonance imaging of the brain with gadolinium contrast showed no abnormalities, and symptoms had completely resolved 4-5 hours later. Unintended spread of the anesthetic solution along tissue planes seems the most likely explanation for this adverse event. An aberrant course of the facial nerve or connections between the facial and occipital nerves also might have played a role, along with the patient's prone position and the use of a relatively large injection volume of a potent anesthetic. Clinicians should be aware that temporary facial nerve palsy is a possible complication of occipital nerve block. © 2014 American Headache Society.

  13. Multi cranial nerve palsies as the presenting features of prostate carcinoma

    International Nuclear Information System (INIS)

    Mitchell, D.M.; Wynne, C.J.; Cowan, I.

    2008-01-01

    Full text: Cranial nerve palsies have previously been reported in metastatic prostate carcinoma, usually occurring late in the course of the disease. We describe the case of a 55-year-old man whose diagnosis of prostate cancer was made following investigation of multiple cranial nerve palsies.

  14. IncobotulinumtoxinA treatment of facial nerve palsy after neurosurgery.

    Science.gov (United States)

    Akulov, Mihail A; Orlova, Ol'ga R; Orlova, Aleksandra S; Usachev, Dmitrij J; Shimansky, Vadim N; Tanjashin, Sergey V; Khatkova, Svetlana E; Yunosha-Shanyavskaya, Anna V

    2017-10-15

    This study evaluates the effect of incobotulinumtoxinA in the acute and chronic phases of facial nerve palsy after neurosurgical interventions. Patients received incobotulinumtoxinA injections (active treatment group) or standard rehabilitation treatment (control group). Functional efficacy was assessed using House-Brackmann, Yanagihara System and Sunnybrook Facial Grading scales, and Facial Disability Index self-assessment. Significant improvements on all scales were seen after 1month of incobotulinumtoxinA treatment (active treatment group, р<0.05), but only after 3months of rehabilitation treatment (control group, р<0.05). At 1 and 2years post-surgery, the prevalence of synkinesis was significantly higher in patients in the control group compared with those receiving incobotulinumtoxinA treatment (р<0.05 and р<0.001, respectively). IncobotulinumtoxinA treatment resulted in significant improvements in facial symmetry in patients with facial nerve injury following neurosurgical interventions. Treatment was effective for the correction of the compensatory hyperactivity of mimic muscles on the unaffected side that develops in the acute period of facial nerve palsy, and for the correction of synkinesis in the affected side that develops in the long-term period. Appropriate dosing and patient education to perform exercises to restore mimic muscle function should be considered in multimodal treatment. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Facial nerve palsy: analysis of cases reported in children in a suburban hospital in Nigeria.

    Science.gov (United States)

    Folayan, M O; Arobieke, R I; Eziyi, E; Oyetola, E O; Elusiyan, J

    2014-01-01

    The study describes the epidemiology, treatment, and treatment outcomes of the 10 cases of facial nerve palsy seen in children managed at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife over a 10 year period. It also compares findings with report from developed countries. This was a retrospective cohort review of pediatric cases of facial nerve palsy encountered in all the clinics run by specialists in the above named hospital. A diagnosis of facial palsy was based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Information retrieved from the case note included sex, age, number of days with lesion prior to presentation in the clinic, diagnosis, treatment, treatment outcome, and referral clinic. Only 10 cases of facial nerve palsy were diagnosed in the institution during the study period. Prevalence of facial nerve palsy in this hospital was 0.01%. The lesion more commonly affected males and the right side of the face. All cases were associated with infections: Mainly mumps (70% of cases). Case management include the use of steroids and eye pads for cases that presented within 7 days; and steroids, eye pad, and physical therapy for cases that presented later. All cases of facial nerve palsy associated with mumps and malaria infection fully recovered. The two cases of facial nerve palsy associated with otitis media only partially recovered. Facial nerve palsy in pediatric patients is more commonly associated with mumps in the study environment. Successes are recorded with steroid therapy.

  16. [A young woman with central facial nerve palsy].

    Science.gov (United States)

    Broere, Christiaan M; de Witte, B R René; Claes, J F H M Franka

    2014-01-01

    The distinction between central and peripheral facial nerve palsy can be difficult but is very important for the workup and treatment. A tumefactive demyelinating lesion (TDL) is a rare condition that can sometimes cause diagnostic difficulties due to its similarity to a brain tumour. We present a 20-year-old female patient who visited her GP with a discrete right-sided drooping corner of her mouth. The GP started treatment with oral glucorticoids because of presumed Bell's palsy and referred her to the neurology outpatient clinic. Repeated neurological examination showed central facial palsy on the right side of the face. An MRI study of the brain revealed a single large contrast-enhanced abnormality in the left hemisphere that was diagnosed as TDL after exclusion of other causes. In view of the limited number of clinical symptoms, an expectative policy was conducted. The patient recovered spontaneously and repeated MRI studies showed partial regression of TDL. TDL is often considered to be a first presentation of multiple sclerosis. Accurate analysis with MRI can help in making a diagnosis without the need for a biopsy.

  17. Experience of monitoring the recurrent laryngeal nerve in thyroid surgery with endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Liang Feng

    2017-01-01

    Full Text Available Purpose:To analysis clinical experience of applying recurrent laryngeal monitoring endotracheal tube (NIM EMG Endotracheal Tube in the surgery of thyroid. Method: A retrospective analysis of 84 patients who underwent endotracheal intubation laryngeal nerve monitoring by thyroid surgery in the Chinese-Japanese Friendship Hospital of Jilin University from March to December in 2015. To summarize the experience of intubation with NIM EMG Endotracheal Tube. Result 77 (91.7%had initial intubation achievement in the 84 patients.FROM the 77 cases we had gotten s atisfactory nerve monitoring signal.Whereas there are 7 cases (8.3% appear abnormal EMG or signal missing, in the 7 cases there is one which being intubated too deep, 3 cases which being intubated too shallow and 3 cases with malrotation intubation.Conclusion: We got the satisfactory signals after adjust1ing the tube by using the visual laryngoscope.

  18. Unilateral abducens and bilateral facial nerve palsies associated with posterior fossa exploration surgery.

    Science.gov (United States)

    Khalil, Ayman; Clerkin, James; Mandiwanza, Tafadzwa; Green, Sandra; Javadpour, Mohsen

    2016-03-06

    Multiple cranial nerves palsies following a posterior fossa exploration confined to an extradural compartment is a rare clinical presentation. This case report describes a young man who developed a unilateral abducens and bilateral facial nerve palsies following a posterior fossa exploration confined to an extradural compartment. There are different theories to explain this presentation, but the exact mechanism remains unclear. We propose that this patient cranial nerve palsies developed following cerebrospinal fluid (CSF) leak, potentially as a consequence of rapid change in CSF dynamics. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2016.

  19. The physiologic impact of unilateral recurrent laryngeal nerve (RLN) lesion on infant oropharyngeal and esophageal performance

    OpenAIRE

    Gould, Francois D. H.; Lammers, Andrew R.; Ohlemacher, Jocelyn; Ballester, Ashley; Fraley, Luke; Gross, Andrew; German, Rebecca Z.

    2015-01-01

    Recurrent laryngeal nerve (RLN) injury in neonates, a complication of patent ductus arteriosus corrective surgery, leads to aspiration and swallowing complications. Severity of symptoms and prognosis for recovery are variable. We transected the RLN unilaterally in an infant mammalian animal model to characterize the degree and variability of dysphagia in a controlled experimental setting. We tested the hypotheses that 1) both airway protection and esophageal function would be compromised by l...

  20. Monitoring of recurrent and superior laryngeal nerve function using an Airwayscope™ during thyroid surgery.

    Science.gov (United States)

    Ijichi, Kei; Sasano, Hiroshi; Harima, Megumi; Murakami, Shingo

    2017-10-01

    In thyroid surgery, intraoperative identification and preservation of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve external branch (SLNEB) are crucial. Several reports have proposed that electromyography (EMG) monitoring is an acceptable adjunct for identification and preservation of the RLN. However, a limited number of hospitals have access to an EMG monitoring system. Therefore, the development of another viable monitoring method is required. The aim of the present study was to design a new RLN and SLNEB monitoring method combining an Airwayscope™ (AWS) and a facial nerve stimulator. The facial nerve-stimulating electrode stimulates the RLN or SLNEB, so that the movement of the vocal cord may be observed with an AWS. This monitoring method was performed on 10 patients with a thyroid tumor. In all the cases, RLN and SLNEB were identified and vocal cord function was preserved. All the patients exhibited normal vocal cord function following surgery. Thus, the new RLN and SLNEB monitoring method using an AWS and a facial nerve stimulator is useful in thyroid surgery, and this method may be used as a reliable and available alternative to EMG monitoring to ensure the normal function of the vocal cord.

  1. Role of nitric oxide in the onset of facial nerve palsy by HSV-1 infection.

    Science.gov (United States)

    Hato, Naohito; Kohno, Hisashi; Yamada, Hiroyuki; Takahashi, Hirotaka; Gyo, Kiyofumi

    2013-12-01

    Although herpes simplex virus type 1 (HSV-1) is a causative agent of Bell palsy, the precise mechanism of the paralysis remains unknown. It is necessary to investigate the pathogenesis and treatment of Bell palsy due to HSV-1 infection. This study elucidated the role of nitric oxide (NO) in the incidence of facial nerve paralysis caused by HSV-1 in mice and to evaluate the possible role of edaravone, a free radical scavenger, in preventing the paralysis. Sixty-two mice served as animal models of Bell palsy in this laboratory study conducted at an academic institution. Levels of NO in the facial nerve were measured using high-performance liquid chromatography and absorption photometry. The incidence of facial palsy was assessed following administration of edaravone immediately after HSV-1 inoculation and daily for 11 days thereafter. The ratio of NO (inoculated side to control side) and incidence of facial palsy. RESULTS Before the onset of facial palsy, no substantial difference in the NO level was noted between the HSV-1-inoculated side and the control side. When facial palsy occurred, usually at 7 days after inoculation, the NO level was significantly higher on the inoculated side than on the control side. Following recovery from the palsy, the high NO level of the inoculated side decreased. No increase in the NO level was observed in animals without transient facial palsy. When edaravone was administered, the incidence of facial palsy decreased significantly. These findings suggest that NO produced by inducible NO synthase in the facial nerve plays an important role in the onset of facial palsy caused by HSV-1 infection, which is considered a causative virus of Bell palsy. Hato and colleagues elucidate the role of nitric oxide in HSV-1–related facial nerve paralysis in mice and evaluate the role of edaravone, a free radical scavenger, in preventing the paralysis.

  2. Transient facial nerve paralysis (Bell's palsy) following administration of hepatitis B recombinant vaccine: a case report.

    Science.gov (United States)

    Paul, R; Stassen, L F A

    2014-01-01

    Bell's palsy is the sudden onset of unilateral transient paralysis of facial muscles resulting from dysfunction of the seventh cranial nerve. Presented here is a 26-year-old female patient with right lower motor neurone facial palsy following hepatitis B vaccination. Readers' attention is drawn to an uncommon cause of Bell's palsy, as a possible rare complication of hepatitis B vaccination, and steps taken to manage such a presentation.

  3. Phrenic Nerve Palsy and Regional Anesthesia for Shoulder Surgery: Anatomical, Physiologic, and Clinical Considerations.

    Science.gov (United States)

    El-Boghdadly, Kariem; Chin, Ki Jinn; Chan, Vincent W S

    2017-07-01

    Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5-C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.

  4. Radiation-induced cranial nerve palsy and its causative factors in nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Kong Lin; Zhang Youwang; Wu Yongru; Guo Xiaomao; Li Longgen

    2005-01-01

    Objective: To analyze the incidence and causative factors of radiation-induced cranial nerve palsy in patients with nasopharyngeal carcinoma (NPC). Methods: 512 NPC patients who underwent radiotherapy from January 1, 1989 to December 31, 1990 and from January 1, 1994 to December 31, 1995 were retrospectively analyzed. According to Fuzhou' 92 NPC Staging Classification, there are 31 patients in stage I, 212 in stage II, 198 in stage III and 71 in stage IV. All patients were treated by 60 Co or 6 MV X-ray with faciocervical fields or pre-auricular fields to primary area. Some patients were boosted by post-auricular fields or cranial fields. The median dose to the nasopharyngeal region was 7130 cGy by external beam radiotherapy. Thirty-four patients were boosted by brachytherapy. The medial dose to cervical lymph nodes was 6410 cGy as definitive treatment and 5480 cGy as prophylactic treatment. 101 patients were treated with combined chemotherapy. Results: The median follow-up was 6.7 years . Radiation-induced cranial nerve palsies occurred in 81 among the 512 patients. The 5- and 10-year cumulative incidences were 10.3%, 25.4%, respectively. The most common affected nerve was XII. On multivariates analysis, cranial nerve invasion before radiation, chemotherapy, dose to the nasopharyngeal region and age were the independent factors of radiation-induced cranial nerve palsy on nerve I-VII, while the N stage and the radiation fields were independent factors on nerve IX-XII. The cumulative incidence of cranial nerve I-VII palsies increased in patients with cranial nerve invasion, chemotherapy and the dose to the nasopharyngeal region (>7000 cGy). The cumulative incidence of cranial nerve IX- XII palsies increased in patients with advanced N stage. Patients in the first group of treatment field had the highest risk to progress cranial nerve IX-XII palsies, followed by the second group, and the third group had the lowest risk. Only 1 in 34 patients with brachytherapy

  5. An overview of the third, fourth and sixth cranial nerve palsies

    African Journals Online (AJOL)

    Palsies of the third, fourth and sixth cranial nerves have ophthalmological consequences. W Marais, MB .... dorsal aspect of the brain (Fig. 4). • crossed ... right hypertropia in left gaze and left .... Clinical Science Course, section 5. American.

  6. Primary oculomotor nerve palsy due to mild head injury. Report of two cases

    International Nuclear Information System (INIS)

    Katsuno, Makoto; Kobayashi, Shiro; Yokota, Hiroyuki; Teramoto, Akira

    2008-01-01

    Two patients with primary oculomotor nerve palsy due to direct mild head injury are reported. They presented with internal ophthalmoplegia, dilated nonreactive pupils, and very mild disturbance in consciousness. Except for the persistent oculomotor nerve palsy, both the patients recovered fully within one week. Neither demonstrated a history that was suggestive of a cause for their oculomotor nerve palsy. Initial CT scans demonstrated localized subarachnoid hemorrhage around the brain stem. One of the patients had sustained a fracture of the anterior clinoid process. As the underlying pathophysiologic mechanism underlying the oculomotor nerve palsy we suspected mild injury to the pupillomotor fibers at the anterior petroclinoidal ligament and that of the pupillary fibers at the posterior petroclinoidal ligament. We speculate that these perforating fibers at the anterior petroclinoidal ligament acted as a fulcrum due to downward displacement of the brainstem at the time of impact. (author)

  7. Facial nerve palsy: Analysis of cases reported in children in a ...

    African Journals Online (AJOL)

    2013-02-28

    Feb 28, 2013 ... steroids and eye pads for cases that presented within 7 days; and steroids, eye pad, and physical ... Key words: Children, facial nerve, malaria, mumps, Nigeria, palsy .... until 200 white blood cells (WBC) have been seen and.

  8. Oculomotor nerve palsy evaluated by diffusion-tensor tractography

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Kei; Kizu, Osamu; Ito, Hirotoshi; Nishimura, Tsunehiko [Kyoto Prefectural University of Medicine, Department of Radiology, Kyoto (Japan); Shiga, Kensuke; Akiyama, Katsuhisa; Nakagawa, Masanori [Kyoto Prefectural University of Medicine, Department of Neurology, Kyoto (Japan)

    2006-06-15

    The aim of the study was to test the feasibility of the tractography technique based on diffusion-tensor imaging (DTI) for the assessment of small infarcts involving the brainstem. A patient who presented with an isolated left third cranial nerve palsy underwent magnetic resonance examination. Images were obtained by use of a whole-body, 1.5-T imager. Data were transferred to an off-line workstation for fiber tracking. The conventional diffusion-weighted imaging (DWI) performed using a 5 mm slice thickness could only depict an equivocal hyperintensity lesion located at the left paramedian midbrain. An additional thin-slice DTI was performed immediately after the initial DWI using a 3 mm slice thickness and was able to delineate the lesion more clearly. Image postprocessing of thin-slice DTI data revealed that the lesion location involved the course of the third cranial nerve tract, corresponding with the patient's clinical symptoms. The tractography technique can be applied to assess fine neuronal structures of the brainstem, enabling direct clinicoradiological correlation of small infarcts involving this region. (orig.)

  9. Oculomotor nerve palsy evaluated by diffusion-tensor tractography

    International Nuclear Information System (INIS)

    Yamada, Kei; Kizu, Osamu; Ito, Hirotoshi; Nishimura, Tsunehiko; Shiga, Kensuke; Akiyama, Katsuhisa; Nakagawa, Masanori

    2006-01-01

    The aim of the study was to test the feasibility of the tractography technique based on diffusion-tensor imaging (DTI) for the assessment of small infarcts involving the brainstem. A patient who presented with an isolated left third cranial nerve palsy underwent magnetic resonance examination. Images were obtained by use of a whole-body, 1.5-T imager. Data were transferred to an off-line workstation for fiber tracking. The conventional diffusion-weighted imaging (DWI) performed using a 5 mm slice thickness could only depict an equivocal hyperintensity lesion located at the left paramedian midbrain. An additional thin-slice DTI was performed immediately after the initial DWI using a 3 mm slice thickness and was able to delineate the lesion more clearly. Image postprocessing of thin-slice DTI data revealed that the lesion location involved the course of the third cranial nerve tract, corresponding with the patient's clinical symptoms. The tractography technique can be applied to assess fine neuronal structures of the brainstem, enabling direct clinicoradiological correlation of small infarcts involving this region. (orig.)

  10. Facial Pain Followed by Unilateral Facial Nerve Palsy: A Case Report with Literature Review

    OpenAIRE

    GV, Sowmya; BS, Manjunatha; Goel, Saurabh; Singh, Mohit Pal; Astekar, Madhusudan

    2014-01-01

    Peripheral facial nerve palsy is the commonest cranial nerve motor neuropathy. The causes range from cerebrovascular accident to iatrogenic damage, but there are few reports of facial nerve paralysis attributable to odontogenic infections. In majority of the cases, recovery of facial muscle function begins within first three weeks after onset. This article reports a unique case of 32-year-old male patient who developed facial pain followed by unilateral facial nerve paralysis due to odontogen...

  11. Motor palsies of cranial nerves (excluding VII) after vaccination: reports to the US Vaccine Adverse Event Reporting System.

    Science.gov (United States)

    Woo, Emily Jane; Winiecki, Scott K; Ou, Alan C

    2014-01-01

    We reviewed cranial nerve palsies, other than VII, that have been reported to the US Vaccine Adverse Event Reporting System (VAERS). We examined patterns for differences in vaccine types, seriousness, age, and clinical characteristics. We identified 68 reports of cranial nerve palsies, most commonly involving the oculomotor (III), trochlear (IV), and abducens (VI) nerves. Isolated cranial nerve palsies, as well as palsies occurring as part of a broader clinical entity, were reported. Forty reports (59%) were classified as serious, suggesting that a cranial nerve palsy may sometimes be the harbinger of a broader and more ominous clinical entity, such as a stroke or encephalomyelitis. There was no conspicuous clustering of live vs. inactivated vaccines. The patient age range spanned the spectrum from infants to the elderly. Independent data may help to clarify whether, when, and to what extent the rates of cranial nerve palsies following particular vaccines may exceed background levels.

  12. Recurrent isolated oculomotor nerve palsy after radiation of a mesencephalic metastasis. Case report and mini-review.

    Directory of Open Access Journals (Sweden)

    Olga eGrabau

    2014-07-01

    Full Text Available Introduction: Recurrent oculomotor nerve palsies are extremely rare clinical conditions. Case report: Here, we report on a unique case of a short-lasting recurrent unilateral incomplete external and complete internal oculomotor nerve palsy. The episodic palsies were probably caused by an ipsilateral mesencephalic metastasis of a breast carcinoma and occurred after successful brain radiation therapy. Discussion: While the pathogenic mechanism remains unclear, the recurrent sudden onset and disappearance of the palsies and their decreasing frequency after antiepileptic treatment suggest the occurrence of epilepsy-like brainstem seizures. A review of case reports of spontaneous reversible oculomotor nerve palsies is presented.

  13. Reinnervation of the diaphragm by the inferior laryngeal nerve to the phrenic nerve in ventilator-dependent tetraplegic patients with C3-5 damage.

    Science.gov (United States)

    Verin, Eric; Morelot-Panzini, Capucine; Gonzalez-Bermejo, Jesus; Veber, Benoit; Perrouin Verbe, Brigitte; Soudrie, Brigitte; Leroi, Anne Marie; Marie, Jean Paul; Similowski, Thomas

    2017-10-01

    The aim of this study was to evaluate the feasibility of unilateral diaphragmatic reinnervation in humans by the inferior laryngeal nerve. This pilot study included chronically ventilated tetraplegic patients with destruction of phrenic nerve motoneurons. Five patients were included. They all had a high level of tetraplegia, with phrenic nerve motor neuron destruction. They were highly dependent on ventilation, without any possibility of weaning. They did not have other chronic pathologies, especially laryngeal disease. They all had diaphragmatic explorations to diagnose the destruction of the motoneurons of the phrenic nerves and nasoendoscopy to be sure that they did not have laryngeal or pharyngeal disease. Then, surgical anastomosis of the right phrenic nerve was performed with the inferior laryngeal nerve, by a cervical approach. A laryngeal reinnervation was performed at the same time, using the ansa hypoglossi. One patient was excluded because of a functional phrenic nerve and one patient died 6 months after the surgery of a cardiac arrest. The remaining three patients were evaluated after the anastomosis every 6 months. They did not present any swallowing or vocal alterations. In these three patients, the diaphragmatic explorations showed that there was a recovery of the diaphragmatic electromyogram of the right and left hemidiaphragms after 1 year. Two patients had surgical diaphragmatic explorations for diaphragmatic pacing 18-24 months after the reinnervation with excellent results. At 36 months, none of the patients could restore their automatic ventilation. In conclusion, this study demonstrated that diaphragmatic reinnervation by the inferior laryngeal nerve is effective, without any vocal or swallowing complications.

  14. Therapeutic outcome of nasopharyngeal carcinoma with cranial nerve palsy: a single institution experience of 104 patients

    Directory of Open Access Journals (Sweden)

    Huang CC

    2017-04-01

    Full Text Available Chun-Chieh Huang,1,2 Fu-Min Fang,1 Hui-Chun Chen,1 Hsuan-Chih Hsu,1 Tai-Lin Huang,3 Yu-Li Su,3 Ya-Chun Chang4 1Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 2Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, 3Department of Hematology and Oncology, 4Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China Purpose: Cranial nerve (CN palsy is the main symptom in patients with locally advanced nasopharyngeal carcinoma (NPC. This study aimed to evaluate the therapeutic outcome of NPC with CN palsy and to analyze the prognostic factors.Patients and methods: A total of 104 NPC patients with CN palsy curatively treated by conventional (n=44 or conformal (n=60 radiotherapy (RT were enrolled. Upper CN palsy was present in 81 patients, lower CN palsy in four patients, and both upper and lower CN palsy in 19 patients. Forty-one patients had CN palsy for >2 months before diagnosis.Results: Complete recovery of CN palsy was observed in 74 patients. The actuarial 5-year locoregional control (LRC, distant metastasis-free survival (DMFS, and overall survival (OS rates were 58.2%, 62.2%, and 38.4%, respectively. No significant difference was observed in CN recovery, LRC, DMFS, or OS for patients treated by conventional versus conformal technique. However, significant reduction of grade 3 or greater toxicities was found in those treated by the conformal technique (odds ratio =0.28.Conclusion: Patients with CN palsy presenting >2 months before diagnosis were hard to recover from palsy. The LRC, OS, and recovery from CN palsy did not significantly change with the treatment evolution. Patients with complete recovery from CN palsy had longer OS. Keywords: nasopharyngeal carcinoma, cranial nerve palsy, radiotherapy

  15. Malpractice claims related to recurrent laryngeal nerve injury: Forensic remarks regarding 15 cases

    Directory of Open Access Journals (Sweden)

    A. Verzeletti

    2016-12-01

    Full Text Available Malpractice claims concerning recurrent laryngeal nerve (RLN injuries are often related to thyroid surgery, but they can also involve surgeons of different specialties. Our survey was made considering expert opinions on claims for medical malpractice evaluated at Brescia Institute of Forensic Medicine in Italy during the period 1992–2012. Fifteen cases concerned RLN injury. Malpractice was identified in 10 cases, according to the following conditions: low pre and intra-operative risk of nerve injury, no documentation showing that the nerve was isolated and preserved despite the existence of potential risk factors. An accurate, well written and complete surgical report is the main tool for the expert examination in malpractice claims.

  16. Electrical and transcranial magnetic stimulation of the facial nerve: diagnostic relevance in acute isolated facial nerve palsy.

    Science.gov (United States)

    Happe, Svenja; Bunten, Sabine

    2012-01-01

    Unilateral facial weakness is common. Transcranial magnetic stimulation (TMS) allows identification of a conduction failure at the level of the canalicular portion of the facial nerve and may help to confirm the diagnosis. We retrospectively analyzed 216 patients with the diagnosis of peripheral facial palsy. The electrophysiological investigations included the blink reflex, preauricular electrical stimulation and the response to TMS at the labyrinthine part of the canalicular proportion of the facial nerve within 3 days after symptom onset. A similar reduction or loss of the TMS amplitude (p facial palsy without being specific for Bell's palsy. These data shed light on the TMS-based diagnosis of peripheral facial palsy, an ability to localize the site of lesion within the Fallopian channel regardless of the underlying pathology. Copyright © 2012 S. Karger AG, Basel.

  17. Clinical significance of quantitative analysis of facial nerve enhancement on MRI in Bell's palsy.

    Science.gov (United States)

    Song, Mee Hyun; Kim, Jinna; Jeon, Ju Hyun; Cho, Chang Il; Yoo, Eun Hye; Lee, Won-Sang; Lee, Ho-Ki

    2008-11-01

    Quantitative analysis of the facial nerve on the lesion side as well as the normal side, which allowed for more accurate measurement of facial nerve enhancement in patients with facial palsy, showed statistically significant correlation with the initial severity of facial nerve inflammation, although little prognostic significance was shown. This study investigated the clinical significance of quantitative measurement of facial nerve enhancement in patients with Bell's palsy by analyzing the enhancement pattern and correlating MRI findings with initial severity of facial palsy and clinical outcome. Facial nerve enhancement was measured quantitatively by using the region of interest on pre- and postcontrast T1-weighted images in 44 patients diagnosed with Bell's palsy. The signal intensity increase on the lesion side was first compared with that of the contralateral side and then correlated with the initial degree of facial palsy and prognosis. The lesion side showed significantly higher signal intensity increase compared with the normal side in all of the segments except for the mastoid segment. Signal intensity increase at the internal auditory canal and labyrinthine segments showed correlation with the initial degree of facial palsy but no significant difference was found between different prognostic groups.

  18. MR findings of facial nerve on oblique sagittal MRI using TMJ surface coil: normal vs peripheral facial nerve palsy

    International Nuclear Information System (INIS)

    Park, Yong Ok; Lee, Myeong Jun; Lee, Chang Joon; Yoo, Jeong Hyun

    2000-01-01

    To evaluate the findings of normal facial nerve, as seen on oblique sagittal MRI using a TMJ (temporomandibular joint) surface coil, and then to evaluate abnormal findings of peripheral facial nerve palsy. We retrospectively reviewed the MR findings of 20 patients with peripheral facial palsy and 50 normal facial nerves of 36 patients without facial palsy. All underwent oblique sagittal MRI using a T MJ surface coil. We analyzed the course, signal intensity, thickness, location, and degree of enhancement of the facial nerve. According to the angle made by the proximal parotid segment on the axis of the mastoid segment, course was classified as anterior angulation (obtuse and acute, or buckling), straight and posterior angulation. Among 50 normal facial nerves, 24 (48%) were straight, and 23 (46%) demonstrated anterior angulation; 34 (68%) showed iso signal intensity on T1W1. In the group of patients, course on the affected side was either straight (40%) or showed anterior angulation (55%), and signal intensity in 80% of cases was isointense. These findings were similar to those in the normal group, but in patients with post-traumatic or post-operative facial palsy, buckling, of course, appeared. In 12 of 18 facial palsy cases (66.6%) in which contrast materials were administered, a normal facial nerve of the opposite facial canal showed mild enhancement on more than one segment, but on the affected side the facial nerve showed diffuse enhancement in all 14 patients with acute facial palsy. Eleven of these (79%) showed fair or marked enhancement on more than one segment, and in 12 (86%), mild enhancement of the proximal parotid segment was noted. Four of six chronic facial palsy cases (66.6%) showed atrophy of the facial nerve. When oblique sagittal MR images are obtained using a TMJ surface coil, enhancement of the proximal parotid segment of the facial nerve and fair or marked enhancement of at least one segment within the facial canal always suggests pathology of

  19. Immediate Nerve Transfer for Treatment of Peroneal Nerve Palsy Secondary to an Intraneural Ganglion: Case Report and Review.

    Science.gov (United States)

    Ratanshi, Imran; Clark, Tod A; Giuffre, Jennifer L

    2018-05-01

    Intraneural ganglion cysts, which occur within the common peroneal nerve, are a rare cause of foot drop. The current standard of treatment for intraneural ganglion cysts involving the common peroneal nerve involves (1) cyst decompression and (2) ligation of the articular nerve branch to prevent recurrence. Nerve transfers are a time-dependent strategy for recovering ankle dorsiflexion in cases of high peroneal nerve palsy; however, this modality has not been performed for intraneural ganglion cysts involving the common peroneal nerve. We present a case of common peroneal nerve palsy secondary to an intraneural ganglion cyst occurring in a 74-year-old female. The patient presented with a 5-month history of pain in the right common peroneal nerve distribution and foot drop. The patient underwent simultaneous cyst decompression, articular nerve branch ligation, and nerve transfer of the motor branch to flexor hallucis longus to a motor branch of anterior tibialis muscle. At final follow-up, the patient demonstrated complete (M4+) return of ankle dorsiflexion, no pain, no evidence of recurrence and was able to bear weight without the need for orthotic support. Given the minimal donor site morbidity and recovery of ankle dorsiflexion, this report underscores the importance of considering early nerve transfers in cases of high peroneal neuropathy due to an intraneural ganglion cyst.

  20. Phrenic nerve palsy associated with birth trauma--case reports and a literature review.

    Science.gov (United States)

    Shiohama, Tadashi; Fujii, Katsunori; Hayashi, Masaharu; Hishiki, Tomoro; Suyama, Maiko; Mizuochi, Hiromi; Uchikawa, Hideki; Yoshida, Shigetoshi; Yoshida, Hideo; Kohno, Yoichi

    2013-04-01

    Phrenic nerve palsy is a peripheral nerve disorder caused by excessive cervical extension due to birth trauma or cardiac surgery. We describe two new patients with phrenic nerve palsy associated with birth trauma. Both patients exhibited profound dyspnea and general hypotonia immediately after birth. A chest roentgenogram and fluoroscopy revealed elevation of the diaphragm, leading to a diagnosis of phrenic nerve palsy associated with birth trauma. Since they had intermittently exhibited dyspnea and recurrent infection, we performed video-assisted thoracoscopic surgery (VATS) plication in both cases, at an early and a late stage, respectively. Both patients subsequently exhibited a dramatic improvement in dyspnea and recurrent respiratory infection. Interestingly, the late stage operated infant exhibited spontaneous recovery at 7 months with cessation of mechanical ventilation once. However, this recovery was transient and subsequently led to an increased ventilation volume demand, finally resulting in surgical treatment at 15 months. Histological examination of the diaphragm at this time showed grouped muscle atrophy caused by phrenic nerve degeneration. To our knowledge, this is the first pathologically proven report of grouped muscle atrophy of the diaphragm due to phrenic nerve degeneration, suggesting that partial impairment of phrenic nerves resulted in respiratory dysfunction with incomplete recovery. We conclude that recently developed VATS plication is a safe and effective treatment for infants with phrenic nerve palsy, and should be considered as a surgical treatment at an early period. Copyright © 2012 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  1. Posterior interosseous nerve palsy as a complication of friction massage in tennis elbow.

    Science.gov (United States)

    Wu, Ya-Ying; Hsu, Wei-Chih; Wang, Han-Cheng

    2010-08-01

    Friction massage is a commonly used physical therapy that is usually safe and without complication. We report an unusual case of posterior interosseous nerve palsy that arose after friction massage. Electrophysiologic findings confirmed a focal neuropathy 4-6 cm distal to the lateral epicondyle. The neurologic symptoms resolved completely 2 mos after discontinuation of friction massage. This case experience broadens the spectrum of etiologies of posterior interosseous nerve palsy. Nerve conduction studies may be a useful adjunct to a thorough physical examination to confirm the diagnosis and is important to prognostic evaluation, if unexplained neurologic symptoms develop after certain physical therapy procedures. Further treatment includes avoiding compression and observation.

  2. Temporary unilateral hypoglossal nerve palsy secondary to infectious mononucleosis: A case report

    Directory of Open Access Journals (Sweden)

    Abbas Al Ramzi

    2016-06-01

    Full Text Available Tongue paralysis due to isolated palsy of XII cranial nerve is uncommon neurological finding. It is a multi-etiological condition, and may occur secondary to infectious mononucleosis. It is presented with characteristic signs e.g. reduced tongue movements with deviation to the affected side on protrusion. The diagnosis is challenging and based on thorough clinical examination and laboratory and imaging findings. A case of 31year old Kuwaiti male, presented to emergency room at Mubarak Alkabeer Hospital-Kuwait, with infectious mononucleosis complicated with temporary unilateral hypoglossal nerve palsy is reported, with an emphasis that paralysis of cranial nerve may be due to a less severe systemic condition, and not necessarily associate an underling malignancy. To the best of our knowledge, hypoglossal nerve palsy complicating infectious mononucleosis has never been previously reported in Kuwait.

  3. Lyme disease in a child presenting with bilateral facial nerve palsy: MRI findings and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Vanzieleghem, B.; Lemmerling, M.; Achten, E.; Vanlangenhove, P.; Kunnen, M. [Dept. of Radiology, University Hospital Gent (Belgium); Carton, D.; Matthys, E. [Dept. of Pediatrics, University Hospital Gent (Belgium)

    1998-11-01

    We report a 7-year-old boy with neuroborreliosis presenting with headache and bilateral facial nerve palsy. MRI demonstrated tentorial and bilateral facial and trigeminal nerve enhancement. (orig.) With 1 fig., 22 refs.

  4. Radiation-induced ocular motor cranial nerve palsies in patients with pituitary tumor.

    Science.gov (United States)

    Vaphiades, Michael S; Spencer, Sharon A; Riley, Kristen; Francis, Courtney; Deitz, Luke; Kline, Lanning B

    2011-09-01

    Radiation therapy is often used in the treatment of pituitary tumor. Diplopia due to radiation damage to the ocular motor cranial nerves has been infrequently reported as a complication in this clinical setting. Retrospective case series of 6 patients (3 men and 3 women) with pituitary adenoma, all of whom developed diplopia following transsphenoidal resection of pituitary adenoma with subsequent radiation therapy. None had evidence of tumor involvement of the cavernous sinus. Five patients developed sixth nerve palsies, 3 unilateral and 2 bilateral, and in 1 patient, a sixth nerve palsy was preceded by a fourth cranial nerve palsy. One patient developed third nerve palsy. Five of the 6 patients had a growth hormone-secreting pituitary tumor with acromegaly. Following transsphenoidal surgery in all 6 patients (2 had 2 surgeries), 4 had 2 radiation treatments consisting of either radiosurgery (2 patients) or external beam radiation followed by radiosurgery (2 patients). Patients with pituitary tumors treated multiple times with various forms of radiation therapy are at risk to sustain ocular motor cranial nerve injury. The prevalence of acromegalic patients in this study reflects an aggressive attempt to salvage patients with recalcitrant growth hormone elevation and may place the patient at a greater risk for ocular motor cranial nerve damage.

  5. A rare cause of facial nerve palsy in children : Hyperostosis corticalis generalisata (Van Buchem disease). Three new pediatric cases and a literature review

    NARCIS (Netherlands)

    van Egmond, M. E.; Dikkers, F. G.; Boot, A. M.; van Lierop, A. H. J. M.; Papapoulos, S. E.; Brouwer, O. F.

    2012-01-01

    Differential diagnosis of facial nerve palsy in children is extensive. We report on three pediatric cases presenting with facial nerve palsy caused by hyperostosis corticalis generalisata (Van Buchem disease). This autosomal recessive disease is characterized by progressive bone overgrowth, with

  6. An unusual case of isolated sixth cranial nerve palsy in leprosy.

    Science.gov (United States)

    Vaishampayan, Sanjeev; Borde, Priyanka

    2012-08-15

    Cranial nerve involvement is not common in leprosy. The fifth and seventh cranial nerves are the most commonly affected in leprosy. Herein we present a patient with Hansen disease (BL) with type I reaction who developed isolated involvement of the sixth cranial nerve leading to lateral rectus muscle palsy. He responded to timely anti-reactional therapy and it produced a good response. Careful observation of patients with lepra reaction is needed to avoid damage to important organs.

  7. Catheter versus non-catheter angiography in isolated third nerve palsy

    International Nuclear Information System (INIS)

    Lee, A.G.

    2007-01-01

    To discuss the controversies surrounding the indications for catheter angiography versus non-catheter and less invasive angiography techniques (e.g. magnetic resonance angiography (MRA) and computerized tomography angiography (CTA)) in the evaluation of patients with a third nerve palsy. Clinical opinion-perspective and literature review. The patient with an isolated third nerve palsy might have a vasculopathic (and typically benign, self limited course) etiology or a life threatening intracranial posterior communicating artery aneurysm. Although it is clear that non-isolated third nerve palsies require imaging directed at the topographical localization of the clinical findings, the evaluation of the neurologically isolated third nerve palsy remains controversial. The completeness of the external (i.e. somatic) motor dysfunction and the presence or absence of internal (i.e. pupillary) dysfunction are generally used to guide the choice of initial neuroimaging. Advances in MRA and CTA technology have reduced but not eliminated our dependence upon catheter angiography in this setting. A properly performed and interpreted MRA or CTA probably will be able to detect greater than 95 % of aneurysms producing a third nerve palsy. The issues surrounding the use of catheter angiography in third nerve palsy are reviewed. If the clinician is highly confident in the capability, availability, and reliability of the neuroradiologist and of their institutional experience and quality of less invasive non-catheter MRA and CTA and if the risk of aneurysm is low or if the risk of angiography is high (e.g. elderly, renal failure, iodinated contrast allergy, risk of stroke) then MRI and MRA (or CTA) may be a reasonable alternative to catheter angiography. Patients with a moderate or uncertain risk of aneurysm and a lower risk for catheter angiography or if there is a low confidence in the quality or the interpretation of the institutional MRA (or CTA) may still require catheter

  8. Transcutaneous Electrical Nerve Stimulation (TENS) and Laryngeal Manual Therapy (LMT): Immediate Effects in Women With Dysphonia.

    Science.gov (United States)

    Conde, Mariana de Cásisa Macedo; Siqueira, Larissa Thaís Donalonso; Vendramini, José Eduardo; Brasolotto, Alcione Ghedini; Guirro, Rinaldo Roberto de Jesus; Silverio, Kelly Cristina Alves

    2018-05-01

    This study aimed to verify the immediate effect of low-frequency transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) in musculoskeletal pain, voice quality, and self-reported signs in women with dysphonia. Thirty women with behavioral dysphonia were randomly divided into the TENS group and the LMT group. All participants fulfilled the pain survey and had their voices recorded to posterior perceptual and acoustic analysis before and after intervention. The TENS group received a unique low-frequency TENS session (20 minutes). The LMT group received LMT (20 minutes) with soft and superficial massage in the sternocleidomastoid muscle, suprahyoid muscles, and larynx. Afterward, the volunteers reported their voice, larynx, breathing, and articulatory signs. Pre and post data were compared by parametric and nonparametric tests. After TENS, a decrease in pain intensity in the posterior or anterior region of the neck, shoulders, upper or lower back, and masseter was observed. After LMT, a decrease in pain intensity in the neck anterior region, shoulders, lower back, and temporal region was observed. Also, after TENS, there was an improvement in vowel /a/ instability; after LMT, there was a general improvement in voice quality, decrease in tension, and decrease in breathiness in speech. Positive voice and laryngeal signs were reported after TENS, and positive laryngeal signs and articulation were reported after LMT. TENS and LMT may be used in voice treatment of women with behavioral dysphonia, and both may be considered important therapy resources that reduce musculoskeletal pain and cause positive laryngeal signs. Both TENS and LMT are able to partially improve voice quality, but TENS presented better results. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  9. A COMPREHENSIVE ANALYSIS OF ISOLATED INFRANUCLEAR ABDUCENS NERVE PALSY IN A TERTIARY EYE CARE CENTRE

    Directory of Open Access Journals (Sweden)

    G. Dhamodara

    2017-01-01

    Full Text Available BACKGROUND A comprehensive analysis of the aetiology and clinical profile of isolated infranuclear abducens nerve palsy in a tertiary eye care centre. MATERIALS AND METHODS A hospital-based retrospective case series analysis of 90 isolated infranuclear neurogenic abducens nerve palsies. Documentation included age, gender, presenting complaints, history of diabetes mellitus, hypertension, mode of onset, progression of the disease, treatment given and recovery rate was evaluated. Detailed ophthalmic evaluation of both eyes including anterior segment examination, extraocular movements, diplopia charting and Hess charting. Thorough central nervous system examination and systemic examination was done. Inclusion Criteria- All isolated infranuclear neurogenic lesions of abducens nerve palsy. Exclusion Criteria- Conditions like supranuclear lesions, myasthenia, orbital inflammation and myopathies, false localising sign of abducens nerve palsy were excluded by appropriate testing and investigations. RESULTS Total cases were 90 patients. Mean age of presentation was between 3rd to 5th decades with male preponderance. Commonest presenting symptom was diplopia (71.1%, commonest cause being idiopathic neuritis (48%, diabetes mellitus (20%, hypertension (15%, trauma (10% and others (7%. CONCLUSION In our study, isolated infranuclear abducens nerve palsy with nonspecific aetiology predominantly affecting males of 3 rd to 5 th decade with variable recovery rates were seen. Hence, careful clinical examination in all cases is essential with close follow up on a long-time basis.

  10. Selective recurrent laryngeal nerve stimulation using a penetrating electrode array in the feline model.

    Science.gov (United States)

    Haidar, Yarah M; Sahyouni, Ronald; Moshtaghi, Omid; Wang, Beverly Y; Djalilian, Hamid R; Middlebrooks, John C; Verma, Sunil P; Lin, Harrison W

    2017-10-31

    Laryngeal muscles (LMs) are controlled by the recurrent laryngeal nerve (RLN), injury of which can result in vocal fold (VF) paralysis (VFP). We aimed to introduce a bioelectric approach to selective stimulation of LMs and graded muscle contraction responses. Acute experiments in cats. The study included six anesthetized cats. In four cats, a multichannel penetrating microelectrode array (MEA) was placed into an uninjured RLN. For RLN injury experiments, one cat received a standardized hemostat-crush injury, and one cat received a transection-reapproximation injury 4 months prior to testing. In each experiment, three LMs (thyroarytenoid, posterior cricoarytenoid, and cricothyroid muscles) were monitored with an electromyographic (EMG) nerve integrity monitoring system. Electrical current pulses were delivered to each stimulating channel individually. Elicited EMG voltage outputs were recorded for each muscle. Direct videolaryngoscopy was performed for visualization of VF movement. Stimulation through individual channels led to selective activation of restricted nerve populations, resulting in selective contraction of individual LMs. Increasing current levels resulted in rising EMG voltage responses. Typically, activation of individual muscles was successfully achieved via single placement of the MEA by selection of appropriate stimulation channels. VF abduction was predominantly observed on videolaryngoscopy. Nerve histology confirmed injury in cases of RLN crush and transection experiments. We demonstrated the ability of a penetrating MEA to selectively stimulate restricted fiber populations within the feline RLN and selectively elicit contractions of discrete LMs in both acute and injury-model experiments, suggesting a potential role for intraneural MEA implantation in VFP management. NA Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  11. Microcystic adnexal carcinoma (MAC)-like squamous cell carcinoma as a differential diagnosis to Bell´s palsy: review of guidelines for refractory facial nerve palsy.

    Science.gov (United States)

    Mueller, S K; Iro, H; Lell, M; Seifert, F; Bohr, C; Scherl, C; Agaimy, A; Traxdorf, M

    2017-01-05

    Bell´s palsy is the most common cause of facial paralysis worldwide and the most common disorder of the cranial nerves. It is a diagnosis of exclusion, accounting for 60-75% of all acquired peripheral facial nerve palsies. Our case shows the first case of a microcystic adnexal carcinoma-like squamous cell carcinoma as a cause of facial nerve palsy. The patient, a 70-year-old Caucasian male, experienced subsequent functional impairment of the trigeminal and the glossopharyngeal nerve about 1½ years after refractory facial nerve palsy. An extensive clinical work-up and tissue biopsy of the surrounding parotid gland tissue was not able to determine the cause of the paralysis. Primary infiltration of the facial nerve with subsequent spreading to the trigeminal and glossopharyngeal nerve via neuroanastomoses was suspected. After discussing options with the patient, the main stem of the facial nerve was resected to ascertain the diagnosis of MAC-like squamous cell carcinoma, and radiochemotherapy was subsequently started. This case report shows that even rare neoplastic etiologies should be considered as a cause of refractory facial nerve palsy and that it is necessary to perform an extended diagnostic work-up to ascertain the diagnosis. This includes high-resolution MRI imaging and, as perilesional parotid biopsies might be inadequate for rare cases like ours, consideration of a direct nerve biopsy to establish the right diagnosis.

  12. De Novo Intraneural Arachnoid Cyst Presenting with Complete Third Nerve Palsy: Case Report and Literature Review.

    Science.gov (United States)

    Brewington, Danielle; Petrov, Dmitriy; Whitmore, Robert; Liu, Grant; Wolf, Ronald; Zager, Eric L

    2017-02-01

    Intraneural arachnoid cyst is an extremely rare etiology of isolated cranial nerve palsy. Although seldom encountered in clinical practice, this pathology is amenable to surgical intervention. Correct identification and treatment of the cyst are required to prevent permanent nerve damage and potentially reverse the deficits. We describe a rare case of isolated third nerve palsy caused by an intraneural arachnoid cyst. A 49-year-old woman with a recent history of headaches experienced acute onset of painless left-sided third nerve palsy. According to hospital records ptosis, mydriasis, absence of adduction, elevation, and intorsion were noted in the left eye. Computed tomography and magnetic resonance imaging studies showed an extra-axial, 1-cm lesion along the left paraclinoid region, causing mild indentation on the uncus. There was dense fluid layering dependently concerning for hemorrhage, but no evidence of aneurysms. A pterional craniotomy was performed, revealing a completely intraneural arachnoid cyst in the third nerve. The cyst was successfully fenestrated. At 7-month follow-up, the left eye had recovered intact intorsion and some adduction, but the left pupil remained dilated and nonreactive. There was still no elevation and no afferent pupillary defect. Double vision persisted with partial improvement in the ptosis, opening up to more than 75% early in the day. To our knowledge, this is the first report of an intraneural arachnoid cyst causing isolated third nerve palsy. This rare pathology proves to be both a diagnostic and therapeutic challenge. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Facial nerve palsy after reactivation of herpes simplex virus type 1 in diabetic mice.

    Science.gov (United States)

    Esaki, Shinichi; Yamano, Koji; Katsumi, Sachiyo; Minakata, Toshiya; Murakami, Shingo

    2015-04-01

    Bell's palsy is highly associated with diabetes mellitus (DM). Either the reactivation of herpes simplex virus type 1 (HSV-1) or diabetic mononeuropathy has been proposed to cause the facial paralysis observed in DM patients. However, distinguishing whether the facial palsy is caused by herpetic neuritis or diabetic mononeuropathy is difficult. We previously reported that facial paralysis was aggravated in DM mice after HSV-1 inoculation of the murine auricle. In the current study, we induced HSV-1 reactivation by an auricular scratch following DM induction with streptozotocin (STZ). Controlled animal study. Diabetes mellitus was induced with streptozotocin injection in only mice that developed transient facial nerve paralysis with HSV-1. Recurrent facial palsy was induced after HSV-1 reactivation by auricular scratch. After DM induction, the number of cluster of differentiation 3 (CD3)(+) T cells decreased by 70% in the DM mice, and facial nerve palsy recurred in 13% of the DM mice. Herpes simplex virus type 1 deoxyribonucleic acid (DNA) was detected in the facial nerve of all of the DM mice with palsy, and HSV-1 capsids were found in the geniculate ganglion using electron microscopy. Herpes simplex virus type 1 DNA was also found in some of the DM mice without palsy, which suggested the subclinical reactivation of HSV-1. These results suggested that HSV-1 reactivation in the geniculate ganglion may be the main causative factor of the increased incidence of facial paralysis in DM patients. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Variant Anterior Digastric Muscle Transfer for Marginal Mandibular Branch of Facial Nerve Palsy

    Directory of Open Access Journals (Sweden)

    Matthew J. Zdilla, DC

    2014-02-01

    Full Text Available Summary: Marginal mandibular branch of facial nerve (MMBFN palsy is a common consequence of head and neck surgeries. MMBFN palsy results in paralysis of muscles which depress the inferior lip. Current management of MMBFN palsy involves ruination of normal neuromuscular anatomy and physiology to restore symmetry to the mouth. The article outlines the possibility to transfer variant anterior digastric musculature to accomplish reanimation of the mouth without adversely affecting normal nonvariant anatomy. The procedure may have the additional cosmetic benefit of correcting asymmetrical muscular bulk in the submental region.

  15. Isolated unilateral sixth cranial nerve palsy: A rare presentation of dengue fever

    Directory of Open Access Journals (Sweden)

    Yang Liang Boo

    2016-11-01

    Full Text Available Dengue fever is a common mosquito-borne viral infection endemic in tropical and subtropical countries. Neurological manifestations in dengue infection are relatively uncommon, and include encephalitis, encephalopathy, neuromuscular disorders and neuro-ocular disorders. Cranial mononeuropathy is a rare manifestation of dengue infection. A 40-year-old man was diagnosed with isolated, unilateral sixth cranial nerve palsy complicating dengue infection. The patient was managed accordingly, and full ocular recovery was observed. This was the first reported case of isolated sixth cranial nerve palsy associated with dengue fever in Malaysia. It is important for clinicians to consider dengue as a differential diagnosis in patients presenting with fever and sixth cranial nerve palsy.

  16. Central pontine myelinolysis presenting as isolated sixth nerve palsy in third trimester of pregnancy

    Directory of Open Access Journals (Sweden)

    Tushar Divakar Gosavi

    2015-01-01

    Full Text Available A 30-year-old primigravida presented with isolated left sixth nerve palsy at 38 weeks gestation. Her MRI showed a lesion consistent with central pontine myelinolysis (CPM. Extensive investigations did not reveal any secondary cause for the CPM. She recovered spontaneously in 2 weeks with complete resolution of her MRI changes. To our knowledge, this is the first report of CPM occurring in third trimester in the absence of identifiable secondary causes and of CPM presenting as an isolated sixth nerve palsy. We discuss the reported causes of CPM in pregnancy, possible pathophysiologic mechanisms involved and the anatomic basis of the unique clinical presentation of sixth nerve palsy in our case.

  17. Glufosinate herbicide intoxication causing unconsciousness, convulsion, and 6th cranial nerve palsy.

    Science.gov (United States)

    Park, Jae-seok; Kwak, Soo-Jung; Gil, Hyo-wook; Kim, So-Young; Hong, Sae-yong

    2013-11-01

    Although glufosinate ammonium herbicides are considered safe when used properly, ingestion of the undiluted form can cause grave outcomes. Recently, we treated a 34-yr-old man who ingested glufosinate ammonium herbicide. In the course of treatment, the patient developed apnea, mental deterioration, and sixth cranial nerve palsy; he has since been discharged with full recovery after intensive care. This case report describes the clinical features of glufosinate intoxication with a focus on sixth cranial nerve palsy. Our observation suggests that neurologic manifestations after ingestion of a "low-grade toxicity herbicide" are variable and more complex than that was previously considered.

  18. Cranial nerve palsy in Wegener's granulomatosis--lessons from clinical cases

    DEFF Research Database (Denmark)

    Nowack, Rainer; Wachtler, Paul; Kunz, Jürgen

    2009-01-01

    The problem of diagnosing vasculitic neuropathy is discussed based on case reports of two patients with Wegener's granulomatosis. One patient developed de novo 6(th) nerve palsy as an isolated relapse manifestation and the second patient a sequence of multiple cranial nerve palsies. Brain imaging...... by the overall clinical presentations. Cranial neuropathy may be the first obvious vasculitic manifestation preceding other organ disease, and since single reliable tests for its diagnosis are lacking, a multidisciplinary approach is advocated here to detect vasculitic manifestations in other organs....

  19. Isolated Bilateral Fourth Cranial Nerve Palsies as the Presenting Sign of Hydrocephalus

    Directory of Open Access Journals (Sweden)

    Dimosthenis Mantopoulos

    2011-07-01

    Full Text Available Midbrain lesions leading to bilateral fourth nerve palsies are typically accompanied by other brainstem symptomatology. Here we report a case of a 29-year-old man with hydrocephalus and significant third ventricle dilation applying pressure on the dorsal midbrain and having as the only manifestation isolated, bilateral fourth cranial nerve palsies. This finding, reported here for the first time, could be attributed to a partially working ventriculoperitoneal shunt previously placed in this patient, which was able to sporadically relieve the increases of the intraventricular pressure on the midbrain that would normally lead to other manifestations.

  20. Adipose-derived mesenchymal stem cells accelerate nerve regeneration and functional recovery in a rat model of recurrent laryngeal nerve injury

    Directory of Open Access Journals (Sweden)

    Yun Li

    2017-01-01

    Full Text Available Medialization thyroplasty or injection laryngoplasty for unilateral vocal fold paralysis cannot restore mobility of the vocal fold. Recent studies have shown that transplantation of mesenchymal stem cells is effective in the repair of nerve injuries. This study investigated whether adipose-derived stem cell transplantation could repair recurrent laryngeal nerve injury. Rat models of recurrent laryngeal nerve injury were established by crushing with micro forceps. Adipose-derived mesenchymal stem cells (ADSCs; 8 × 105 or differentiated Schwann-like adipose-derived mesenchymal stem cells (dADSCs; 8 × 105 or extracellular matrix were injected at the site of injury. At 2, 4 and 6 weeks post-surgery, a higher density of myelinated nerve fiber, thicker myelin sheath, improved vocal fold movement, better recovery of nerve conduction capacity and reduced thyroarytenoid muscle atrophy were found in ADSCs and dADSCs groups compared with the extracellular matrix group. The effects were more pronounced in the ADSCs group than in the dADSCs group. These experimental results indicated that ADSCs transplantation could be an early interventional strategy to promote regeneration after recurrent laryngeal nerve injury.

  1. Non-Hodgkin's lymphoma of the sphenoid sinus presenting as isolated oculomotor nerve palsy

    Directory of Open Access Journals (Sweden)

    Huh Ji

    2007-08-01

    Full Text Available Abstract Background Solitary involvement of the sphenoid sinus has rarely been reported in non-Hodgkin's lymphoma. Isolated oculomotor nerve palsy is uncommon as an initial presentation of malignant tumors of the sphenoid sinus. Case presentation A 53-year-old woman presented with a three-month history of headache and diplopia. Neurological examination revealed complete left oculomotor nerve palsy. Magnetic Resonance Imaging (MRI demonstrated a homogenous soft-tissue lesion occupying the left sphenoid sinus and invading the left cavernous sinus. The patient underwent transsphenoidal biopsy and the lesion was histologically diagnosed as non-Hodgkin's lymphoma, diffuse large B-cell type. Tumor cells were positive for CD20 and negative for CD3. Following six cycles of chemotherapy, the left oculomotor nerve palsy that had been previously observed was completely resolved. There was no enhancing lesion noted on follow-up MRI. Conclusion It is important to recognize that non-Hodgkin's lymphoma of the sphenoid sinus can present with isolated oculomotor nerve palsy, although it is extremely rare. The cranial nerve deficits can resolve dramatically after chemotherapy.

  2. Isolated abducens nerve palsy after closed head trauma: a pediatric case report.

    Science.gov (United States)

    Janssen, Karen; Wojciechowski, Marek; Poot, Sandra; De Keyser, Katrien; Ceulemans, Berten

    2008-09-01

    Cranial nerve lessions often accompany head trauma. Nevertheless, isolated involvement of the sixth nerve without any cranial or cervical fracture is rare. Nerve injury could occur at the sites of the dural entry points and at the petrous apex during down- or upward movement of the brain caused by violent linear force to the head. Management is symptomatic. Most cases improve within three months and many resolve by six months, but spontaneous recovery does not always occur. We describe the case of a 13-year-old boy who developed isolated abducens nerve palsy after closed head trauma.

  3. Neuromuscular electrical stimulation of the cricothyroid muscle in patients with suspected superior laryngeal nerve weakness.

    Science.gov (United States)

    Guzman, Marco; Rubin, Adam; Cox, Paul; Landini, Fernando; Jackson-Menaldi, Cristina

    2014-03-01

    In this retrospective case study, we report the apparent clinical effectiveness of neuromuscular electrical stimulation (NMES) in combination with voice therapy (VT) for rehabilitating dysphonia secondary to suspected superior laryngeal nerve (SLN) weakness in two female patients. Both patients failed or plateaued with traditional VT but had significant improvement with the addition of NMES of the cricothyroid muscle and SLN using a VitalStim unit. Stimulation was provided simultaneously with voice exercises based on musical phonatory tasks. Both acoustic analysis and endoscopic evaluation demonstrated important improvements after treatment. In the first patient, the major change was obtained within the primo passaggio region; specifically, a decrease in voice breaks was demonstrated. In the second patient, an improvement in voice quality (less breathiness) and vocal range were the most important findings. Additionally, each patient reported a significant improvement in their voice complaints. Neuromuscular laryngeal electrical stimulation in combination with vocal exercises might be a useful tool to improve voice quality in patients with SLN injury. Copyright © 2014 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  4. Frequency of the superior rectus muscle overaction/contracture syndrome in unilateral fourth nerve palsy.

    Science.gov (United States)

    Molinari, Andrea; Ugrin, Maria Cristina

    2009-12-01

    Superior oblique palsy is accompanied in most cases by overaction of the muscle's ipsilateral antagonist, the inferior oblique muscle. Overaction and contracture of the ipsilateral superior rectus muscle in patients with unilateral fourth (trochlear) nerve palsy is seldom discussed in the literature. The purpose of this study is to evaluate the frequency of superior rectus muscle overaction/contracture syndrome in patients with unilateral trochlear nerve palsy. The records of 198 patients with unilateral trochlear nerve palsy examined by the authors between July 1987 and July 2008 were reviewed retrospectively. All patients underwent complete eye examination with measurement of the deviation in the 9 positions of gaze and with the head tilted to both sides in all cooperative patients. Selection criteria for superior rectus muscle overaction/contracture syndrome in these patients were as follows: vertical deviation of 15(Delta) or larger in primary position, equal or larger hypertropia with the ipsilateral forced tilt test than with the eyes looking straight ahead, more than 5(Delta) hypertropia of the affected eye in horizontal gaze to the same side, hypertropia in all upgazes, and overaction of the contralateral superior oblique muscle. Of 198 patients, 33 (16.6%) met the selection criteria for superior rectus muscle overaction/contracture syndrome. Superior rectus muscle overaction/contracture syndrome frequently occurs in unilateral superior oblique palsy.

  5. Predictive factors and prognosis for recurrent laryngeal nerve invasion in papillary thyroid carcinoma

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    Chen W

    2017-09-01

    Full Text Available Wenjie Chen,1 Jianyong Lei,1 Jiaying You,2 Yali Lei,3 Zhihui Li,1 Rixiang Gong,1 Huairong Tang,3 Jingqiang Zhu1 1Thyroid and Parathyroid Surgery Center, 2West China School of Clinical Medicine, 3Health and Management Center, West China Hospital of Sichuan University, Chengdu, People’s Republic of China Background: Recurrent laryngeal nerve (RLN invasion in papillary thyroid carcinoma (PTC is one of the main predictors of poor prognosis. The present study investigated the risk factors for RLN invasion in PTC patients.Methods: A total of 3,236 patients who received thyroidectomy due to PTC in Thyroid and Parathyroid Surgery Center of West China Hospital of Sichuan University were reviewed. Demographics and clinical factors, imaging examination (ultrasonography characteristics, surgical details, postoperative pathological details, recurrence, and postoperative complications were recorded. Univariate and multivariate analyses were used to study the risk factors of RLN invasion, Kaplan–Meier method was performed to compare the outcomes of tumor recurrence.Results: Patients with RLN invasion had a higher recurrence rate than those in the control group (p<0.001. Multivariate analyses showed that age greater than 45 years (p<0.001, a largest tumor size bigger than 10 mm (p<0.001, clinical lymph node metastasis (cN1 (p<0.001, posterior focus (p<0.001, extrathyroidal extension (p<0.001, esophageal extension (p<0.001, tracheal extension (p<0.001, and preoperative vocal cord paralysis (p<0.001 were independent predictors for RLN invasion.Conclusion: PTC patients with RLN invasion have a negative prognosis and a higher recurrence rate. Meticulous operation and careful follow-up of patients with the above factors is recommended. Keywords: papillary thyroid carcinoma, recurrent laryngeal nerve invasion, predictive factors, lymph node metastases, Hashimoto’s thyroiditis

  6. Effect of phrenic nerve palsy on early postoperative lung function after pneumonectomy: a prospective study.

    Science.gov (United States)

    Kocher, Gregor J; Mauss, Karl; Carboni, Giovanni L; Hoksch, Beatrix; Kuster, Roland; Ott, Sebastian R; Schmid, Ralph A

    2013-12-01

    The issue of phrenic nerve preservation during pneumonectomy is still an unanswered question. So far, its direct effect on immediate postoperative pulmonary lung function has never been evaluated in a prospective trial. We conducted a prospective crossover study including 10 patients undergoing pneumonectomy for lung cancer between July 2011 and July 2012. After written informed consent, all consecutive patients who agreed to take part in the study and in whom preservation of the phrenic nerve during operation was possible, were included in the study. Upon completion of lung resection, a catheter was placed in the proximal paraphrenic tissue on the pericardial surface. After an initial phase of recovery of 5 days all patients underwent ultrasonographic assessment of diaphragmatic motion followed by lung function testing with and without induced phrenic nerve palsy. The controlled, temporary paralysis of the ipsilateral hemidiaphragm was achieved by local administration of lidocaine 1% at a rate of 3 mL/h (30 mg/h) via the above-mentioned catheter. Temporary phrenic nerve palsy was accomplished in all but 1 patient with suspected catheter dislocation. Spirometry showed a significant decrease in dynamic lung volumes (forced expiratory volume in 1 second and forced vital capacity; p phrenic nerve palsy causes a significant impairment of dynamic lung volumes during the early postoperative period after pneumonectomy. Therefore, in these already compromised patients, intraoperative phrenic nerve injury should be avoided whenever possible. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. The vagal nerve stimulation outcome, and laryngeal effect: Otolaryngologists roles and perspective.

    Science.gov (United States)

    Al Omari, Ahmad I; Alzoubi, Firas Q; Alsalem, Mohammad M; Aburahma, Samah K; Mardini, Diala T; Castellanos, Paul F

    Epilepsy is one of the most common neurologic disorders. Vagus nerve stimulation (VNS), first investigated in 1938 and subsequently studied as a potential therapy for epilepsy. The FDA approved the use of VNS in 1997 as an adjunctive non-pharmacologic symptomatic treatment option for refractory epilepsy for adults and adolescents over 12years. VNS can cause laryngeal and voice side effects that can be managed by otolaryngologists safely and effectively. This study is to review the outcomes of vagal nerve stimulator (VNS) implantation in terms of the surgical procedures, complications, seizure frequency, and the clinical effect on larynx and vocal folds motion. Series of thirty consecutive patients who had VNS implantation between 2007 and 2014 were recruited. Seizure-frequency outcome, surgical complications and device adverse effects of VNS were retrospectively reviewed. Additional evaluation included use of the Voice Handicap Index and Maximum Phonation Time (MPT) were conducted before and after the implantation. Videolaryngoscopy was used to evaluate the vocal fold mobility before and after the VNS implantation. Seizure frequency reduction over a minimum of 2years of follow up demonstrated: 100% in seizure frequency reduction in 1 patient, drastic reduction in seizure frequency (70-90%) in 9 patients, a good reduction in terms of seizure frequency (50%) in 8 patients, a 30% reduction in 5 patients, no response in 6 patients, and 1 patient had increased frequency. The most commonly reported adverse effects after VNS activation were coughing and voice changes with pitch breaks, as well as mild intermittent shortness of breath in 33% of patients. For those patients secondary supraglottic muscle tension and hyper function with reduced left vocal fold mobility were noticed on videolaryngoscopy, though none had aspiration problems. Surgical complications included a wound dehiscence in one patient (3%) which was surgically managed, minor intra-operative bleeding 3%; a

  8. Thixotropy of levator palpebrae as the cause of lagophthalmos after peripheral facial nerve palsy

    NARCIS (Netherlands)

    Aramideh, M.; Koelman, J. H. T. M.; Devriese, P. P.; Speelman, J. D.; Ongerboer de Visser, B. W.

    2002-01-01

    Patients with facial nerve palsy are at risk of developing corneal ulceration because of lagophthalmos (incomplete closure of the affected eyelid). Lagophthalmos could result from thixotropy of the levator palpebrae muscle-that is, the formation of tight crossbridges between the actin and myosin

  9. Facial nerve palsy in a thirteen-year-old male youth with Kawasaki disease

    NARCIS (Netherlands)

    Biezeveld, Maarten H.; Voorbrood, Bas S.; Clur, Sally-Ann B.; Kuijpers, Taco W.

    2002-01-01

    A 13-year-old male youth was hospitalized with Kawasaki disease. In the course of the disease he developed a facial nerve palsy and an aneurysm of the right coronary artery. After treatment with immunoglobulins both complications disappeared within 10 days and 1 month, respectively

  10. Bell palsy in lyme disease-endemic regions of canada: a cautionary case of occult bilateral peripheral facial nerve palsy due to Lyme disease.

    Science.gov (United States)

    Ho, Karen; Melanson, Michel; Desai, Jamsheed A

    2012-09-01

    Lyme disease caused by the spirochete Borrelia burgdorferi is a multisystem disorder characterized by three clinical stages: dermatologic, neurologic, and rheumatologic. The number of known Lyme disease-endemic areas in Canada is increasing as the range of the vector Ixodes scapularis expands into the eastern and central provinces. Southern Ontario, Nova Scotia, southern Manitoba, New Brunswick, and southern Quebec are now considered Lyme disease-endemic regions in Canada. The use of field surveillance to map risk and endemic regions suggests that these geographic areas are growing, in part due to the effects of climate warming. Peripheral facial nerve palsy is the most common neurologic abnormality in the second stage of Lyme borreliosis, with up to 25% of Bell palsy (idiopathic peripheral facial nerve palsy) occurring due to Lyme disease. Here we present a case of occult bilateral facial nerve palsy due to Lyme disease initially diagnosed as Bell palsy. In Lyme disease-endemic regions of Canada, patients presenting with unilateral or bilateral peripheral facial nerve palsy should be evaluated for Lyme disease with serologic testing to avoid misdiagnosis. Serologic testing should not delay initiation of appropriate treatment for presumed Bell palsy.

  11. Diagnosis and management with botulinum toxin in 11 cases of laryngeal synkinesis.

    Science.gov (United States)

    Lekue, Asier; García-López, Isabel; Santiago, Susana; Del Palacio, Antonio; Gavilán, Javier

    2015-09-01

    Laryngeal synkinesis is a vocal fold movement disorder produced by a misdirected reinnervation after a recurrent laryngeal nerve injury. Its symptoms differ greatly between patients, requiring diverse therapeutical approaches. We aim to describe our experience in the diagnosis and treatment of different laryngeal synkinesis presentations. 11 patients diagnosed between 2011 and 2014 in a tertiary referral center with laryngeal synkinesis confirmed by laryngeal electromyography were included in our study. All medical records and laryngoscopic and electromyographic data were reviewed retrospectively. Four patients had previous unilateral vocal fold palsy and seven had a bilateral palsy with different degrees of clinical involvement. All of them showed paradoxical movements during inhalation in videofibrolaryngoscopic examination. Laryngeal electromyography confirmed the diagnosis of laryngeal synkinesis. Dyspnea was the main presentation symptom. Three patients with mild symptoms were not treated. Patients with unilateral vocal fold immobility were successfully treated with periodic botulinum toxin injections. Patients with bilateral immobility had a good initial response to botulinum toxin, although in some of them, a posterior cordectomy had to be finally performed. In conclusion, laryngeal synkinesis is a heterogeneous clinic entity that appears in patients with unilateral or bilateral vocal fold paralysis. Videofibrolaryngoscopy and laryngeal electromyography are essential to a correct diagnosis. Botulinum toxin injections are the main treatment for symptomatic cases, even if in bilateral palsy cases more aggressive treatments are often required.

  12. Case Study of Oriental Medicine Treatment with Acupotomy Therapy of the Peroneal Nerve Palsy through Ultrasound Case Report

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    Kim Sungha

    2011-03-01

    Full Text Available Purpose: In order to estimate clinical effects of Oriental Medicine Treatment with acupotomy therapy of Peroneal nerve Palsy. Methods: From 10th June, 2010 to 19th June, 2010, 1 female patient diagnosed as Peroneal nerve Palsy(clinical diagnosed was treated with general oriental medicine therapy (acupuncture, pharmacopuncture,moxibustion, cupping, physical therapy, herbal medication and acupotomy. Results: The patient's left foot drop was remarkably improved. Conclusions: This study demonstrates that oriental medical treatment with acuputomy therapy has notable effect in improving symptoms of peroneal nerve palsy. as though we had not wide experience in this treatment, more research is needed.

  13. Median Nerve Palsy following Elastic Stable Intramedullary Nailing of a Monteggia Fracture: An Unusual Case and Review of the Literature

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    Surjit Lidder

    2011-01-01

    Full Text Available Monteggia fractures are rare in children, and subtle radial head dislocations, with minor plastic deformation of the ulna, may be missed in up to a third of cases. Complications of Monteggia fractures-dislocations include persistent radial head dislocation, forearm deformity, elbow stiffness, and nerve palsies at the time of presentation. An unusual case of median nerve palsy following elastic stable intramedullary nailing of a type I Monteggia lesion in a 6-year-old girl is presented, and we highlight that, although most nerve palsies associated with a Monteggia fracture-dislocations are treated expectantly in children, early intervention here probably provided the best outcome.

  14. Modified first or second cervical nerve transplantation technique for the treatment of recurrent laryngeal neuropathy in horses.

    Science.gov (United States)

    Rossignol, F; Brandenberger, O; Perkins, J D; Marie, J-P; Mespoulhès-Rivière, C; Ducharme, N G

    2018-07-01

    In horses, the only established method for reinnervation of the larynx is the nerve-muscle pedicle implantation, whereas in human medicine, direct nerve implantation is a standard surgical technique for selective laryngeal reinnervation in human patients suffering from bilateral vocal fold paralysis. (1) To describe a modified first or second cervical nerve transplantation technique for the treatment of recurrent laryngeal neuropathy (RLN) in horses and (2) evaluate the outcomes of reinnervation using direct nerve needle-stimulation of the first cervical nerve and exercising endoscopy before and after surgery. Case series. Nerve transplantation surgery, in which the first or second cervical nerve is tunnelled through the atrophied left cricoarytenoideus dorsalis muscle, was performed in combination with ipsilateral laser ventriculocordectomy. Ultrasound-guided stimulation of the first cervical nerve at the level of the alar foramen was used to confirm successful reinnervation post-operatively. Exercising endoscopy was performed before and after surgery. The exercising RLN grade of the left arytenoid was blindly determined at the highest stride frequency for each examination. Surgery was performed in 17 client-owned animals with RLN. Reinnervation was confirmed by nerve stimulation and subsequent arytenoid abduction observed in 11 out of 12 cases between 4 and 12 months post-operatively. Fourteen horses had exercising endoscopy before and after surgery. Nine horses had an improved exercising RLN grade, four horses had the same exercising grade and one horse had a worse exercising grade after surgery. A sham-operated control group was not included and follow-up beyond 12 months and objective performance data were not obtained. The modified first or second cervical nerve transplantation technique, using tunnelling and direct implantation of the donor nerve into the cricoarytenoideus dorsalis muscle, resulted in reinnervation in 11 out of 12 cases and improved

  15. [Correlation between facial nerve functional evaluation and efficacy evaluation of acupuncture treatment for Bell's palsy].

    Science.gov (United States)

    Zhou, Zhang-ling; Li, Cheng-xin; Jiang, Yue-bo; Zuo, Cong; Cai, Yun; Wang, Rui

    2012-09-01

    To assess and grade facial nerve dysfunction according to the extent of facial paralysis in the clinical course of acupuncture treatment for Bell's palsy, and to observe the interrelationship between the grade, the efficacy and the period of treatment, as well as the effect on prognosis. The authors employed the House-Brackmann scale, a commonly used evaluation scale for facial paralysis motor function, and set standards for eye fissure and lips. According to the improved scale, the authors assessed and graded the degree of facial paralysis in terms of facial nerve dysfunction both before and after treatment. The grade was divided into five levels: mild, moderate, moderately severe, severe dysfunction and complete paralysis. The authors gave acupuncture treatment according to the state of the disease without artificially setting the treatment period. The observation was focused on the efficacy and the efficacy was evaluated throughout the entire treatment process. Fifty-three cases out of 68 patients with Bell's palsy were cured and the overall rate of efficacy was 97%. Statistically significant differences (PBell's palsy in terms of severity of facial nerve dysfunction. Efficacy is reduced in correlation with an increase in facial nerve dysfunction, and the period of treatment varies in need of different levels of facial nerve dysfunction. It is highly necessary to assess and grade patients before observation and treatment in clinical study, and choose corresponding treatment according to severity of damage of the disease.

  16. Serial neurophysiological and neurophysiological examinations for delayed facial nerve palsy in a patient with Fisher syndrome.

    Science.gov (United States)

    Umekawa, Motoyuki; Hatano, Keiko; Matsumoto, Hideyuki; Shimizu, Takahiro; Hashida, Hideji

    2017-05-27

    The patient was a 47-year-old man who presented with diplopia and gait instability with a gradual onset over the course of three days. Neurological examinations showed ophthalmoplegia, diminished tendon reflexes, and truncal ataxia. Tests for anti-GQ1b antibodies and several other antibodies to ganglioside complex were positive. We made a diagnosis of Fisher syndrome. After administration of intravenous immunoglobulin, the patient's symptoms gradually improved. However, bilateral facial palsy appeared during the recovery phase. Brain MRI showed intensive contrast enhancement of bilateral facial nerves. During the onset phase of facial palsy, the amplitude of the compound muscle action potential (CMAP) in the facial nerves was preserved. During the peak phase, the facial CMAP amplitude was within the lower limit of normal values, or mildly decreased. During the recovery phase, the CMAP amplitude was normalized, and the R1 and R2 responses of the blink reflex were prolonged. The delayed facial nerve palsy improved spontaneously, and the enhancement on brain MRI disappeared. Serial neurophysiological and neuroradiological examinations suggested that the main lesions existed in the proximal part of the facial nerves and the mild lesions existed in the facial nerve terminals, probably due to reversible conduction failure.

  17. Isolated oculomotor nerve palsy resulting from acute traumatic tentorial subdural hematoma

    Directory of Open Access Journals (Sweden)

    Cui V

    2016-10-01

    Full Text Available Victoria Cui,1 Timur Kouliev2 1Washington University School of Medicine, St Louis, MO, USA; 2Emergency Department, Beijing United Family Hospital, Beijing, China Abstract: Acute subdural hematoma (SDH resulting from head trauma is a potentially life-threatening condition that requires expedient diagnosis and intervention to ensure optimal patient outcomes. Rapidly expanding or large hematomas, elevated intracranial pressure, and associated complications of brain herniation are associated with high mortality rates and poor recovery of neurological function. However, smaller bleeds (clot thickness <10 mm or hematomas occurring in infrequent locations, such as the tentorium cerebelli, may be difficult to recognize and patients may present with unusual or subtle signs and symptoms, including isolated cranial nerve palsies. Knowledge of neuroanatomy supported by modern neuroimaging can greatly aid in recognition and diagnosis of such lesions. In this report, we present a case of isolated oculomotor nerve palsy resulting from compressive tentorial SDH following blunt head trauma, review the literature concerning similar cases, and make recommendations regarding the diagnosis of SDH in patients presenting with isolated cranial nerve palsies. Keywords: head injury, oculomotor, palsy, subdural hematoma, trauma, tentorium, cerebral herniation, intracranial hemorrhage

  18. Small vestibular schwannomas presenting with facial nerve palsy.

    Science.gov (United States)

    Espahbodi, Mana; Carlson, Matthew L; Fang, Te-Yung; Thompson, Reid C; Haynes, David S

    2014-06-01

    To describe the surgical management and convalescence of two patients presenting with severe facial nerve weakness associated with small intracanalicular vestibular schwannomas (VS). Retrospective review. Two adult female patients presenting with audiovestibular symptoms and subacute facial nerve paralysis (House-Brackmann Grade IV and V). In both cases, post-contrast T1-weighted magnetic resonance imaging revealed an enhancing lesion within the internal auditory canal without lateral extension beyond the fundus. Translabyrinthine exploration demonstrated vestibular nerve origin of tumor, extrinsic to the facial nerve, and frozen section pathology confirmed schwannoma. Gross total tumor resection with VIIth cranial nerve preservation and decompression of the labyrinthine segment of the facial nerve was performed. Both patients recovered full motor function between 6 and 8 months after surgery. Although rare, small VS may cause severe facial neuropathy, mimicking the presentation of facial nerve schwannomas and other less common pathologies. In the absence of labyrinthine extension on MRI, surgical exploration is the only reliable means of establishing a diagnosis. In the case of confirmed VS, early gross total resection with facial nerve preservation and labyrinthine segment decompression may afford full motor recovery-an outcome that cannot be achieved with facial nerve grafting.

  19. Clinical Features and Outcomes of Strabismus Treatment in Third Cranial Nerve Palsy during a 10-Year Period

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    Abbas Bagheri

    2014-01-01

    Conclusion: Surgical management of strabismus in patients with third nerve palsy is difficult and challenging, however the majority of patients achieve ideal results with appropriate and stepwise surgical plans.

  20. Long-Term Facial Nerve Outcomes after Microsurgical Resection of Vestibular Schwannomas in Patients with Preoperative Facial Nerve Palsy.

    Science.gov (United States)

    Mooney, Michael A; Hendricks, Benjamin; Sarris, Christina E; Spetzler, Robert F; Almefty, Kaith K; Porter, Randall W

    2018-06-01

    Objectives  This study aimed at evaluating facial nerve outcomes in vestibular schwannoma patients presenting with preoperative facial nerve palsy. Design  A retrospective review. Setting  Single-institution cohort. Participants  Overall, 368 consecutive patients underwent vestibular schwannoma resection. Patients with prior microsurgery or radiosurgery were excluded. Main Outcome Measures  Incidence, House-Brackmann grade. Results  Of 368 patients, 9 had confirmed preoperative facial nerve dysfunction not caused by prior treatment, for an estimated incidence of 2.4%. Seven of these nine patients had Koos grade 4 tumors. Mean tumor diameter was 3.0 cm (range: 2.1-4.4 cm), and seven of nine tumors were subtotally resected. All nine patients were followed up clinically for ≥ 6 months. Of the six patients with a preoperative House-Brackmann grade of II, two improved to grade I, three were stable, and one patient worsened to grade III. Of the three patients with grade III or worse, all remained stable at last follow-up. Conclusions  Preoperative facial nerve palsy is rare in patients with vestibular schwannoma; it tends to occur in patients with relatively large lesions. Detailed long-term outcomes of facial nerve function after microsurgical resection for these patients have not been reported previously. We followed nine patients and found that eight (89%) of the nine patients had either stable or improved facial nerve outcomes after treatment. Management strategies varied for these patients, including rates of subtotal versus gross-total resection and the use of stereotactic radiosurgery in patients with residual tumor. These results can be used to help counsel patients preoperatively on expected outcomes of facial nerve function after treatment.

  1. Bony exostosis of the atlas with resultant cranial nerve palsy

    International Nuclear Information System (INIS)

    Slavotinek, J.P.; Sage, M.R.; Brophy, B.P.

    1991-01-01

    A case of tenth and twelfth nerve compression secondary to a bony exostosis of the first cervical vertebra is described. This uncommon phenomenon serves to outline the importance of imaging the course of a cranial nerve when no intracranial abnormality is demonstrable on CT or MRI. The radiologic features of spinal osteochondromas are reviewed. (orig.)

  2. Conjugate Gaze Palsies

    Science.gov (United States)

    ... version Home Brain, Spinal Cord, and Nerve Disorders Cranial Nerve Disorders Conjugate Gaze Palsies Horizontal gaze palsy Vertical ... Version. DOCTORS: Click here for the Professional Version Cranial Nerve Disorders Overview of the Cranial Nerves Internuclear Ophthalmoplegia ...

  3. Radial nerve palsy in mid/distal humeral fractures: is early exploration effective?

    Science.gov (United States)

    Keighley, Geffrey; Hermans, Deborah; Lawton, Vidya; Duckworth, David

    2018-03-01

    Radial nerve palsies are a common complication with displaced distal humeral fractures. This case series examines the outcomes of early operative exploration and decompression of the nerve with fracture fixation with the view that this provides a solid construct for optimisation of nerve recovery. A total of 10 consecutive patients with a displaced distal humeral fracture and an acute radial nerve palsy were treated by the senior author by open reduction and internal fixation of the distal humerus and exploration and decompression of the radial nerve. Motor function and sensation of the radial nerve was assessed in the post-operative period every 2 months or until full recovery of the radial nerve function had occurred. All patients (100%) had recovery of motor and sensation function of their upper limb in the radial nerve distribution over a 12-month period. Recovery times ranged between 4 and 32 weeks, with the median time to recovery occurring at 26 weeks and the average time to full recovery being 22.9 weeks. Wrist extension recovered by an average of 3 months (range 2-26 weeks) and then finger extension started to recover 2-6 weeks after this. Disability of the arm, shoulder and hand scores ranged from 0 to 11.8 at greater than 1 year post-operatively. Our study demonstrated that early operative exploration of the radial nerve when performing an open stabilization of displaced distal humeral fractures resulted in a 100% recovery of the radial nerve. © 2017 Royal Australasian College of Surgeons.

  4. Distal nerve transfer versus supraclavicular nerve grafting: comparison of elbow flexion outcome in neonatal brachial plexus palsy with C5-C7 involvement.

    Science.gov (United States)

    Heise, Carlos O; Siqueira, Mario G; Martins, Roberto S; Foroni, Luciano H; Sterman-Neto, Hugo

    2017-09-01

    Ulnar and median nerve transfers to arm muscles have been used to recover elbow flexion in infants with neonatal brachial plexus palsy, but there is no direct outcome comparison with the classical supraclavicular nerve grafting approach. We retrospectively analyzed patients with C5-C7 neonatal brachial plexus palsy submitted to nerve surgery and recorded elbow flexion recovery using the active movement scale (0-7) at 12 and 24 months after surgery. We compared 13 patients submitted to supraclavicular nerve grafting with 21 patients submitted to distal ulnar or median nerve transfer to biceps motor branch. We considered elbow flexion scores of 6 or 7 as good results. The mean elbow flexion score and the proportion of good results were better using distal nerve transfers than supraclavicular grafting at 12 months (p nerve grafting at 12 months showed good elbow flexion recovery after ulnar nerve transfers. Distal nerve transfers provided faster elbow flexion recovery than supraclavicular nerve grafting, but there was no significant difference in the outcome after 24 months of surgery. Patients with failed supraclavicular grafting operated early can still benefit from late distal nerve transfers. Supraclavicular nerve grafting should remain as the first line surgical treatment for children with neonatal brachial plexus palsy.

  5. Evidence and recommendation. Intermitent neuromonitoring in thyroid surgery is usefulness for reduction of recurrent nerve palsy?

    Directory of Open Access Journals (Sweden)

    José Luis PARDAL-REFOYO

    2017-03-01

    Full Text Available Introduction and objective: Clinical Question. In a patient with thyroid disease [patient], submitted to thyroidectomy [intervention], the use of neuromonitoring against the single visual identification of recurrent laryngeal nerve (RLN [comparison], offers advantages? [result]. Material and Methods: Literature review in PubMed, Scopus and Cochrane Library data descriptors and search strategy: (((((((laryngeal OR larynx AND nerve AND monitoring AND thyroidectomy AND meta-analysis. 10 items in English or Spanish of which 7 were selected for the qualitative study were obtained. Results: Level of evidence. Evidence for the lower incidence of transient unilateral paralysis in patients with neuromonitoring is moderate-high. Evidence on the lower incidence of permanent unilateral paralysis of RLN with NM is low. Evidence on the lower incidence of bilateral paralysis of RLN with neuromonitoring is low. Conclusions: Recommendation. Concerning the reduction of transient paralysis of the RLN the recommendation of the use of neuromonitoring in thyroid surgery is strongly in favor. Regarding permanent paralysis recommendation is weak in favor (no recommendation against. Regarding prevention of bilateral laryngeal paralysis recommendation for weak. The decision to use NM cannot be based on the incidence of RLN paralysis.

  6. Intravenous mesenchymal stem cell therapy after recurrent laryngeal nerve injury: a preliminary study.

    Science.gov (United States)

    Lerner, Michael Z; Matsushita, Takashi; Lankford, Karen L; Radtke, Christine; Kocsis, Jeffery D; Young, Nwanmegha O

    2014-11-01

    Intravenous administration of mesenchymal stem cells (MSCs) has been recently shown to enhance functional recovery after stroke and spinal cord injury. The therapeutic properties of MSCs are attributed to their secretion of a variety of potent antiinflammatory and neurotrophic factors. We hypothesize that intravenous administration of MSCs after recurrent laryngeal nerve (RLN) injury in the rat may enhance functional recovery. Animal Research. Twelve 250-gram Sprague-Dawley rats underwent a controlled crush injury to the left RLN. After confirming postoperative vocal fold immobility, each rat was intravenously infused with either green fluorescent protein-expressing MSCs or control media in a randomized and blinded fashion. Videolaryngoscopy was performed weekly. The laryngoscopy video recordings were reviewed and rated by a fellowship-trained laryngologist who remained blinded to the intervention using a 0 to 3 scale. At 1 week postinjury, the MSC-infused group showed a trend for higher average functional recovery scores compared to the control group (2.2 vs 1.3), but it did not reach statistical significance (P value of 0.06). By 2 weeks, however, both groups exhibited complete return of function. These pilot data indicate that with complete nerve transection by crush injury of the RLN in rat, there is complete recovery of vocal fold mobility at 2 weeks. At 1 week postinjury, animals receiving intravenous infusion of MSCs showed a trend for greater functional recovery, suggesting a potential beneficial effect of MSCs; however, this did not reach statistical significance. Therefore, no definite conclusions can be drawn from these data and further study is required. N/A. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  7. Lateral medullary infarction with ipsilateral hemiparesis, lemniscal sensation loss and hypoglossal nerve palsy.

    Science.gov (United States)

    Li, Xiaodi; Wang, Yuzhou

    2014-04-01

    Here, we present a rare case of a lateral medullary infarction with ipsilateral hemiparesis, lemniscal sensation loss and hypoglossal nerve palsy. In this case, we proved Opalski's hypothesis by diffusion tensor tractography that ipsilateral hemiparesis in a medullary infarction is due to the involvement of the decussated corticospinal tract. We found that the clinical triad of ipsilateral hemiparesis, lemniscal sensation loss and hypoglossal nerve palsy, which had been regarded as a variant of medial medullary syndrome, turned out to be caused by lateral lower medullary infarction. Therefore, this clinical triad does not imply the involvement of the anteromedial part of medulla oblongata, when it is hard to distinguish a massive lateral medullary infarction from a hemimedullary infarction merely from MR images. At last, we suggest that hyperreflexia and Babinski's sign may not be indispensable to the diagnosis of Opalski's syndrome and we propose that "hemimedullary infarction with ipsilateral hemiparesis" is intrinsically a variant of lateral medullary infarction.

  8. Outcome of Tendon Transfers for Radial Nerve Palsy in a Malaysian Tertiary Centre

    Directory of Open Access Journals (Sweden)

    Richford J

    2018-03-01

    Full Text Available Tendon transfers for radial nerve palsy is a common operation with good results. We did a retrospective study on twenty patients with radial nerve palsy who underwent tendon transfer surgery and recovered between January 2008 and December 2012. Outcomes measured were motor power of wrist extension, finger extension, grip strength and DASH scores. There was significant improvement of motor power of wrist and finger extension between the preoperative period and three months post-operatively, between the pre operative period and six months post operatively and between three and six months postoperatively (p = 0.0005. Grip strength improved significantly as well between preoperative, three and six months postoperatively (p = 0.0005. DASH scores reflecting patient satisfaction at six months postoperatively showed only mild or moderate difficulty of function.

  9. Transient sixth cranial nerve palsy following orgasm abrogated by treatment with sympathomimetic amines.

    Science.gov (United States)

    Check, J H; Katsoff, B

    2014-01-01

    To describe a unique disorder where a transient 6th nerve palsy leading to diploplia following orgasm developed in a 28-year-old woman. This coincided with a weight gain of 100 pounds in a short time without a corresponding change in dietary habits. She was treated with the sympathomimetic amine dextroamphetamine sulfate. Indeed she immediately responded to treatment with dextroamphetamine sulfate sustained release capsules with complete resolution of the episodes of 6th nerve palsy following orgasm. The main importance of this case is that it suggests that orgasm causes a transient generalized decrease in sympathetic nervous system activity and that the achievement of an orgasm may require an increase in the sympathetic nervous system activity.

  10. [Third cranial nerve palsy and Purtscher retinopathy in a child with multiple injuries].

    Science.gov (United States)

    Larrañaga-Fragoso, P; del-Barrio, Z; Noval, S; Pastora, N; Royo, A

    2015-07-01

    A 4 year-old girl was referred to our hospital after have suffered a severe accident. The patient was diagnosed with complete third nerve palsy in her right eye and Purtscher retinopathy in her left eye. Purtscher retinopathy is a rare condition. The diagnosis is made on clinical ground and its treatment is not well defined although it is believed that systemic steroids could improve the visual outcome. Traumatic third nerve palsy has a poor spontaneous recovery. The use of botulinum toxin might be useful in children to improve the recovery rate, maintaining binocularity, and avoiding amblyopia in other cases. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier España, S.L.U. All rights reserved.

  11. Combined Ipsilateral Oculomotor Nerve Palsy and Contralateral Downbeat Nystagmus in a Case of Cerebral Infarction

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    Kosuke Matsuzono

    2014-04-01

    Full Text Available We report a patient with acute cerebral infarction of the left paramedian thalamus, upper mesencephalon and cerebellum who exhibited ipsilateral oculomotor nerve palsy and contralateral downbeat nystagmus. The site of the infarction was considered to be the paramedian thalamopeduncular and cerebellar regions, which are supplied by the superior cerebellar artery containing direct perforating branches or both the superior cerebellar artery and the superior mesencephalic and posterior thalamosubthalamic arteries. Contralateral and monocular downbeat nystagmus is very rare. Our case suggests that the present downbeat nystagmus was due to dysfunction of cerebellar-modulated crossed oculovestibular fibers of the superior cerebellar peduncle or bilateral downbeat nystagmus with one-sided oculomotor nerve palsy.

  12. Oculomotor Nerve Palsy following Cardiac Tamponade with Churg-Strauss Syndrome: A Case Report

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    Kazuki Suganuma

    2011-10-01

    Full Text Available A 57-year-old man with a history of more than 10 years of bronchial asthma and chronic sinusitis complained of double vision which developed 18 days after cardiac tamponade with eosinophil-rich fluid (eosinophils 30%. He had oculomotor nerve palsy, and a blood test revealed eosinophilia (12,700/mm3 and elevation of both C-reactive protein and rheumatoid factor. He was diagnosed as having Churg-Strauss syndrome. His symptoms were relieved by corticosteroid therapy. Our case and previous cases in the literature revealed that oculomotor nerve palsy in Churg-Strauss syndrome is associated with pupil involvement and may be relieved by corticosteroid treatment.

  13. Dural carotid cavernous sinus fistula presenting as isolated oculomotor nerve palsy: Case report

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    Şehnaz Arıcı

    2015-04-01

    Full Text Available Indirect (dural carotid cavernous fistula is formed by the connection between meningeal branches of the internal carotid artery and the cavernous sinüs, and low flow circulation with low pressure is occured. Proptosis, ophtalmoplegia, headache, scleral and conjuctival hyperemia expanding around the eyeball can be observed. A forty-eight year old female patient with a background of diabetes mellitus and hypertension was admitted with complaints of double vision. Isolated oculomotor nerve palsy was found in neurological examination and an indirect carotid cavernous fistula was revealed by digital subtraction angiography. Our case with carotid cavernous fistula as a rare cause of isolated oculomotor nerve palsy is worth to be reported.

  14. The Physiologic Impact of Unilateral Recurrent Laryngeal Nerve (RLN) Lesion on Infant Oropharyngeal and Esophageal Performance.

    Science.gov (United States)

    Gould, Francois D H; Lammers, Andrew R; Ohlemacher, Jocelyn; Ballester, Ashley; Fraley, Luke; Gross, Andrew; German, Rebecca Z

    2015-12-01

    Recurrent laryngeal nerve (RLN) injury in neonates, a complication of patent ductus arteriosus corrective surgery, leads to aspiration and swallowing complications. Severity of symptoms and prognosis for recovery are variable. We transected the RLN unilaterally in an infant mammalian animal model to characterize the degree and variability of dysphagia in a controlled experimental setting. We tested the hypotheses that (1) both airway protection and esophageal function would be compromised by lesion, (2) given our design, variability between multiple post-lesion trials would be minimal, and (3) variability among individuals would be minimal. Individuals' swallowing performance was assessed pre- and post-lesion using high speed VFSS. Aspiration was assessed using the Infant Mammalian Penetration-Aspiration Scale (IMPAS). Esophageal function was assessed using two measures devised for this study. Our results indicate that RLN lesion leads to increased frequency of aspiration, and increased esophageal dysfunction, with significant variation in these basic patterns at all levels. On average, aspiration worsened with time post-lesion. Within a single feeding sequence, the distribution of unsafe swallows varied. Individuals changed post-lesion either by increasing average IMPAS score, or by increasing variation in IMPAS score. Unilateral RLN transection resulted in dysphagia with both compromised airway protection and esophageal function. Despite consistent, experimentally controlled injury, significant variation in response to lesion remained. Aspiration following RLN lesion was due to more than unilateral vocal fold paralysis. We suggest that neurological variation underlies this pattern.

  15. Glufosinate Herbicide Intoxication Causing Unconsciousness, Convulsion, and 6th Cranial Nerve Palsy

    OpenAIRE

    Park, Jae-seok; Kwak, Soo-Jung; Gil, Hyo-wook; Kim, So-Young; Hong, Sae-yong

    2013-01-01

    Although glufosinate ammonium herbicides are considered safe when used properly, ingestion of the undiluted form can cause grave outcomes. Recently, we treated a 34-yr-old man who ingested glufosinate ammonium herbicide. In the course of treatment, the patient developed apnea, mental deterioration, and sixth cranial nerve palsy; he has since been discharged with full recovery after intensive care. This case report describes the clinical features of glufosinate intoxication with a focus on six...

  16. Diagnostic gait pattern of a patient with longstanding left femoral nerve palsy: a case report.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2010-12-01

    The gait pattern of a 35-year-old man with longstanding, left femoral nerve palsy was assessed using 3-dimensional kinematic and kinetic analysis. Stability of his left knee in stance was achieved by manipulating the external moments of the limb so that the ground reaction force passes in front of the knee joint. This compensatory mechanism of locking the knee in extension is reliant on the posterior capsular structures. The patient was managed conservatively and continued to walk without aids.

  17. A Case of Wegener’s Granulomatosis Presenting with Unilateral Facial Nerve Palsy

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    Roy Ujjawal

    2016-01-01

    Full Text Available Wegener’s granulomatosis or granulomatosis with polyangiitis is a necrotizing vasculitis affecting both arterioles and venules. The disease is characterized by the classical triad involving acute inflammation of the upper and lower respiratory tracts with renal involvement. However, the disease pathology can affect any organ system. This case presents Wegener’s granulomatosis presenting with facial nerve palsy as the first manifestation of the disease, which is rarely reported in medical literature.

  18. A rare case of quadrigeminal plate lipoma presenting with the sixth cranial nerve palsy

    Institute of Scientific and Technical Information of China (English)

    Bipin Kumar Chaurasia; Tolga Dundar; Narendra Shalike; Silak Ram Chaudhary; Shamsul Alam; Dhiman Chowdhory; Kanak Kanti Barua; Ranjit Kumar Chaurasiya; Raushan Kumar Chaurasia; Ramesh Kumar Chaurasia

    2017-01-01

    Intracranial lipomas are rare benign tumour that is slow growing, generally asymptomatic, most frequently located in the midline areas and are usually an incidental finding on imaging and therefore cases are not frequently reported. This study reports a case of a patient with quadrigeminal plate lipoma presenting with obstructive hydrocephalous and the 6th cranial nerve palsy that was successfully treated with ventriculo-peritoneal shunting without addressing the lesion.

  19. The imaging of abducens nerve in normal volunteers and palsy cases using 1.5T MRI 3-D CISS

    International Nuclear Information System (INIS)

    Takahashi, Mayu; Ezuka, Isamu; Kakinuma, Kenichi; Yamada, Haruyuki; Harada, Atsukuni; Kanazawa, Tsutomu

    2002-01-01

    The purpose of this study was to identify the cisternal segment of the abducens nerve and to investigate its anatomical features using three-dimensional Fourier transform constructive interference in steady-state (3-D CISS) sequence with a 1.5-tesla magnetic resonance (MR) imaging system. Images of abducens nerve palsy were also studied. Using this imaging system, the following procedures were performed to identify the abducens nerve. First, gray scale of the original images was inverted (inverted image). Second, Dollero's canal was identified, which contains the abducens nerve, and third, the nerve was followed to the root exit zone with a multiple-planar reconstruction method. Twenty-one volunteers and 3 patients with abducens nerve palsies participated in this study and following results were derived: all nerves in volunteers were clearly identified in the coronal and sagittal planes, the images closely resembled autopsy cases, seven nerves in asymptomatic cases were remarkably distorted by the vessels, and the cause of the palsy was not clear by their shapes in the images; this technique, however, can play a great role in evaluating abducens nerve palsy. (author)

  20. Transient Femoral Nerve Palsy Complicating “Blind” Transversus Abdominis Plane Block

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    Dimitrios K. Manatakis

    2013-01-01

    Full Text Available We present two cases of patients who reported quadriceps femoris weakness and hypoesthesia over the anterior thigh after an inguinal hernia repair under transversus abdominis plane (TAP block. Transient femoral nerve palsy is the result of local anesthetic incorrectly injected between transversus abdominis muscle and transversalis fascia and pooling around the femoral nerve. Although it is a minor and self-limiting complication, it requires overnight hospital stay and observation of the patients. Performing the block under ultrasound guidance and injecting the least volume of local anesthetic required are ways of minimizing its incidence.

  1. [Descending hypoglossal branch-facial nerve anastomosis in treating unilateral facial palsy after acoustic neuroma resection].

    Science.gov (United States)

    Liang, Jiantao; Li, Mingchu; Chen, Ge; Guo, Hongchuan; Zhang, Qiuhang; Bao, Yuhai

    2015-12-15

    To evaluate the efficiency of the descending hypoglossal branch-facial nerve anastomosis for the severe facial palsy after acoustic neuroma resection. The clinical data of 14 patients (6 males, 8 females, average age 45. 6 years old) underwent descending hypoglossal branch-facial nerve anastomosis for treatment of unilateral facial palsy was analyzed retrospectively. All patients previously had undergone resection of a large acoustic neuroma. House-Brackmann (H-B) grading system was used to evaluate the pre-, post-operative and follow up facial nerve function status. 12 cases (85.7%) had long follow up, with an average follow-up period of 24. 6 months. 6 patients had good outcome (H-B 2 - 3 grade); 5 patients had fair outcome (H-B 3 - 4 grade) and 1 patient had poor outcome (H-B 5 grade) Only 1 patient suffered hemitongue myoparalysis owing to the operation. Descending hypoglossal branch-facial nerve anastomosis is effective for facial reanimation, and it has little impact on the function of chewing, swallowing and pronunciation of the patients compared with the traditional hypoglossal-facial nerve anastomosis.

  2. Facial nerve palsy: incidence of different ethiologies in a tertiary ambulatory

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    Atolini Junior, Nédio

    2009-06-01

    Full Text Available Introduction: The ethiologic diferencial diagnostic for facial nerve paralisis is still a challenge and the literature has shown conflictive results concerning its epidemiology. Objective: To outline the incidence of the different ethiologies and the profile of peripheral facial nerve paralysis patients in the otolaryngology ambulatory of the Faculdade de Ciencias Medicas e Biologicas da PUC-SP - campus Sorocaba. Method: The records of 54 patients with facial nerve paralysis seen during the years of 2007 and 2008 were analysed retrospectively. Results: From the 54 patients analysed, 55,5% were male, median age of 40,6 years and had the right side of the face acomitted in 66,6%. Parestesia of the accomited side in 51,85% and increased tears in 66,6% of the patients were observed as associated symptoms. Bell´s palsy was the most frequent ethiology (53,7%, follwed by: traumatic (24%, Ramsay Hunt syndrome (9,2%, Cholesteatoma (5,5%, malignant otitis media (3,7% and acute otits media (3,7%. Three cases of Bell´s palsy during pregancy was also seen in this series. Conclusion: The data found are similiar of the most of the literature, showing that Bell´s palsy is still the most frequent, followed by traumatic causes and others. There is an equilibrium concerning to the gender, with a slight prevalence for males and for the right side of the face.

  3. Superior Oblique Anterior Transposition with Horizontal Recti Recession-Resection for Total Third-Nerve Palsy

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    Muhsin Eraslan

    2015-01-01

    Full Text Available Aims. To report the results of lateral rectus muscle recession, medial rectus muscle resection, and superior oblique muscle transposition in the restoration and maintenance of ocular alignment in primary position for patients with total third-nerve palsy. Methods. The medical records of patients who underwent surgery between March 2007 and September 2011 for total third-nerve palsy were reviewed. All patients underwent a preoperative assessment, including a detailed ophthalmologic examination. Results. A total of 6 patients (age range, 14–45 years were included. The median preoperative horizontal deviation was 67.5 Prism Diopter (PD (interquartile range [IQR] 57.5–70 and vertical deviation was 13.5 PD (IQR 10–20. The median postoperative horizontal residual exodeviation was 8.0 PD (IQR 1–16, and the vertical deviation was 0 PD (IQR 0–4. The median correction of hypotropia following superior oblique transposition was 13.5 ± 2.9 PD (range, 10–16. All cases were vertically aligned within 5 PD. Four of the six cases were aligned within 10 PD of the horizontal deviation. Adduction and head posture were improved in all patients. All patients gained new area of binocular single vision in the primary position after the operation. Conclusion. Lateral rectus recession, medial rectus resection, and superior oblique transposition may be used to achieve satisfactory cosmetic and functional results in total third-nerve palsy.

  4. Biofeedback Therapy Effect on Facial Nerve Palsy and Prevention of Synkinesis

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    Abbas ali Pour-Momeny

    2011-04-01

    Full Text Available Objective: Synkiesia is a sequel of facial nerve palsy. It usually begins 3-4 months after axonal regeneration and progressed up to two years afterward. Treatment of synkinesia is very difficult and sometimes impossible.The aim of our study is find a better procedure to treat facial nerve palsy and prevent synkinesia. Materials and Methods: Twenty nine patients with facial nerve palsy were selected by electrodiagnosis tests. They were divided in two groups. The experimental group was treated by biofeedback electromyography and the second group was treated by common physiotherapy. The evaluation of all patients was done by Photoshop assessment and facial grading scale before and after treatment. Result: After the treatment, a significant general improvement was observed in both groups (p<0.05, but in experimental group (biofeedback showed better result than the other one. The number of patients with synkinesia as well as the severity of their synkinesis in experimental group were lesser than the other one. Conclusion: Biofeedback therapy is more efficient than common physiotherapy.By using this approach, control and reducing synkinesia is more feasible. Assessment by Pohotoshop procedure showed better accuracy than facial grading scale.

  5. Oculomotor nerve palsy by posterior communicating artery aneurysms: influence of surgical strategy on recovery.

    Science.gov (United States)

    Güresir, Erdem; Schuss, Patrick; Seifert, Volker; Vatter, Hartmut

    2012-11-01

    Resolution of oculomotor nerve palsy (ONP) after clipping of posterior communicating artery (PCoA) aneurysms has been well documented. However, whether additional decompression of the oculomotor nerve via aneurysm sac dissection or resection is superior to pure aneurysm clipping is the subject of much debate. Therefore, the objective in the present investigation was to analyze the influence of surgical strategy--specifically, clipping with or without aneurysm dissection--on ONP resolution. Between June 1999 and December 2010, 18 consecutive patients with ruptured and unruptured PCoA aneurysms causing ONP were treated at the authors' institution. Oculomotor nerve palsy was evaluated on admission and at follow-up. The electronic database MEDLINE was searched for additional data in published studies of PCoA aneurysms causing ONP. Two reviewers independently extracted data. Overall, 8 studies from the literature review and 6 patients in the current series (121 PCoA aneurysms) met the study inclusion criteria. Ninety-four aneurysms were treated with simple aneurysm neck clipping and 27 with clipping plus aneurysm sac decompression. The surgical strategy, simple aneurysm neck clipping versus clipping plus oculomotor nerve decompression, had no effect on full ONP resolution on univariate (p = 0.5) and multivariate analyses. On multivariate analysis, patients with incomplete ONP at admission were more likely to have full resolution of the palsy than were those with complete ONP at admission (p = 0.03, OR = 4.2, 95% CI 1.1-16). Data in the present study indicated that ONP caused by PCoA aneurysms improves after clipping without and with oculomotor nerve decompression. The resolution of ONP is inversely associated with the initial severity of ONP.

  6. Immediate balloon deflation for prevention of persistent phrenic nerve palsy during pulmonary vein isolation by balloon cryoablation.

    Science.gov (United States)

    Ghosh, Justin; Sepahpour, Ali; Chan, Kim H; Singarayar, Suresh; McGuire, Mark A

    2013-05-01

    Persistent phrenic nerve palsy is the most frequent complication of cryoballoon ablation for atrial fibrillation and can be disabling. To describe a technique-immediate balloon deflation (IBD)-for the prevention of persistent phrenic nerve palsy, provide data for its use, and describe in vitro simulations performed to investigate the effect of IBD on the atrium and pulmonary vein. Cryoballoon procedures for atrial fibrillation were analyzed retrospectively (n = 130). IBD was performed in patients developing phrenic nerve dysfunction (n = 22). In vitro simulations were performed by using phantoms. No adverse events occurred, and all patients recovered normal phrenic nerve function before leaving the procedure room. No patient developed persistent phrenic nerve palsy. The mean cryoablation time to onset of phrenic nerve dysfunction was 144 ± 64 seconds. Transient phrenic nerve dysfunction was seen more frequently with the 23-mm balloon than with the 28-mm balloon (11 of 39 cases vs 11 of 81 cases; P = .036). Balloon rewarming was faster following IBD. The time to return to 0 and 20° C was shorter in the IBD group (6.7 vs 8.9 seconds; P = .007 and 16.7 vs 37.6 seconds; Pphrenic nerve palsy. Simulations suggest that IBD is unlikely to damage the atrium or pulmonary vein. Copyright © 2013 Heart Rhythm Society. All rights reserved.

  7. A Rare Neurological Involvement in Sjogrens Syndrome: Abducens Nerve Palsy

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    Yunus Ugan

    2016-05-01

    Full Text Available Sjogren%u2019s syndrome (SS is an autoimmune disorder characterized by lymphocytic infiltration of exocrine organs. Although neurological involvement occurs in approximately one quarter of patients, involvement of cranial nerves is a relatively rare occurrence. Here a rare case of cranial neuropathy related to SS is reported.

  8. Ultrasound-Guided Interscalene Catheter Complicated by Persistent Phrenic Nerve Palsy

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    Andrew T. Koogler

    2018-01-01

    Full Text Available A 76-year-old male presented for reverse total shoulder arthroplasty (TSA in the beach chair position. A preoperative interscalene nerve catheter was placed under direct ultrasound-guidance utilizing a posterior in-plane approach. On POD 2, the catheter was removed. Three weeks postoperatively, the patient reported worsening dyspnea with a subsequent chest X-ray demonstrating an elevated right hemidiaphragm. Pulmonary function testing revealed worsening deficit from presurgical values consistent with phrenic nerve palsy. The patient decided to continue conservative management and declined further invasive testing or treatment. He was followed for one year postoperatively with moderate improvement of his exertional dyspnea over that period of time. The close proximity of the phrenic nerve to the brachial plexus in combination with its frequent anatomical variation can lead to unintentional mechanical trauma, intraneural injection, or chemical injury during performance of ISB. The only previously identified risk factor for PPNP is cervical degenerative disc disease. Although PPNP has been reported following TSA in the beach chair position without the presence of a nerve block, it is typically presumed as a complication of the interscalene block. Previously published case reports and case series of PPNP complicating ISBs all describe nerve blocks performed with either paresthesia technique or localization with nerve stimulation. We report a case of a patient experiencing PPNP following an ultrasound-guided placement of an interscalene nerve catheter.

  9. Cannabinoids facilitate the swallowing reflex elicited by the superior laryngeal nerve stimulation in rats.

    Science.gov (United States)

    Mostafeezur, Rahman Md; Zakir, Hossain Md; Takatsuji, Hanako; Yamada, Yoshiaki; Yamamura, Kensuke; Kitagawa, Junichi

    2012-01-01

    Cannabinoids have been reported to be involved in affecting various biological functions through binding with cannabinoid receptors type 1 (CB1) and 2 (CB2). The present study was designed to investigate whether swallowing, an essential component of feeding behavior, is modulated after the administration of cannabinoid. The swallowing reflex evoked by the repetitive electrical stimulation of the superior laryngeal nerve in rats was recorded before and after the administration of the cannabinoid receptor agonist, WIN 55-212-2 (WIN), with or without CB1 or CB2 antagonist. The onset latency of the first swallow and the time intervals between swallows were analyzed. The onset latency and the intervals between swallows were shorter after the intravenous administration of WIN, and the strength of effect of WIN was dose-dependent. Although the intravenous administration of CB1 antagonist prior to intravenous administration of WIN blocked the effect of WIN, the administration of CB2 antagonist did not block the effect of WIN. The microinjection of the CB1 receptor antagonist directly into the nucleus tractus solitarius (NTS) prior to intravenous administration of WIN also blocked the effect of WIN. Immunofluorescence histochemistry was conducted to assess the co-localization of CB1 receptor immunoreactivity to glutamic acid decarboxylase 67 (GAD67) or glutamate in the NTS. CB1 receptor was co-localized more with GAD67 than glutamate in the NTS. These findings suggest that cannabinoids facilitate the swallowing reflex via CB1 receptors. Cannabinoids may attenuate the tonic inhibitory effect of GABA (gamma-aminobuteric acid) neurons in the central pattern generator for swallowing.

  10. Cannabinoids facilitate the swallowing reflex elicited by the superior laryngeal nerve stimulation in rats.

    Directory of Open Access Journals (Sweden)

    Rahman Md Mostafeezur

    Full Text Available Cannabinoids have been reported to be involved in affecting various biological functions through binding with cannabinoid receptors type 1 (CB1 and 2 (CB2. The present study was designed to investigate whether swallowing, an essential component of feeding behavior, is modulated after the administration of cannabinoid. The swallowing reflex evoked by the repetitive electrical stimulation of the superior laryngeal nerve in rats was recorded before and after the administration of the cannabinoid receptor agonist, WIN 55-212-2 (WIN, with or without CB1 or CB2 antagonist. The onset latency of the first swallow and the time intervals between swallows were analyzed. The onset latency and the intervals between swallows were shorter after the intravenous administration of WIN, and the strength of effect of WIN was dose-dependent. Although the intravenous administration of CB1 antagonist prior to intravenous administration of WIN blocked the effect of WIN, the administration of CB2 antagonist did not block the effect of WIN. The microinjection of the CB1 receptor antagonist directly into the nucleus tractus solitarius (NTS prior to intravenous administration of WIN also blocked the effect of WIN. Immunofluorescence histochemistry was conducted to assess the co-localization of CB1 receptor immunoreactivity to glutamic acid decarboxylase 67 (GAD67 or glutamate in the NTS. CB1 receptor was co-localized more with GAD67 than glutamate in the NTS. These findings suggest that cannabinoids facilitate the swallowing reflex via CB1 receptors. Cannabinoids may attenuate the tonic inhibitory effect of GABA (gamma-aminobuteric acid neurons in the central pattern generator for swallowing.

  11. A case of bilateral lower cranial nerve palsies after base of skull trauma with complex management issues: case report and review of the literature.

    Science.gov (United States)

    Lehn, Alexander Christoph; Lettieri, Jennie; Grimley, Rohan

    2012-05-01

    Fractures of the skull base can cause lower cranial nerve palsies because of involvement of the nerves as they traverse the skull. A variety of syndromes have been described, often involving multiple nerves. These are most commonly unilateral, and only a handful of cases of bilateral cranial nerve involvement have been reported. We describe a 64-year-old man with occipital condylar fracture complicated by bilateral palsies of IX and X nerves associated with dramatic physiological derangement causing severe management challenges. Apart from debilitating postural hypotension, he developed dysphagia, severe gastrointestinal dysmotility, issues with airway protection as well as airway obstruction, increased oropharyngeal secretions and variable respiratory control. This is the first report of a patient with traumatic bilateral cranial nerve IX and X nerve palsies. This detailed report and the summary of all 6 previous case reports of traumatic bilateral lower cranial nerve palsies illustrate clinical features, treatment strategies, and outcomes of these rare events.

  12. Impact of the surgical strategy on the incidence of C5 nerve root palsy in decompressive cervical surgery.

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    Theresa Krätzig

    Full Text Available Our aim was to identify the impact of different surgical strategies on the incidence of C5 palsy.Degenerative cervical spinal stenosis is a steadily increasing morbidity in the ageing population. Postoperative C5 nerve root palsy is a common complication with severe impact on the patients´ quality of life.We identified 1708 consecutive patients who underwent cervical decompression surgery due to degenerative changes. The incidence of C5 palsy and surgical parameters including type and level of surgery were recorded to identify predictors for C5 nerve palsy.The overall C5 palsy rate was 4.8%, with 18.3% of cases being bilateral. For ACDF alone the palsy rate was low (1.13%, compared to 14.0% of C5 palsy rate after corpectomy. The risk increased with extension of the procedures. Hybrid constructs with corpectomy plus ACDF at C3-6 showed significantly lower rates of C5 palsy (10.7% than corpectomy of two vertebrae (p = 0.005. Multiple regression analysis identified corpectomy of C4 or C5 as a significant predictor. We observed a lower overall incidence for ventral (4.3% compared to dorsal (10.9% approaches (p<0.001. When imaging detected a postoperative shift of the spinal cord at index segment C4/5, palsy rate increased significantly (33.3% vs. 12.5%, p = 0.034.Extended surgical strategies, such as dorsal laminectomies, multilevel corpectomies and procedures with extensive spinal cord shift were shown to display a high risk of C5 palsy. The use of extended procedures should therefore be employed cautiously. Switching to combined surgical methods like ACDF plus corpectomy can reduce the rate of C5 palsy.

  13. Prognostic Value of Facial Nerve Antidromic Evoked Potentials in Bell Palsy: A Preliminary Study

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    Zhang WenHao

    2012-01-01

    Full Text Available To analyze the value of facial nerve antidromic evoked potentials (FNAEPs in predicting recovery from Bell palsy. Study Design. Retrospective study using electrodiagnostic data and medical chart review. Methods. A series of 46 patients with unilateral Bell palsy treated were included. According to taste test, 26 cases were associated with taste disorder (Group 1 and 20 cases were not (Group 2. Facial function was established clinically by the Stennert system after monthly follow-up. The result was evaluated with clinical recovery rate (CRR and FNAEP. FNAEPs were recorded at the posterior wall of the external auditory meatus of both sides. Results. Mean CRR of Group 1 and Group 2 was 61.63% and 75.50%. We discovered a statistical difference between two groups and also in the amplitude difference (AD of FNAEP. Mean ± SD of AD was −6.96% ± 12.66% in patients with excellent result, −27.67% ± 27.70% with good result, and −66.05% ± 31.76% with poor result. Conclusions. FNAEP should be monitored in patients with intratemporal facial palsy at the early stage. FNAEP at posterior wall of external auditory meatus was sensitive to detect signs of taste disorder. There was close relativity between FNAEPs and facial nerve recovery.

  14. Prognostic Value of Facial Nerve Antidromic Evoked Potentials in Bell Palsy: A Preliminary Study

    Science.gov (United States)

    WenHao, Zhang; Minjie, Chen; Chi, Yang; Weijie, Zhang

    2012-01-01

    To analyze the value of facial nerve antidromic evoked potentials (FNAEPs) in predicting recovery from Bell palsy. Study Design. Retrospective study using electrodiagnostic data and medical chart review. Methods. A series of 46 patients with unilateral Bell palsy treated were included. According to taste test, 26 cases were associated with taste disorder (Group 1) and 20 cases were not (Group 2). Facial function was established clinically by the Stennert system after monthly follow-up. The result was evaluated with clinical recovery rate (CRR) and FNAEP. FNAEPs were recorded at the posterior wall of the external auditory meatus of both sides. Results. Mean CRR of Group 1 and Group 2 was 61.63% and 75.50%. We discovered a statistical difference between two groups and also in the amplitude difference (AD) of FNAEP. Mean ± SD of AD was −6.96% ± 12.66% in patients with excellent result, −27.67% ± 27.70% with good result, and −66.05% ± 31.76% with poor result. Conclusions. FNAEP should be monitored in patients with intratemporal facial palsy at the early stage. FNAEP at posterior wall of external auditory meatus was sensitive to detect signs of taste disorder. There was close relativity between FNAEPs and facial nerve recovery. PMID:22164176

  15. [A case of leptomeningeal melanomatosis with acute paraplegia and multiple cranial nerve palsies].

    Science.gov (United States)

    Hattori, Kasumi; Matsuda, Nozomu; Murakami, Takenobu; Ito, Eiichi; Ugawa, Yoshikazu

    2017-12-27

    A 62-year-old man with acute paraplegia was transferred to our hospital. He had flaccid paraplegia and multiple cranial nerve palsies, such as mydriasis of the left pupil, abduction palsy of the left eye, hoarseness and dysphagia, but no meningeal irritation signs. MRI of the spinal canal showed swellings of the conus medullaris and the cauda equine, and also contrast enhancement of the spinal meninges. The cerebrospinal fluid (CSF) showed pleocytosis and protein increment. The lymph node was swollen in his right axilla. The biopsy specimen from the right axillary lymph node revealed metastasis of malignant melanoma histologically. Careful check-up of his whole body found a malignant melanoma in the subungual region of the right ring finger. Repeated cytological examination revealed melanoma cells in the CSF, confirming the diagnosis of leptomeningeal melanomatosis. His consciousness was gradually deteriorated. His family members chose supportive care instead of chemotherapy or surgical therapy after full information about his conditions. Finally, he died 60 days after transfer to our hospital. This is a rare case of leptomenigeal melanomatosis presenting with acute paraplegia and multiple cranial nerve palsies. Careful follow-up and repeated studies are vital for the early diagnosis of leptomenigeal melanomatosis in spite of atypical clinical presentation.

  16. Idiopathic Ninth, Tenth, and Twelfth Cranial Nerve Palsy with Ipsilateral Headache: A Case Report

    Directory of Open Access Journals (Sweden)

    Sun Seung-Ho

    2012-12-01

    Full Text Available Objective: This case report is to report the effect of Korean traditional treatment for idiopathic ninth, tenth, and twelfth cranial nerve palsy with ipsilateral headache. Methods: The medical history and imaging and laboratory test of a 39-year-old man with cranial palsy were tested to identify the cause of disease. A 0.2-mL dosage of Hwangyeonhaedoktang pharmacopuncture was administered at CV23 and CV17, respectively. Acupuncture was applied at P06, Li05, TE05, and G37 on the right side of the body. Zhuapiandutongbang (左偏頭痛方 was administered at 30 minutes to 1 hour after mealtime three times a day. The symptoms were investigated using Visual Analogue Scale (VAS. Results: The results of magnetic resonance imaging (MRI, computed tomography (CT, and laboratory tests were normal. The medical history showed no trauma, other illnesses, family history of diseases, medications, smoking, drinking and so on. All symptoms disappeared at the 10th day of treatment. Conclusion: Korean traditional treatment such as acupuncture, pharmcopuncture, and herbal medicine for the treatment of ninth, tenth, and twelfth cranial nerve palsy of unknown origin is suggested to be effective even though this conclusion is based on a single.

  17. [Bilateral facial nerve palsy associated with Epstein-Barr virus infection in a 3-year-old boy].

    Science.gov (United States)

    Grassin, M; Rolland, A; Leboucq, N; Roubertie, A; Rivier, F; Meyer, P

    2017-06-01

    Bilateral facial nerve palsy is a rare and sometimes difficult diagnosis. We describe a case of bilateral simultaneous facial nerve palsy associated with Epstein-Barr virus (EBV) infection in a 3-year-old boy. Several symptoms led to the diagnosis of EBV infection: the clinical situation (fever, stomachache, and throat infection), white blood cell count (5300/mm 3 with 70% lymphocyte count), seroconversion with EBV-specific antibodies, lymphocytic meningitis, and a positive blood EBV polymerase chain reaction (9.3×10 3 copies of EBV-DNA). An MRI brain scan showed bilateral gadolinium enhancement of the facial nerve. A treatment plan with IV antibiotics (ceftriaxone) and corticosteroids was implemented. Antibiotics were stopped after the diagnosis of Lyme disease was ruled out. The patient's facial weakness improved within a few weeks. Bilateral facial nerve palsy is rare and, unlike unilateral facial palsy, it is idiopathic in only 20% of cases. Therefore, it requires further investigation and examination to search for the underlying etiology. Lyme disease is the first infectious disease that should be considered in children, especially in endemic areas. An antibiotic treatment effective against Borrelia burgdorferi should be set up until the diagnosis is negated or confirmed. Further examination should include a blood test (such as immunologic testing, and serologic testing for viruses and bacterium with neurological tropism), a cerebrospinal fluid test, and an MRI brain scan to exclude any serious or curable underlying etiology. Facial bilateral nerve palsy associated with EBV is rarely described in children. Neurological complications have been reported in 7% of all EBV infections. The facial nerve is the most frequently affected of all cranial nerves. Facial palsy described in EBV infections is bilateral in 35% of all cases. The physiopathology is currently unknown. Prognosis is good most of the time. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  18. Transient superficial peroneal nerve palsy after anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Majed Alrowaili

    2016-06-01

    Full Text Available A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the patient woke up from general anesthesia, he started experience loss of sensation in the area of superficial peroneal nerve with inverted dorsiflexion of foot and ankle. Instantly, the bandage and knee brace was removed and a diagnosis of compartment syndrome was ruled out. After eight hours, post-operatively, the patient started receiving physiotherapy. He complained of numbness and tingling in the same area. After 24 h, post-operatively, the patient started to regain dorsiflexion and eversion gradually. Two days after the surgery, the patient exhibited complete recovery of neurological status.

  19. A comparison between succinylcholine and rocuronium on the recovery profile of the laryngeal muscles during intraoperative neuromonitoring of the recurrent laryngeal nerve: A prospective porcine model

    Directory of Open Access Journals (Sweden)

    I-Cheng Lu

    2013-09-01

    Full Text Available The use of succinylcholine and rocuronium are reportedly feasible during intraoperative neuromonitoring (IONM of the recurrent laryngeal nerve (RLN in thyroid surgery. This study aimed to investigate and compare the recovery profiles of succinylcholine and rocuronium on the laryngeal muscle during IONM of the RLN in a porcine model. Nine male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without neuromuscular blocking agents (NMBAs. Needle electrodes were inserted into the vocalis muscles through the cricothyroid ligament. The RLN was exposed and stimulated. Electromyographic (EMG signals were obtained before and after the intravenous administration of a NMBA. The EMG amplitudes were measured before and after (at 1-minute intervals the administration of the study drug until complete recovery. The study NMBA regimen included succinylcholine (1 mg/kg, low-dose rocuronium (0.3 mg/kg, and standard dose rocuronium (0.6 mg/kg. The maximal neuromuscular blockade and 80% recovery (i.e., duration of the control responses were recorded and analyzed. The 80% recovery of the control response for succinylcholine (1 mg/kg was 19.7 ± 1.5 minutes; low-dose rocuronium (0.3 mg/kg, 16.3 ± 2.5 minutes; and standard dose rocuronium (0.6 mg/kg, 29.3 ± 5.7 minutes. Succinylcholine (1 mg/kg and low-dose rocuronium (0.3 mg/kg had significantly shorter durations than standard dose rocuronium (0.6 mg/kg. The EMG signal recovery returned to baseline within 30 minutes in the succinylcholine and low-dose rocuronium groups, but it did not return to baseline until 1 hour after surgery in the rocuronium (0.6 mg/kg group. In this study, succinylcholine (1 mg/kg and low-dose rocuronium (0.3 mg/kg had favorable recovery profiles on the laryngeal muscle. It is recommended that low-dose rocuronium may replace succinylcholine for the induction of general anesthesia during IONM of the RLN in thyroid surgery.

  20. A comparison between succinylcholine and rocuronium on the recovery profile of the laryngeal muscles during intraoperative neuromonitoring of the recurrent laryngeal nerve: a prospective porcine model.

    Science.gov (United States)

    Lu, I-Cheng; Chang, Pi-Ying; Hsu, Hung-Te; Tseng, Kuang-Yi; Wu, Che-Wei; Lee, Ka-Wo; Ho, Kuen-Yao; Chiang, Feng-Yu

    2013-09-01

    The use of succinylcholine and rocuronium are reportedly feasible during intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) in thyroid surgery. This study aimed to investigate and compare the recovery profiles of succinylcholine and rocuronium on the laryngeal muscle during IONM of the RLN in a porcine model. Nine male Duroc-Landrace piglets were anesthetized with thiamylal and underwent tracheal intubation without neuromuscular blocking agents (NMBAs). Needle electrodes were inserted into the vocalis muscles through the cricothyroid ligament. The RLN was exposed and stimulated. Electromyographic (EMG) signals were obtained before and after the intravenous administration of a NMBA. The EMG amplitudes were measured before and after (at 1-minute intervals) the administration of the study drug until complete recovery. The study NMBA regimen included succinylcholine (1 mg/kg), low-dose rocuronium (0.3 mg/kg), and standard dose rocuronium (0.6 mg/kg). The maximal neuromuscular blockade and 80% recovery (i.e., duration) of the control responses were recorded and analyzed. The 80% recovery of the control response for succinylcholine (1 mg/kg) was 19.7 ± 1.5 minutes; low-dose rocuronium (0.3 mg/kg), 16.3 ± 2.5 minutes; and standard dose rocuronium (0.6 mg/kg), 29.3 ± 5.7 minutes. Succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had significantly shorter durations than standard dose rocuronium (0.6 mg/kg). The EMG signal recovery returned to baseline within 30 minutes in the succinylcholine and low-dose rocuronium groups, but it did not return to baseline until 1 hour after surgery in the rocuronium (0.6 mg/kg) group. In this study, succinylcholine (1 mg/kg) and low-dose rocuronium (0.3 mg/kg) had favorable recovery profiles on the laryngeal muscle. It is recommended that low-dose rocuronium may replace succinylcholine for the induction of general anesthesia during IONM of the RLN in thyroid surgery. Copyright © 2013. Published by

  1. Anatomical study of the facial nerve canal in comparison to the site of the lesion in Bell's palsy.

    Science.gov (United States)

    Dawidowsky, Krsto; Branica, Srećko; Batelja, Lovorka; Dawidowsky, Barbara; Kovać-Bilić, Lana; Simunić-Veselić, Anamarija

    2011-03-01

    The term Bell's palsy is used for the peripheral paresis of the facial nerve and is of unknown origin. Many studies have been performed to find the cause of the disease, but none has given certain evidence of the etiology. However, the majority of investigators agree that the pathophysiology of the palsy starts with the edema of the facial nerve and consequent entrapment of the nerve in the narrow facial canal in the temporal bone. In this study the authors wanted to find why the majority of the paresis are suprastapedial, i.e. why the entrapment of the nerve mainly occurs in the proximal part of the canal. For this reason they carried out anatomical measurements of the facial canal diameter in 12 temporal bones. By use of a computer program which measures the cross-sectional area from the diameter, they proved that the width of the canal is smaller at its proximal part. Since the nerve is thicker at that point because it contains more nerve fibers, the authors conclude that the discrepancy between the nerve diameter and the surrounding bony walls in the suprastapedial part of the of the canal would, in cases of a swollen nerve after inflammation, cause the facial palsy.

  2. The management of humeral shaft fractures with associated radial nerve palsy: a review of 117 cases.

    Science.gov (United States)

    Bumbasirević, Marko; Lesić, Aleksandar; Bumbasirević, Vesna; Cobeljić, Goran; Milosević, Ivan; Atkinson, Henry Dushan E

    2010-04-01

    This single center retrospective study reviews the management and outcomes of 117 consecutive patients with humeral shaft fractures and associated radial nerve palsy (RNP) treated over a 20-year period (1986-2006). A total of 101 fractures were managed conservatively and 16 fractures underwent external fixation for poor bony alignment. Sixteen grade 1 and 2 open fractures underwent wound toileting alone. No patients underwent initial radial nerve exploration or opening of the fracture sites. All patients achieved clinical and radiological bony union at a mean of 8 weeks (range 7-12 weeks). There were no complications or pin tract infections in the operated patients. A total of 111 cases had initial spontaneous RNP recovery at a mean of 6 weeks (range 3-24 weeks) with full RNP recovery at a mean of 17 weeks (range 3-70 weeks) post-injury. Fourteen patients had no clinical/EMG signs of nerve activity at 12 weeks and 6 subsequently failed to regain any radial nerve recovery; 2 had late explorations and the lacerated nerves underwent sural nerve cable neurorraphy; and 4 patients underwent delayed tendon transposition 2-3 years after initial injury, with good/excellent functional outcomes. Humeral fractures with associated RNP may be treated expectantly. With low rates of humeral nonunion, 95% spontaneous nerve recovery in closed fractures and 94% in grade 1 and 2 open fractures, one has the opportunity of waiting. If at 10-12 weeks there are no clinical/EMG signs of recovery, then nerve exploration/secondary reconstruction is indicated. Late tendon transfers may also give good/excellent functional results.

  3. [Foster Modification of Full Tendon Transposition of Vertical Rectus Muscles for Sixth Nerve Palsy].

    Science.gov (United States)

    Heede, Santa

    2018-04-11

    Since 1907 a variety of muscle transposition procedures for the treatment of abducens nerve palsy has been established internationally. Full tendon transposition of the vertical rectus muscle was initially described by O'Connor 1935 and then augmented by Foster 1997 with addition of posterior fixation sutures on the vertical rectus muscle. Full tendon transposition augmented by Foster belongs to the group of the most powerful surgical techniques to improve the abduction. Purpose of this study was to evaluate the results of full tendon vertical rectus transposition augmented with lateral fixation suture for patients with abducens nerve palsy. Full tendon transpositions of vertical rectus muscles augmented with posterior fixation suture was performed in 2014 on five patients with abducens nerve palsy. Two of the patients received Botox injections in the medial rectus muscle: one of them three months after the surgery and another during the surgery. One of the patients had a combined surgery of the horizontal muscles one year before. On three of the patients, who received a pure transposition surgery, the preoperative deviation at the distance (mean: + 56.6 pd; range: + 40 to + 80 pd) was reduced by a mean of 39.6 pd (range 34 to 50 pd), the abduction was improved by a mean of 3 mm (range 2 to 4 mm). The other two patients, who received besides the transposition procedure additional surgeries of the horizontal muscles, the preoperative deviation at the distance (+ 25 and + 126 pd respectively) was reduced by 20 and 81 pd respectively. The abduction was improved by 4 and 8 mm respectively. After surgery two patients developed a vertical deviation with a maximum of 4 pd. None of the patients had complications or signs of anterior segment ischemia. The elevation and/or depression was only marginally affected. There was no diplopia in up- or downgaze. Full tendon transposition of vertical rectus muscles, augmented with lateral posterior fixation suture is

  4. Hypermetabolism of compensatory laryngeal muscles in unilateral vocal cord palsy: comparison study between speech and silence with normal subjects by co-registered PET-CT fusion images

    International Nuclear Information System (INIS)

    Pai, Moon Sun; Kim, Hyon Kyong; Kim, Han Su; Chung, Sung Min

    2005-01-01

    There are a few case reports on asymmetric vocal cord uptake on FDG-PET in patients with unilateral vocal cord paralysis, which could be a potential pitfall in the interpretation of FDG-PET images. We evaluated the metabolic activity of laryngeal muscles of patients with unilateral vocal cord paralysis in comparison to normal controls during both speech and silence. Eleven patients with iatrogenic unilateral vocal cord palsy(thyroidectomy 7, lung cancer = 1, others = 3) and 12 normal controls underwent FDG-PET with usual protocol. They were divided into two groups respectively; one group read books aloud for 20 minutes (phonation group) and the other kept silence (non-phonation groups) after FDG injection. Recent neck CT scan were co-registered with FDG-PET to produce PET-CT fusion images to elaborate small laryngeal muscles. In patients with unilateral vocal cord palsy, contralateral non-paralyzed vocal cord showed increased FDG uptake, more intense with phonation group (SUV =5.88, n =5) than non-phonation group (SUV =2.33, n =6) --mainly on thyroarytenoid muscle. Normal control subjects showed symmetric mildly increased FDG uptake (SUV=1.92, n=6) only in phonation group, which was significantly low against patient groups and was localized in lateral cricoarytenoid muscle. Hypermetabolism of contralateral thyroarytenoid muscle in patients with unilateral vocal cord paralysis could be encountered during FDG-PET imaging even with keeping silence. Phonation during FDG-PET study enhance FDG uptake on different laryngeal muscles between unilateral vocal cord paralysis and normal subjects

  5. Hypermetabolism of compensatory laryngeal muscles in unilateral vocal cord palsy: comparison study between speech and silence with normal subjects by co-registered PET-CT fusion images

    International Nuclear Information System (INIS)

    Pai, Moon Sun; Kim, Hyon Kyong; Kim, Han Su

    2006-01-01

    There are a few case report on asymmetric vocal cord uptake on FDG-PET in patients with unilateral vocal cord paralysis, which could be a potential pitfall in the interpretation of FDG-PET images. We evaluated the metabolic activity of laryngeal muscles of patients with unilateral vocal cord paralysis in comparison to normal controls during both speech and silence. Eleven patients with unilateral vocal cord palsy (thyroidectomy=7, lung cancer=1, other=3) and 12 normal controls underwent FDG-PET with usual protocol. They were divided into two groups respectively; one group read books aloud for 20 minutes (phonation group) and the other kept silence (non-phonation groups) after FDG injection. Recent neck CT scan were co-registered with FDG-PET to produce PET-CT fusion images to elaborate small laryngeal muscles. In patients with unilateral vocal cord palsy, contralateral non-paralyzed vocal cord showed hypermetabolism mainly on thyroarytenoid muscle, more intensely with phonation group (SUV=5.88±2.65) than with non-phonation group (SUV=2.30±0.39). Normal control subjects showed hypermetabolism (3.68± 0.96) in interarytenoid muscle and symmetric mild hypermetabolism in both lateral cricoarytenoid muscles in only phonation group. FDG-PET with fusion images using CT scan in patients with unilateral vocal cord paralysis showed hypermetabolism of contralateral non-paralyzed thyroarytedoid muscle, suggesting compensatory action during phonation. Phonation during FDG-PET study enhanced FDG uptake on different laryngeal muscles between patients with unilateral vocal cord paralysis and normal subjects

  6. Low Median Nerve Palsy as Initial Manifestation of Churg-Strauss Syndrome.

    Science.gov (United States)

    Roh, Young Hak; Koh, Young Do; Noh, Jung Ho; Gong, Hyun Sik; Baek, Goo Hyun

    2017-06-01

    Anterior interosseous nerve (AIN) syndrome is typically characterized by forearm pain and partial or complete dysfunction of the AIN-innervated muscles. Although the exact etiology and pathophysiology of the disorder remain unclear, AIN syndrome is increasingly thought to be an inflammatory condition of the nerve rather than a compressive neuropathy because the symptoms often resolve spontaneously following prolonged observation. However, peripheral neuropathy can be 1 of the first symptoms of systemic vasculitis that needs early systemic immunotherapy to prevent extensive nerve damage. Churg-Strauss syndrome (CSS; eosinophilic granulomatosis with polyangiitis) is 1 type of primary systemic vasculitis that frequently damages the peripheral nervous system. CSS-associated neuropathy usually involves nerves of the lower limb, and few studies have reported on the involvement of the upper limb alone. We report on a rare case of low median nerve palsy as the initial manifestation of CSS. The patient recovered well with early steroid treatment for primary systemic vasculitis. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. Outcome following phrenic nerve transfer to musculocutaneous nerve in patients with traumatic brachial palsy: a qualitative systematic review.

    Science.gov (United States)

    de Mendonça Cardoso, Marcio; Gepp, Ricardo; Correa, José Fernando Guedes

    2016-09-01

    The phrenic nerve can be transferred to the musculocutaneous nerve in patients with traumatic brachial plexus palsy in order to recover biceps strength, but the results are controversial. There is also a concern about pulmonary function after phrenic nerve transection. In this paper, we performed a qualitative systematic review, evaluating outcomes after this procedure. A systematic review of published studies was undertaken in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Data were extracted from the selected papers and related to: publication, study design, outcome (biceps strength in accordance with BMRC and pulmonary function) and population. Study quality was assessed using the "strengthening the reporting of observational studies in epidemiology" (STROBE) standard or the CONSORT checklist, depending on the study design. Seven studies were selected for this systematic review after applying inclusion and exclusion criteria. One hundred twenty-four patients completed follow-up, and most of them were graded M3 or M4 (70.1 %) for biceps strength at the final evaluation. Pulmonary function was analyzed in five studies. It was not possible to perform a statistical comparison between studies because the authors used different parameters for evaluation. Most of the patients exhibited a decrease in pulmonary function tests immediately after surgery, with recovery in the following months. Study quality was determined using STROBE in six articles, and the global score varied from 8 to 21. Phrenic nerve transfer to the musculocutaneous nerve can recover biceps strength ≥M3 (BMRC) in most patients with traumatic brachial plexus injury. Early postoperative findings revealed that the development of pulmonary symptoms is rare, but it cannot be concluded that the procedure is safe because there is no study evaluating pulmonary function in old age.

  8. Recovery of Third Nerve Palsy after Endovascular Packing of Internal Carotid-Posterior Communicating Artery Aneurysms

    Science.gov (United States)

    Mavilio, N.; Pisani, R.; Rivano, C.; Testa, V.; Spaziante, R.; Rosa, M.

    2000-01-01

    Summary Endovascular packing of intracranial aneurysm with preservation of the parent vessel has become in many cases a valid alternative to surgical clipping. Regression of oculomotor disorders after clipping of internal carotid-posterior communicating artery (ICA-PCoA) aneurysms has been well assessed. This report focuses on the reversal of third nerve palsy after endovascular packing of ICA-PCoA aneurysms. To this end, clinical appearances, neuroradiological features, and endovascular interventional procedures of six treated patient are reported and discussed in the light of the very few previous case observations found in the literature. Results indicate that endovascular packing of ICA-PCoA aneurysms may produce effective recovery of correlated third nerve dysfunction. PMID:20667199

  9. Ophthalmologic outcome after third cranial nerve palsy or paresis in childhood.

    Science.gov (United States)

    Mudgil, A V; Repka, M X

    1999-02-01

    The purpose of this study was to evaluate the causes and ophthalmologic outcome of oculomotor nerve palsy or paresis in children younger than 8 years of age. Patients evaluated between 1985 and 1997 were retrospectively reviewed. Data analyzed included vision, residual strabismus after surgery, aberrant reinnervation, binocular function, and anisometropia. Long-term outcome was assessed in patients followed-up longer than 6 months. Forty-one patients were identified. The most frequent causes were congenital (39%), traumatic (37%), and neoplastic (17%). Visual acuities were reduced in 71% of patients at the time of the initial visit. Long-term outcome could be assessed in 20 of the 41 patients (49%), with a mean follow-up of 3.6 years (range, 0.5 to 13 years). Visual acuities were reduced because of amblyopia in 35% and nonamblyopic factors in 25% of patients in the long-term outcome group at last follow-up. The best response to amblyopia therapy was in the congenital group, in which all patients improved to normal visual acuity. Strabismus surgery was performed on 8 of 20 children (40%) followed-up, none of whom demonstrated measurable stereopsis after operation despite improved alignment. Aberrant reinnervation was present in 9 of 20 patients (45%). Only 3 patients fully recovered from their oculomotor nerve injuries, and these were the only patients to regain measurable stereopsis. The causes in those 3 patients were congenital, traumatic, and neoplastic. Oculomotor nerve palsy/paresis is associated with poor visual and sensorimotor outcome in children younger than 8 years of age. The best ophthalmologic outcome was in the resolved cases (3 of 20; 15%). Amblyopia therapy was most effective with congenital causes, but treatment results were poor with other causes. Young children with posttraumatic and postneoplastic oculomotor nerve injuries demonstrated the worst ophthalmologic outcomes.

  10. Phrenic Nerve Palsy Secondary to Parsonage-Turner Syndrome: A Diagnosis Commonly Overlooked.

    Science.gov (United States)

    McEnery, Tom; Walsh, Ronan; Burke, Conor; McGowan, Aisling; Faul, John; Cormican, Liam

    2017-04-01

    Neuralgic Amyotrophy (NA) or Parsonage-Turner syndrome is an idiopathic neuropathy commonly affecting the brachial plexus. Associated phrenic nerve involvement, though recognised, is thought to be very rare. We present a case series of four patients (all male, mean age 53) presenting with dyspnoea preceded by severe self-limiting upper limb and shoulder pain, with an elevated hemi-diaphragm on clinical examination and chest X-ray. Neurological examination of the upper limb at the time of presentation was normal. Diaphragmatic fluoroscopy confirmed unilateral diaphragmatic paralysis. Pulmonary function testing demonstrated characteristic reduction in forced vital capacity between supine and sitting position (mean 50%, range 42-65% predicted, mean change 23%, range 22-46%), reduced maximal inspiratory pressures (mean 61%, range 43-86% predicted), reduced sniff nasal inspiratory pressure (mean 88.25, range 66-109 cm H 2 O) and preserved maximal expiratory pressure (mean 107%, range 83-130% predicted). Phrenic nerve conduction studies confirmed phrenic nerve palsy. All patients were managed conservatively. Follow-up ranged from 6 months to 3 years. Symptoms and lung function variables normalised in three patients and improved significantly in the fourth. The classic history of severe ipsilateral shoulder and upper limb neuromuscular pain should be elicited and thus NA considered in the differential for a unilateral diaphragmatic paralysis, even in the absence of neurological signs. Parsonage-Turner syndrome is likely to represent a significantly under-diagnosed aetiology of phrenic nerve palsy. Conservative management as opposed to surgical intervention is advocated as most patients demonstrate gradual resolution over time in this case series.

  11. Effects of Electroacupuncture on Facial Nerve Function and HSV-1 DNA Quantity in HSV-1 Induced Facial Nerve Palsy Mice

    Directory of Open Access Journals (Sweden)

    Hongzhi Tang

    2014-01-01

    Full Text Available Acupuncture is a common and effective therapeutic method to treat facial nerve palsy (FNP. However, its underlying mechanism remains unclear. This study was aimed to investigate the effects of electroacupuncture on symptoms and content of HSV-1 DNA in FNP mice. Mice were randomized into four groups, an electroacupuncture treatment group, saline group, model animal group, and blank control group. Electroacupuncture was applied at Jiache (ST6 and Hegu (LI4 in electroacupuncture group once daily for 14 days, while electroacupuncture was not applied in model animal group. In electroacupuncture group, mice recovered more rapidly and HSV-1 DNA content also decreased more rapidly, compared with model animal group. We conclude that electroacupuncture is effective to alleviate symptoms and promote the reduction of HSV-1 in FNP.

  12. MRI enhancement of the facial nerve with Gd-DTPA, 2; Investigation of enhanced nerve portions in patients with facial palsy

    Energy Technology Data Exchange (ETDEWEB)

    Yanagida, Masahiro (Kansai Medical School, Moriguchi, Osaka (Japan))

    1993-08-01

    We performed enhanced MRI using Gd-DTPA in 84 patients with facial palsy. After assessing enhancement of the normal facial nerve, we examined enhancement in patients with Bell's palsy and Ramsay Hunt syndrome. In 95% of patients with Bell's palsy, enhancement was obtained in the distal IAC and labyrinthine portions. In 72%, enhancement was significant from the distal IAC portion through the vertical portion. In some of the patients who underwent enhanced MRI twice, increased signal intensity was observed in distal portions such as the vertical portion. In many cases of Ramsay Hunt syndrome, enhancement was seen extensively in the IAC portion through the vertical portion. In the subjects with internal auditory symptoms such as vertigo and tinnitus, enhancement of the IAC portion was seen not only in the facial nerve but also in the vestibular and the cochlear nerves. These results suggest that the vascular permeability of lesions in Bell's palsy may be increased from the distal IAC portion to the vertical portion. Judging from the present findings with Ramsay Hunt syndrome, symptoms related to the enhanced portions suggest that accompanying internal auditory symptoms occur due to inflammation of the IAC portions of cochlear and vestibular nerves. (author).

  13. MRI enhancement of the facial nerve with Gd-DTPA, 2; Investigation of enhanced nerve portions in patients with facial palsy

    Energy Technology Data Exchange (ETDEWEB)

    Yanagida, Masahiro [Kansai Medical School, Moriguchi, Osaka (Japan)

    1993-08-01

    We performed enhanced MRI using Gd-DTPA in 84 patients with facial palsy. After assessing enhancement of the normal facial nerve, we examined enhancement in patients with Bell's palsy and Ramsay Hunt syndrome. In 95% of patients with Bell's palsy, enhancement was obtained in the distal IAC and labyrinthine portions. In 72%, enhancement was significant from the distal IAC portion through the vertical portion. In some of the patients who underwent enhanced MRI twice, increased signal intensity was observed in distal portions such as the vertical portion. In many cases of Ramsay Hunt syndrome, enhancement was seen extensively in the IAC portion through the vertical portion. In the subjects with internal auditory symptoms such as vertigo and tinnitus, enhancement of the IAC portion was seen not only in the facial nerve but also in the vestibular and the cochlear nerves. These results suggest that the vascular permeability of lesions in Bell's palsy may be increased from the distal IAC portion to the vertical portion. Judging from the present findings with Ramsay Hunt syndrome, symptoms related to the enhanced portions suggest that accompanying internal auditory symptoms occur due to inflammation of the IAC portions of cochlear and vestibular nerves. (author).

  14. [Lymphadenectomy performed along the left recurrent laryngeal nerve after anterior detachment of the esophagus via thoracoscopic esophagectomy in the prone position under artificial pneumothorax].

    Science.gov (United States)

    Yamamoto, Shinichi; Ohshima, Hisami; Katsumori, Takashi; Hamaguchi, Hiromitsu; Tsukamoto, Yukika; Iwanaga, Tomohiro

    2014-11-01

    Thoracoscopic esophagectomy was performed in the prone position under artificial pneumothorax and did not affect the surgical area during lung ventilation; tracheal mobility was also improved. Lymphadenectomy around the left recurrent laryngeal nerve was performed by separating the left main bronchus and trachea between the esophagus and pericardium before detaching the dorsal side of the esophagus.

  15. Management of synkinesis and asymmetry in facial nerve palsy: a review article.

    Science.gov (United States)

    Pourmomeny, Abbas Ali; Asadi, Sahar

    2014-10-01

    The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy. Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013. Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG) biofeedback to be effective through neuromuscular re-education. Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy.

  16. ABDUCENS NERVE PALSY AND THROMBOSIS OF THE CEREBRAL VEINS AND SINUSES - A DIAGNOSTIC PITFALL

    Directory of Open Access Journals (Sweden)

    Alexandra J. Tzoukeva

    2012-12-01

    Full Text Available Thrombosis of the cerebral veins and sinuses is an infrequent cerebrovascular disorder. Because the highly variable symptoms, recent neuroimaging plays a key role in the diagnosis. Abducens nerve palsy as a focal neurological deficit is a rare clinical manifestation in these patients. We present two cases with sudden onset of diplopia and headache. Case 1: A 3-year old girl with B cell lymphoblastic leukemia developed bilateral abducens deficit and bilateral optic disc edema after treatment including L-asparaginase. Thrombosis of the right jugular vein, sagittal and right sigmoid sinuses was visualized on magnetic resonance imaging (MRI and magnetic resonance venography (MRV. Symptoms gradually resolved after treatment with enoxiparine and MRV demonstrated recanalization.Case 2: A 75-year old female with medical history of arterial hypertension presented with headache and sudden left abduction deficit. Computerized tomography (CT scan was normal. MRI and MRV revealed aging brain and disruption of venous flow at the left internal jugular vein, suspecting thrombosis. Extracranial colour duplex sonography and CT angiography proved haemodinamic equivalent of left internal jugular vein thrombosis due to sclerotic pathology of aortic arch.Our first case illustrates the role of improved neuroimaging techniques as the best method for diagnosis of cerebral veins and sinuses thrombosis, presenting with abducens nerve palsy. With second case the potential neuroimaging pitfalls concerning the accurate diagnosis of these cerebrovascular disorders with neuro-ophthalmologic manifestation are discussed.

  17. Management of Synkinesis and Asymmetry in Facial Nerve Palsy: A Review Article

    Directory of Open Access Journals (Sweden)

    Abbasali pourmomeny

    2014-10-01

    Full Text Available Introduction: The important sequelae of facial nerve palsy are synkinesis, asymmetry, hypertension and contracture; all of which have psychosocial effects on patients. Synkinesis due to mal regeneration causes involuntary movements during a voluntary movement. Previous studies have advocated treatment using physiotherapy modalities alone or with exercise therapy, but no consensus exists on the optimal approach. Thus, this review summarizes clinical controlled studies in the management of synkinesis and asymmetry in facial nerve palsy.   Materials and Methods: Case-controlled clinical studies of patients at the acute stage of injury were selected for this review article. Data were obtained from English-language databases from 1980 until mid-2013.   Results: Among 124 articles initially captured, six randomized controlled trials involving 269 patients were identified with appropriate inclusion criteria. The results of all these studies emphasized the benefit of exercise therapy. Four studies considered electromyogram (EMG biofeedback to be effective through neuromuscular re-education.   Conclusion:  Synkinesis and inconsistency of facial muscles could be treated with educational exercise therapy. EMG biofeedback is a suitable tool for this exercise therapy.

  18. Long-Lasting Cranial Nerve III Palsy as a Presenting Feature of Chronic Inflammatory Demyelinating Polyneuropathy

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    Rossella Spataro

    2015-01-01

    Full Text Available We describe a patient with chronic inflammatory demyelinating polyneuropathy (CIDP in which an adduction deficit and ptosis in the left eye presented several years before the polyneuropathy. A 52-year-old man presented with a 14-year history of unremitting diplopia, adduction deficit, and ptosis in the left eye. At the age of 45 a mild bilateral foot drop and impaired sensation in the four limbs appeared, with these symptoms showing a progressive course. The diagnostic workup included EMG/ENG which demonstrated reduced conduction velocity with bilateral and symmetrical sensory and motor involvement. Cerebrospinal fluid studies revealed a cytoalbuminologic dissociation. A prolonged treatment with corticosteroids allowed a significant improvement of the limb weakness. Diplopia and ptosis remained unchanged. This unusual form of CIDP presented as a long-lasting isolated cranial nerve palsy. A diagnostic workup for CIDP should therefore be performed in those patients in which an isolated and unremitting cranial nerve palsy cannot be explained by common causes.

  19. Mastoid bone fracture presenting as unusual delayed onset of facial nerve palsy.

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    Hsu, Ko-Chiang; Wang, Ann-Ching; Chen, Shyi-Jou

    2008-03-01

    Delayed-onset facial nerve paralysis is a rather uncommon complication of a mastoid bone fracture for children younger than 10 years. We routinely arrange a cranial computed tomography (CT) for patients encountering initial loss of consciousness, severe headache, intractable vomiting, and/or any neurologic deficit arising from trauma to the head. However, minor symptomatic cranial nerve damage may be missed and the presenting symptom diagnosed as being a peripheral nerve problem. Herein, we report a case of a young boy who presented at our emergency department (ED) 3 days subsequent to his accident, complaining of hearing loss in the right ear and paralysis of the ipsilateral face. Unpredictably, we observed his cranial CT scan revealing a linear fracture of the skull over the right temporal bone involving the right mastoid air cells. The patient was treated conservatively and recovered well without any adverse neurologic consequences. We emphasize that ED physicians should arrange a cranial CT scan for a head-injured child with symptomatic facial nerve palsy, even if there are no symptoms such as severe headache, vomiting, Battle sign, and/or initial loss of consciousness.

  20. Nasopharyngeal carcinoma with cranial nerve palsy: The importance of MRI for radiotherapy

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    Chang, Joseph T.-C.; Lin, C.-Y.; Chen, T.-M.; Kang, C.-J.; Ng, S.-H.; Chen, I.-H.; Wang, H.-M.; Cheng, A.-J.; Liao, C.-T.

    2005-01-01

    Purpose: To evaluate various prognostic factors and the impact of imaging modalities on tumor control in patients with nasopharyngeal cancer (NPC) with cranial nerve (China) palsy. Material and Methods: Between September 1979 and December 2000, 330 NPC patients with CN palsy received radical radiotherapy (RT) by the conventional opposing technique at Chang Gung Memorial Hospital-Linkou. Imaging methods used varied over that period, and included conventional tomography (Tm) for 47 patients, computerized tomography (CT) for 195 patients, and magnetic resonance image (MRI) for 88 patients. Upper CN (II-VI) palsy was found in 268 patients, lower CN (IX-XII) in 13, and 49 patients had both. The most commonly involved CN were V or VI or both (23%, 12%, and 16%, respectively). All patients had good performance status (World Health Organization <2). The median external RT dose was 70.2 Gy (range, 63-77.5 Gy). Brachytherapy was also given to 156 patients in addition to external RT, delivered by the remote after-loading, high-dose-rate technique. A total of 139 patients received cisplatin-based chemotherapy, in 115 received as neoadjuvant or adjuvant chemotherapy and in 24 concomitant with RT. Recovery from CN palsy occurred in 171 patients during or after radiotherapy. Patients who died without a specific cause identified were regarded as having died with persistent disease. Results: The 3-year, 5-year, and 10-year overall survival was 47.1%, 34.4%, and 22.2%. The 3-year, 5-year, and 10-year disease-specific survival (DSS) rates were 50.4%, 37.8%, and 25.9%. The 5-year DSS for patients staged with MRI, CT, and Tm were 46.9%, 36.7%, and 21.9%, respectively (p = 0.016). The difference between MRI and CT was significant (p = 0.015). The 3-year and 5-year local control rates were 62% and 53%, respectively. The 5-year local control was 68.2% if excluding patients who died without a specific cause. Patients who had an MRI had a significantly better tumor control rate than those

  1. Bilateral abducens nerve and right facial nerve palsy occuring after head trauma

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    ismail Boyraz

    2016-06-01

    Full Text Available Lesions of the nervus abducens, the 6th cranial nerve tend to be rare, usually occur suddenly following head injuries. A 43-year-old male patient presented with a history of fall from a height due to an occupational accident on the date of 11.01.2014. Cranial tomography demonstrated bilateral epidural hematoma. The epidural hematoma was drained during the operation. After the surgery, eye examination showed no vision loss, except limited bilateral lateral gaze. When the patient was unable to walk due to diplopia, he was advised to close one eye. On the right side, there were findings suggesting central facial paralysis. There may be multiple cranial nerve damage following head injury. Therefore, all cranial nerves should be thoroughly examined. [J Contemp Med 2016; 6(2.000: 110-113

  2. Incidence and predictors of radial nerve palsy with the anterolateral brachialis splitting approach to the humeral shaft

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    Mohamad Gouse

    2016-08-01

    Conclusion: Contrary to our expectations, secondary procedures and prior multiple surgeries with failed implants and poor soft tissue were not predictive factors of postoperative deficit. From our study, we also conclude that radial nerve recovery can be reasonably expected in all patients with a postoperative palsy following the anterolateral approach.

  3. Increased Risk of Stroke in Patients with Isolated Third, Fourth, or Sixth Cranial Nerve Palsies: A Nationwide Cohort Study.

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    Hoi, Chu-Peng; Chen, Yung-Tai; Fuh, Jong-Ling; Yang, Chun-Pai; Wang, Shuu-Jiun

    2016-01-01

    The aim of this nationwide cohort study was to evaluate whether the occurrence of isolated 3rd, 4th or 6th cranial nerve (CN) palsies is associated with a higher risk of ischemic stroke. This study utilized data from Taiwan Longitudinal Health Insurance Database during 1995-2012. Subjects aged 20 years or older who had isolated CN 3/4/6 palsies diagnosed by a neurologist or ophthalmologist between January 2000 and December 2011 were included. A set of propensity score matched, randomly sampled patients who had never been diagnosed with CN 3/4/6 palsies were extracted to constitute the control group (cases and controls = 1:4). All subjects were followed until death, loss due to follow-up or completion of the study. Cox proportional hazard regression model stratified by matched pairs was used to estimate the hazards ratio (HR) of ischemic stroke. A total of 657 patients with isolated CN 3/4/6 palsies (61.1% male, mean age 54.8 years) were identified. Compared with control group, the patients with isolated CN 3/4/6 palsies exhibited an increased risk of ischemic stroke (CN3: adjusted HR 3.69 (95% CI 2.20-6.19); CN4: 2.71 (95% CI 1.11-6.64); CN6: 2.15 (95% CI 1.31-3.52)). The association between CN 3/4/6 palsies and ischemic stroke was detected in both separate subgroup and sensitivity analyses. The patients with CN 3/4/6 palsies exhibited an increased risk of developing ischemic stroke. Therefore, isolated ocular motor nerves palsies appear to represent an unrecognized risk factor for ischemic stroke, and these require further confirmation and exploration. © 2016 S. Karger AG, Basel.

  4. Effects of laryngeal manual therapy (LMT) and transcutaneous electrical nerve stimulation (TENS) in vocal folds diadochokinesis of dysphonic women: a randomized clinical trial.

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    Siqueira, Larissa Thaís Donalonso; Silverio, Kelly Cristina Alves; Brasolotto, Alcione Ghedini; Guirro, Rinaldo Roberto de Jesus; Carneiro, Christiano Giácomo; Behlau, Mara

    2017-05-15

    To verify and compare the effect of transcutaneous electrical nerve stimulation (TENS) and laryngeal manual therapy (LMT) on laryngeal diadochokinesis (DDK) of dysphonic women. Twenty women with bilateral vocal nodules participated and were equally divided into: LMT Group - LMT application; TENS Group - TENS application; both groups received 12 sessions of treatment, twice a week, with a duration of 20 minutes each, applied by the same therapist. The women were evaluated as to laryngeal DDK at three moments: diagnostic, pre-treatment, and post-treatment, which produced three groups of measurements. The DDK recording was performed with intersected repetition of vowels /a/ and / i/. The analysis of vowels was performed by the program Motor Speech Profile Advanced (MSP)-KayPentax. The DDK parameters of the three evaluations were compared by means of the paired t-test (p≤0.05). The measurements of laryngeal DDK parameters were similar in the phase without treatment, indicating no individual variability over time. There was no change with respect to the speed of DDK after intervention, but after LMT, DDK of the vowel /i/ was more stable in terms of the duration of the emissions and intensity of emissions repeated. These results show improved coordination of vocal folds movement during phonation. There were no changes in the DDK parameters following TENS. LMT provides greater regularity of movement during laryngeal diadochokinesis in dysphonic women, which extends knowledge on the effect of rebalancing the larynx muscles during phonation, although TENS does not impact laryngeal diadochokinesis.

  5. Different nerve ultrasound patterns in charcot-marie-tooth types and hereditary neuropathy with liability to pressure palsies.

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    Padua, Luca; Coraci, Daniele; Lucchetta, Marta; Paolasso, Ilaria; Pazzaglia, Costanza; Granata, Giuseppe; Cacciavillani, Mario; Luigetti, Marco; Manganelli, Fiore; Pisciotta, Chiara; Piscosquito, Giuseppe; Pareyson, Davide; Briani, Chiara

    2018-01-01

    Nerve ultrasound in Charcot-Marie-Tooth (CMT) disease has focused mostly on the upper limbs. We performed an evaluation of a large cohort of CMT patients in which we sonographically characterized nerve abnormalities in different disease types, ages, and nerves. Seventy patients affected by different CMT types and hereditary neuropathy with liability to pressure palsies (HNPP) were evaluated, assessing median, ulnar, fibular, tibial, and sural nerves bilaterally. Data were correlated with age. Nerve dimensions were correlated with CMT type, age, and nerve site. Nerves were larger in demyelinating than in axonal neuropathies. Nerve involvement was symmetric. CMT1 patients had larger nerves than did patients with other CMT types. Patients with HNPP showed enlargement at entrapment sites. Our study confirms the general symmetry of ultrasound nerve patterns in CMT. When compared with ultrasound studies of nerves of the upper limbs, evaluation of the lower limbs did not provide additional information. Muscle Nerve 57: E18-E23, 2018. © 2017 Wiley Periodicals, Inc.

  6. Partial Recurrent Laryngeal Nerve Paralysis or Paresis? In Search for the Accurate Diagnosis

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    Alexander Delides

    2015-01-01

    Full Text Available “Partial paralysis” of the larynx is a term often used to describe a hypomobile vocal fold as is the term “paresis.” We present a case of a dysphonic patient with a mobility disorder of the vocal fold, for whom idiopathic “partial paralysis” was the diagnosis made after laryngeal electromyography, and discuss a proposition for a different implementation of the term.

  7. Facial nerve decompression surgery using bFGF-impregnated biodegradable gelatin hydrogel in patients with Bell palsy.

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    Hato, Naohito; Nota, Jumpei; Komobuchi, Hayato; Teraoka, Masato; Yamada, Hiroyuki; Gyo, Kiyofumi; Yanagihara, Naoaki; Tabata, Yasuhiko

    2012-04-01

    Basic fibroblast growth factor (bFGF) promotes the regeneration of denervated nerves. The aim of this study was to evaluate the regeneration-facilitating effects of novel facial nerve decompression surgery using bFGF in a gelatin hydrogel in patients with severe Bell palsy. Prospective clinical study. Tertiary referral center. Twenty patients with Bell palsy after more than 2 weeks following the onset of severe paralysis were treated with the new procedure. The facial nerve was decompressed between tympanic and mastoid segments via the mastoid. A bFGF-impregnated biodegradable gelatin hydrogel was placed around the exposed nerve. Regeneration of the facial nerve was evaluated by the House-Brackmann (H-B) grading system. The outcomes were compared with the authors' previous study, which reported outcomes of the patients who underwent conventional decompression surgery (n = 58) or conservative treatment (n = 43). The complete recovery (H-B grade 1) rate of the novel surgery (75.0%) was significantly better than the rate of conventional surgery (44.8%) and conservative treatment (23.3%). Every patient in the novel decompression surgery group improved to H-B grade 2 or better even when undergone between 31 and 99 days after onset. Advantages of this decompression surgery are low risk of complications and long effective period after onset of the paralysis. To the authors' knowledge, this is the first clinical report of the efficacy of bFGF using a new drug delivery system in patients with severe Bell palsy.

  8. Isolated abducens nerve palsy associated with subarachnoid hemorrhage: a localizing sign of ruptured posterior inferior cerebellar artery aneurysms.

    Science.gov (United States)

    Burkhardt, Jan-Karl; Winkler, Ethan A; Lasker, George F; Yue, John K; Lawton, Michael T

    2018-06-01

    OBJECTIVE Compressive cranial nerve syndromes can be useful bedside clues to the diagnosis of an enlarging intracranial aneurysm and can also guide subsequent evaluation, as with an acute oculomotor nerve (cranial nerve [CN] III) palsy that is presumed to be a posterior communicating artery aneurysm and a surgical emergency until proven otherwise. The CN VI has a short cisternal segment from the pontomedullary sulcus to Dorello's canal, remote from most PICA aneurysms but in the hemodynamic pathway of a rupturing PICA aneurysm that projects toward Dorello's canal. The authors describe a cranial nerve syndrome for posterior inferior cerebellar artery (PICA) aneurysms that associates subarachnoid hemorrhage (SAH) and an isolated abducens nerve (CN VI) palsy. METHODS Clinical and radiological data from 106 surgical patients with PICA aneurysms (66 ruptured and 40 unruptured) were retrospectively reviewed. Data from a group of 174 patients with other aneurysmal SAH (aSAH) were analyzed in a similar manner to control for nonspecific effects of SAH. Univariate statistical analysis compared incidence and risk factors associated with CN VI palsy in subarachnoid hemorrhage. RESULTS Overall, 13 (4.6%) of 280 patients had CN VI palsy at presentation, and all of them had ruptured aneurysms (representing 13 [5.4%] of the 240 cases of ruptured aneurysms). CN VI palsies were observed in 12 patients with ruptured PICA aneurysms (12/66 [18.1%]) and 1 patient with other aSAH (1/174 [0.1%], p < 0.0001). PICA aneurysm location in ruptured aneurysms was an independent predictor for CN VI palsy on multivariate analysis (p = 0.001). PICA aneurysm size was not significantly different in patients with or without CN VI palsy (average size 4.4 mm and 5.2 mm, respectively). Within the PICA aneurysm cohort, modified Fisher grade (p = 0.011) and presence of a thick cisternal SAH (modified Fisher Grades 3 and 4) (p = 0.003) were predictors of CN VI palsy. In all patients with ruptured PICA

  9. Femoral nerve palsy caused by ileopectineal bursitis after total hip replacement: a case report

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    Bähr Mathias

    2011-05-01

    Full Text Available Abstract Introduction Infectious ileopectineal bursitis is a rare complication after total hip replacement and is associated mainly with rheumatoid arthritis. The main complications are local swelling and pain, but communication of the inflamed bursa with the joint can occur, leading to subsequent cartilage damage and bone destruction. Case presentation We report a case of a 47-year-old Caucasian woman without rheumatoid arthritis who reported pain and palsy in her left leg almost one year after total hip replacement. She was diagnosed with an ileopectineal bursitis after total hip replacement, leading to femoral nerve palsy. The diagnosis was obtained by thorough clinical examination, the results of focused computed tomography and magnetic resonance imaging. Conclusion To the best of our knowledge, this is the first report of non-infectious ileopectineal bursitis in a patient without rheumatoid arthritis as a complication of total hip replacement. This rare case underlines the importance of proper neurologic examination of persistent conditions after orthopedic intervention in otherwise healthy individuals. We believe this case should be useful for a broad spectrum of medical specialties, including orthopedics, neurology, radiology, and general practice.

  10. Sudden headache, third nerve palsy and visual deficit: thinking outside the subarachnoid haemorrhage box.

    Science.gov (United States)

    Ní Chróinín, Danielle; Lambert, John

    2013-11-01

    A 75-year-old lady presented with sudden severe headache and vomiting. Examination was normal, and CT and lumbar puncture not convincing for subarachnoid haemorrhage. Shortly thereafter, she developed painless diplopia. Examination confirmed right third cranial nerve palsy plus homonymous left inferior quadrantanopia. Urgent cerebral MRI with angiography was requested to assess for a possible posterior communicating artery aneurysm, but revealed an unsuspected pituitary mass. Pituitary adenoma with pituitary apoplexy was diagnosed. Pituitary apopolexy is a syndrome comprising sudden headache, meningism, visual and/or oculomotor deficits, with an intrasellar mass. It is commonly due to haemorrhage or infarction within a pituitary adenoma. Treatment includes prompt steroid administration, and potentially surgical decompression. While subarachnoid haemorrhage is an important, well-recognised cause of sudden severe headache, other aetiologies, including pituitary apoplexy, should be considered and sought.

  11. Granulomatosis with polyangiitis presenting as facial nerve palsy in a teenager.

    Science.gov (United States)

    Wang, James C; Leader, Brittany A; Crane, Ryan A; Koch, Bernadette L; Smith, Matthew M; Ishman, Stacey L

    2018-04-01

    Granulomatosis with polyangiitis (GPA, previously known as Wegener's granulomatosis) is an autoimmune systemic small-vessel vasculitis, associated with the presence of anti-neurophil cytoplasmic antibodies with a cytoplasmic staining pattern (c-ANCA). It is characterized by necrotizing granulomas, usually affecting the airways and kidneys. GPA should be considered when patients do not improve despite adequate treatment of otologic symptoms, when patients have unspecific symptoms suggesting systemic disease (e.g. fever, malaise), or when other organs are involved (kidney, lungs, etc.). We present an interesting case of a 14-year-old female with eight-weeks of bilateral otalgia, unilateral facial nerve palsy, decreased appetite, and fatigue refractory to steroid, anti-viral, and antibiotic treatment ultimately diagnosed with GPA. Copyright © 2018. Published by Elsevier B.V.

  12. Idiopathic Non-traumatic Facial Nerve Palsy (Bell’s Palsy) in Neonates; An Atypical Age and Management Dilemma

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    Khair, Abdulhafeez M.; Ibrahim, Khalid

    2018-01-01

    Idiopathic (Bell’s) palsy is the commonest cause of unilateral facial paralysis in children. Although being idiopathic by definition, possible infectious, inflammatory, and ischemic triggers have been suggested. Bell’s palsy is thought to be responsible for up to three-fourths of cases of acute unilateral facial paralysis worldwide. The diagnosis has to be reached after other causes of acute peripheral palsy have been excluded. However, it is rarely described in neonates and young infants. Steroids may have some role in treatment, but antiviral therapies have doubtful evidence of benefit. Prognosis is good, though residual dysfunction is occasionally encountered. We report the case of a two-week-old neonate with no prior illnesses who presented with acute left facial palsy. Clinical findings and normal brain imaging were consistent with the diagnosis of Bell’s palsy. The patient had a good response to oral steroids. PMID:29468002

  13. Idiopathic Non-traumatic Facial Nerve Palsy (Bell’s Palsy in Neonates; An Atypical Age and Management Dilemma

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    Abdulhafeez M. Khair

    2018-01-01

    Full Text Available Idiopathic (Bell’s palsy is the commonest cause of unilateral facial paralysis in children. Although being idiopathic by definition, possible infectious, inflammatory, and ischemic triggers have been suggested. Bell’s palsy is thought to be responsible for up to three-fourths of cases of acute unilateral facial paralysis worldwide. The diagnosis has to be reached after other causes of acute peripheral palsy have been excluded. However, it is rarely described in neonates and young infants. Steroids may have some role in treatment, but antiviral therapies have doubtful evidence of benefit. Prognosis is good, though residual dysfunction is occasionally encountered. We report the case of a two-week-old neonate with no prior illnesses who presented with acute left facial palsy. Clinical findings and normal brain imaging were consistent with the diagnosis of Bell’s palsy. The patient had a good response to oral steroids.

  14. Resolution of Oculomotor Nerve Palsy Secondary to Posterior Communicating Artery Aneurysms: Comparison of Clipping and Coiling.

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    McCracken, D Jay; Lovasik, Brendan P; McCracken, Courtney E; Caplan, Justin M; Turan, Nefize; Nogueira, Raul G; Cawley, C Michael; Dion, Jacques E; Tamargo, Rafael J; Barrow, Daniel L; Pradilla, Gustavo

    2015-12-01

    Previous studies have attempted to determine the best treatment for oculomotor nerve palsy (ONP) secondary to posterior communicating artery (PCoA) aneurysms, but have been limited by small sample sizes and limited treatment. To analyze the treatment of ONP secondary to PCoA with both coiling and clipping in ruptured and unruptured aneurysms. Data from 2 large academic centers was retrospectively collected over 22 years, yielding a total of 93 patients with ONP secondary to PCoA aneurysms. These patients were combined with 321 patients from the literature review for large data analyses. Onset symptoms, recovery, and time to resolution were evaluated with respect to treatment and aneurysm rupture status. For all patients presenting with ONP (n = 414) 56.6% of those treated with microsurgical clipping made a full recovery vs 41.5% of those treated with endovascular coil embolization (P = .02). Of patients with a complete ONP (n = 229), full recovery occurred in 47.3% of those treated with clipping but in only 20% of those undergoing coiling (P = .01). For patients presenting with ruptured aneurysms (n = 130), full recovery occurred in 70.9% compared with 49.3% coiled patients (P = .01). Additionally, although patients with full ONP recovery had a median time to treatment of 4 days, those without full ONP recovery had a median time to treatment of 7 days (P = .01). Patients with ONP secondary to PCoA aneurysms treated with clipping showed higher rates of full ONP resolution than patients treated with coil embolization. Larger prospective studies are needed to determine the true potential of recovery associated with each treatment. EUH, Emory University HospitalIQR, interquartile rangeJHU, Johns Hopkins UniversitymRS, modified Rankin ScaleONP, oculomotor nerve palsyPCoA, posterior communicating arterySAH, subarachnoid hemorrhage.

  15. Imaging before cryoablation of atrial fibrillation: is phrenic nerve palsy predictable?

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    Canpolat, Uğur; Aytemir, Kudret; Hızal, Mustafa; Hazırolan, Tuncay; Yorgun, Hikmet; Sahiner, Levent; Kaya, Ergun Barış; Oto, Ali

    2014-04-01

    Multidetector computerized tomography (MDCT) with improved temporal and spatial resolution is one of the most commonly used non-invasive tests for evaluation of pulmonary veins (PVs) and adjacent structures before cryoablation of atrial fibrillation (AF). Identification of spatial neighbouring of phrenic nerves is important to decrease likelihood of phrenic nerve palsy (PNP). The purpose of our study is to clarify the course of right phrenic nerve, its relations to PVs using 64-slice MDCT, and effect on occurrence of PNP. A total of 162 patients underwent MDCT with 3D reconstruction of left atrium prior to cryoablation for AF. The location of the right pericardiophrenic artery (RPA) was identified on axial images and artery distance to the right upper PV (RUPV) ostium was measured in 3D image. Right pericardiophrenic artery was detectable in 145 of 162 (89.5%) patients (52.4% male, age 54.5 ± 10.1 years, and 80.7% paroxysmal AF). Acute procedural success rate was 96.2%. Mean procedural and fluoroscopy times were 74.4 ± 6.2 and 15.7 ± 4.3 min. Transient right PNP was developed in four (2.75%) patients. RUPV ostium to RPA distance was lower in patients with PNP (P = 0.033). In multivariate regression analysis, only RUPV ostium to RPA distance (odds ratio: 2.95; 95% confidence interval: 1.76-4.66, P = 0.001) was the independent predictor of PNP occurrence during cryoablation. Our results revealed that pre-ablation cardiac imaging with 64-slice MDCT adequately detected RPA bordering the phrenic nerve, which was an important determinant of PNP development during cryoballoon-based AF ablation.

  16. Concurrent Rotator Cuff Tear and Axillary Nerve Palsy Associated with Anterior Dislocation of the Shoulder and Large Glenoid Rim Fracture: A “Terrible Tetrad”

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    Fumiaki Takase

    2014-01-01

    Full Text Available We present a case of concurrent rotator cuff tear and axillary nerve palsy resulting from anterior dislocation of the shoulder and a large glenoid rim fracture—a “terrible tetrad.” A 61-year-old woman fell on her right shoulder. Radiographs showed anterior dislocation of the shoulder with a glenoid rim fracture, and an MRI two months after injury revealed a rotator cuff tear. Upon referral to our hospital, physical and electrophysiological examinations revealed axillary nerve palsy. The axillary nerve palsy was incomplete and recovering, and displacement of the glenoid rim fracture was minimal and already united; therefore, we surgically repaired only the rotator cuff tear three months after injury. The patient recovered satisfactorily following the operation. In patients whose axillary nerve palsy is recovering, surgeons should consider operating on rotator cuff tears in an attempt to prevent rotator cuff degeneration.

  17. A pediatric case with peripheral facial nerve palsy caused by a granulomatous lesion associated with cat scratch disease.

    Science.gov (United States)

    Nakamura, Chizuko; Inaba, Yuji; Tsukahara, Keiko; Mochizuki, Mie; Sawanobori, Emi; Nakazawa, Yozo; Aoyama, Kouki

    2018-02-01

    Cat scratch disease is a common infectious disorder caused by Bartonella henselae that is transmitted primarily by kittens. It typically exhibits a benign and self-limiting course of subacute regional lymphadenopathy and fever lasting two to eight weeks. The most severe complication of cat scratch disease is involvement of the nervous system, such as encephalitis, meningitis, and polyneuritis. Peripheral facial nerve palsy associated with Bartonella infection is rare; few reported pediatric and adult cases exist and the precise pathogenesis is unknown. A previously healthy 7-year-old boy presented with fever, cervical lymphadenopathy, and peripheral facial nerve palsy associated with serologically confirmed cat scratch disease. The stapedius muscle reflex was absent on the left side and brain magnetic resonance imaging revealed a mass lesion at the left internal auditory meatus. The patient's symptoms and imaging findings were gradually resolved after the antibiotics and corticosteroids treatment. The suspected granulomatous lesion was considered to have resulted from the host's immune reaction to Bartonella infection and impaired the facial nerve. This is the first case report providing direct evidence of peripheral facial nerve palsy caused by a suspected granulomatous lesion associated with cat scratch disease and its treatment course. Copyright © 2017. Published by Elsevier B.V.

  18. Èlectroneuromyographiс parameters as prognostic criteria in facial nerve palsy outcome

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    N. G. Savitskaya

    2012-01-01

    Full Text Available In the article we present the results of the retrospective clinico-electrophysiological analysis of 182 patients suffering from the idiopathic neuropathy of the facial nerve (Bell`s palsy. The comparison of the most common electromyographical (ENMG predictors of outcomes was made. It was demonstrated that the most sensitive method in the acutest period (less then 5 days is the level of excitability of the nerve, in the acute period (less then 14 days – estimation of M-answer amplitude loss, and from the 21st day – the presence of denervation in muscles. The most specific electromyographical approach to estimate the therapy efficiency is an analysis of the M-answer amplitude and latency. In conclusion, neurologists have the possibility to predict the outcome and to control the therapy efficiency in any period of the disease. The correlation dynamics ÈNMG sensitivity settings – NLN on different dates can be used to determine the volume of ÈNMG – the NLN study depending on the timing for the treatment of patients.

  19. Electromyographic monitoring for prevention of phrenic nerve palsy in second-generation cryoballoon procedures.

    Science.gov (United States)

    Franceschi, Frédéric; Koutbi, Linda; Gitenay, Edouard; Hourdain, Jérome; Maille, Baptiste; Trévisan, Lory; Deharo, Jean-Claude

    2015-04-01

    Electromyography-guided phrenic nerve (PN) monitoring using a catheter positioned in a hepatic vein can aid in preventing phrenic nerve palsy (PNP) during cryoballoon ablation for atrial fibrillation. We wanted to evaluate the feasibility and efficacy of PN monitoring during procedures using second-generation cryoballoons. This study included 140 patients (43 women) in whom pulmonary vein isolation was performed using a second-generation cryoballoon. Electromyography-guided PN monitoring was performed by pacing the right PN at 60 per minute and recording diaphragmatic compound motor action potential (CMAP) via a quadripolar catheter positioned in a hepatic vein. If a 30% decrease in CMAP amplitude was observed, cryoapplication was discontinued with forced deflation to avoid a PNP. Monitoring was unfeasible in 8 of 140 patients (5.7%), PNP occurred in 1. Stable CMAP amplitudes were achieved before ablation in 132 of 140 patients (94.3%). In 18 of 132 patients (13.6%), a 30% decrease in CMAP amplitude occurred and cryoablation was discontinued. Each time, recovery of CMAP amplitude took <60 s. In 9 of 18 cases, a second cryoapplication in the same pulmonary vein was safely performed. We observed no PNP or complication related to electromyography-guided PN monitoring. Electromyography-guided PN monitoring using a catheter positioned in a hepatic vein seems feasible and effective to prevent PNP during cryoballoon ablation using second-generation cryoballoon. © 2015 American Heart Association, Inc.

  20. Role of the Internal Superior Laryngeal Nerve in the Motor Responses of Vocal Cords and the Related Voice Acoustic Changes

    Science.gov (United States)

    Seifpanahi, Sadegh; Izadi, Farzad; Jamshidi, Ali-Ashraf; Torabinezhad, Farhad; Sarrafzadeh, Javad; Mohammadi, Siavash

    2016-01-01

    Background: Repeated efforts by researchers to impose voice changes by laryngeal surface electrical stimulation (SES) have come to no avail. This present pre-experimental study employed a novel method for SES application so as to evoke the motor potential of the internal superior laryngeal nerve (ISLN) and create voice changes. Methods: Thirty-two normal individuals (22 females and 10 males) participated in this study. The subjects were selected from the students of Iran University of Medical Sciences in 2014. Two monopolar active electrodes were placed on the thyrohyoid space at the location of the ISLN entrance to the larynx and 1 dispersive electrode was positioned on the back of the neck. A current with special programmed parameters was applied to stimulate the ISLN via the active electrodes and simultaneously the resultant acoustic changes were evaluated. All the means of the acoustic parameters during SES and rest periods were compared using the paired t-test. Results: The findings indicated significant changes (P=0.00) in most of the acoustic parameters during SES presentation compared to them at rest. The mean of fundamental frequency standard deviation (SD F0) at rest was 1.54 (SD=0.55) versus 4.15 (SD=3.00) for the SES period. The other investigated parameters comprised fundamental frequency (F0), minimum F0, jitter, shimmer, harmonic-to-noise ratio (HNR), mean intensity, and minimum intensity. Conclusion: These findings demonstrated significant changes in most of the important acoustic features, suggesting that the stimulation of the ISLN via SES could induce motor changes in the vocal folds. The clinical applicability of the method utilized in the current study in patients with vocal fold paralysis requires further research. PMID:27582586

  1. Role of the Internal Superior Laryngeal Nerve in the Motor Responses of Vocal Cords and the Related Voice Acoustic Changes

    Directory of Open Access Journals (Sweden)

    Sadegh Seifpanahi

    2016-09-01

    Full Text Available Background: Repeated efforts by researchers to impose voice changes by laryngeal surface electrical stimulation (SES have come to no avail. This present pre-experimental study employed a novel method for SES application so as to evoke the motor potential of the internal superior laryngeal nerve (ISLN and create voice changes. Methods: Thirty-two normal individuals (22 females and 10 males participated in this study. The subjects were selected from the students of Iran University of Medical Sciences in 2014. Two monopolar active electrodes were placed on the thyrohyoid space at the location of the ISLN entrance to the larynx and 1 dispersive electrode was positioned on the back of the neck. A current with special programmed parameters was applied to stimulate the ISLN via the active electrodes and simultaneously the resultant acoustic changes were evaluated. All the means of the acoustic parameters during SES and rest periods were compared using the paired t-test. Results: The findings indicated significant changes (P=0.00 in most of the acoustic parameters during SES presentation compared to them at rest. The mean of fundamental frequency standard deviation (SD F0 at rest was 1.54 (SD=0.55 versus 4.15 (SD=3.00 for the SES period. The other investigated parameters comprised fundamental frequency (F0, minimum F0, jitter, shimmer, harmonic-to-noise ratio (HNR, mean intensity, and minimum intensity. Conclusion: These findings demonstrated significant changes in most of the important acoustic features, suggesting that the stimulation of the ISLN via SES could induce motor changes in the vocal folds. The clinical applicability of the method utilized in the current study in patients with vocal fold paralysis requires further research.

  2. Bilateral recurrent laryngeal nerve injury in total thyroidectomy with or without intraoperative neuromonitoring. Systematic review and meta-analysis.

    Science.gov (United States)

    Pardal-Refoyo, José Luis; Ochoa-Sangrador, Carlos

    2016-01-01

    The risk of producing bilateral laryngeal paralysis (BLP) in total thyroidectomy (TT) is low, but it is a concern for the surgeon and a serious safety incident that may compromise the airway, require reintubation or tracheostomy and cause serious sequelae or death. Neuromonitoring (NM), as an early diagnostic tool for the existence of injury to the recurrent laryngeal nerve (RLN), has not been shown to have reduced the risk, even though published series show lower incidences. Our objective was to estimate the risk of bilateral RLN paralysis with and without NM TT by systematic review and meta-analysis. We performed a systematic review of clinical trials, cohort studies and case series with total thyroidectomy without NM published in the period 2000-2014. A database search was performed using PubMed, Scopus (EMBASE) and the Cochrane Library. Heterogeneity between studies was explored and weighted risks grouped according to random effects models were estimated. We selected 40 articles and estimates of risk were identified in 54 case series (without NM, 25; with NM, 29) with 30,922 patients. The prevalence of BLP in the series with NM was lower compared to that without NM (2.43‰, [1.55 to 3.5‰] versus 5.18‰ [2.53 to 8.7‰]). This difference is equivalent to an absolute risk reduction of 2.75‰ with a number needed to treat of 364.13. The NM group was more homogeneous (I2=7.52%) than those without NM (I2=79.32%). The observed differences in the subgroup analysis were very imprecise because the number of observed paralysis was very low. The risk of bilateral paralysis is lower in studies with neuromonitoring. Copyright © 2014 Elsevier España, S.L.U. and Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  3. Nerve crush but not displacement-induced stretch of the intra-arachnoidal facial nerve promotes facial palsy after cerebellopontine angle surgery.

    Science.gov (United States)

    Bendella, Habib; Brackmann, Derald E; Goldbrunner, Roland; Angelov, Doychin N

    2016-10-01

    Little is known about the reasons for occurrence of facial nerve palsy after removal of cerebellopontine angle tumors. Since the intra-arachnoidal portion of the facial nerve is considered to be so vulnerable that even the slightest tension or pinch may result in ruptured axons, we tested whether a graded stretch or controlled crush would affect the postoperative motor performance of the facial (vibrissal) muscle in rats. Thirty Wistar rats, divided into five groups (one with intact controls and four with facial nerve lesions), were used. Under inhalation anesthesia, the occipital squama was opened, the cerebellum gently retracted to the left, and the intra-arachnoidal segment of the right facial nerve exposed. A mechanical displacement of the brainstem with 1 or 3 mm toward the midline or an electromagnet-controlled crush of the facial nerve with a tweezers at a closure velocity of 50 and 100 mm/s was applied. On the next day, whisking motor performance was determined by video-based motion analysis. Even the larger (with 3 mm) mechanical displacement of the brainstem had no harmful effect: The amplitude of the vibrissal whisks was in the normal range of 50°-60°. On the other hand, even the light nerve crush (50 mm/s) injured the facial nerve and resulted in paralyzed vibrissal muscles (amplitude of 10°-15°). We conclude that, contrary to the generally acknowledged assumptions, it is the nerve crush but not the displacement-induced stretching of the intra-arachnoidal facial trunk that promotes facial palsy after cerebellopontine angle surgery in rats.

  4. Endoscopic mode for three-dimensional CT display of normal and pathologic laryngeal structures

    International Nuclear Information System (INIS)

    Sanuki, Tetsuji; Hyodo, Masamitsu; Yumoto, Eiji; Yasuhara, Yoshifumi; Ochi, Takashi

    1997-01-01

    The recent development of helical (spiral) computed tomography allows collection of volumetric data to obtain high quality three-dimensional (3D) reconstructed images. The authors applied the 3D CT endoscopic imaging technique to asses normal and pathologic laryngeal structures. The latter included trauma, vocal fold atrophy, cancer of the larynx and recurrent nerve palsy. This technique was able to show normal laryngeal structures and characteristic findings of each pathology. The 3D CT endoscopic images can be rotated around any axis, allowing optimal depiction of pathologic lesion. The use of 3D CT endoscopic technique provides the display of the location and extent of pathology and affords accurate therapeutic planning. (author)

  5. Delayed Onset of Isolated Unilateral Oculomotor Nerve Palsy Caused by Post-Traumatic Pituitary Apoplexy: A Case Report

    Directory of Open Access Journals (Sweden)

    Tomoki Ishigaki

    2017-09-01

    Full Text Available Post-traumatic pituitary apoplexy is uncommon, most of which present with a sudden onset of severe headache and visual impairments associated with a dumbbell-shaped pituitary tumor. We experienced an unusual case of post-traumatic pituitary apoplexy with atypical clinical features. A 66-year-old man presented with mild cerebral contusion and an incidentally diagnosed intrasellar tumor after a fall accident with no loss of consciousness. The patients denied any symptoms before the accident. After 4 days, the left oculomotor nerve palsy developed and deteriorated associated with no severe headache. Repeated neuroimages suggested that pituitary apoplexy had occurred at admission and showed that the tumor compressed the left cavernous sinus. The patient underwent endonasal transsphenoidal surgery at 6 days after head injury, and the mass reduction improved the oculomotor nerve palsy completely within the following 14 days. The pathologic diagnosis was nonfunctioning pituitary adenoma with hemorrhage and necrosis.

  6. A Case of Death Secondary to Phrenic Nerve Palsy after Huge Mediastinal Teratoma 
Resection in Newborn

    Directory of Open Access Journals (Sweden)

    Yuanda CHENG

    2015-08-01

    Full Text Available Neonatal teratomas, not common in clinical, are often some case reports, female more than male, most are benign. It can occur anywhere of body midline; sacrococcygeal teratoma is the most common and the second most frequent site of extragonadal teratomas is mediastinum. Benign is more commom and malignant is very rarely seen. Completely surgical resection is the main and effective treatment. This review reports a case of neonatal teratoma, which is complicated with a fatal phrenic nerve palsy after surgery.

  7. [Facial palsy].

    Science.gov (United States)

    Cavoy, R

    2013-09-01

    Facial palsy is a daily challenge for the clinicians. Determining whether facial nerve palsy is peripheral or central is a key step in the diagnosis. Central nervous lesions can give facial palsy which may be easily differentiated from peripheral palsy. The next question is the peripheral facial paralysis idiopathic or symptomatic. A good knowledge of anatomy of facial nerve is helpful. A structure approach is given to identify additional features that distinguish symptomatic facial palsy from idiopathic one. The main cause of peripheral facial palsies is idiopathic one, or Bell's palsy, which remains a diagnosis of exclusion. The most common cause of symptomatic peripheral facial palsy is Ramsay-Hunt syndrome. Early identification of symptomatic facial palsy is important because of often worst outcome and different management. The prognosis of Bell's palsy is on the whole favorable and is improved with a prompt tapering course of prednisone. In Ramsay-Hunt syndrome, an antiviral therapy is added along with prednisone. We also discussed of current treatment recommendations. We will review short and long term complications of peripheral facial palsy.

  8. Hemodynamic and morphological characteristics of unruptured posterior communicating artery aneurysms with oculomotor nerve palsy.

    Science.gov (United States)

    Lv, Nan; Yu, Ying; Xu, Jinyu; Karmonik, Christof; Liu, Jianmin; Huang, Qinghai

    2016-08-01

    OBJECT Unruptured posterior communicating artery (PCoA) aneurysms with oculomotor nerve palsy (ONP) have a very high risk of rupture. This study investigated the hemodynamic and morphological characteristics of intracranial aneurysms with high rupture risk by analyzing PCoA aneurysms with ONP. METHODS Fourteen unruptured PCoA aneurysms with ONP, 33 ruptured PCoA aneurysms, and 21 asymptomatic unruptured PCoA aneurysms were included in this study. The clinical, morphological, and hemodynamic characteristics were compared among the different groups. RESULTS The clinical characteristics did not differ among the 3 groups (p > 0.05), whereas the morphological and hemodynamic analyses showed that size, aspect ratio, size ratio, undulation index, nonsphericity index, ellipticity index, normalized wall shear stress (WSS), and percentage of low WSS area differed significantly (p PCoA aneurysms with ONP demonstrated a distinctive morphological-hemodynamic pattern that was significantly different compared with asymptomatic unruptured PCoA aneurysms and was similar to ruptured PCoA aneurysms. The larger size, more irregular shape, and lower WSS might be related to the high rupture risk of PCoA aneurysms.

  9. Foot Drop: Looking Beyond Common Peroneal Nerve Palsy – A Neurophysiology Centre Experience

    LENUS (Irish Health Repository)

    Yap, SM

    2016-04-01

    Foot drop is a complex symptom with a considerable range in aetiology, severity and prognosis. We aim to characterise the aetiologies of foot drop and assess the diagnostic contribution of neurophysiologic testing (NCS\\/EMG). Retrospective review of consecutive referrals of foot drop to the Neurophysiology Department in Cork University Hospital was performed over a two year period (January 2012 to December 2013). Of a total of 59 referrals, common peroneal nerve (CPN) palsy comprised only slightly more than half of cases; 3(5%) have central origin; 3(5%) have motor neuron disease. Six (10%) have diabetes; 7(12%) have cancer; 5(8%) were bilateral. NCS\\/EMG altered initial working diagnosis in 14 out of 52 (27%) cases whereby initial diagnosis was provided. However one-third of all cases revealed additional coexistent pathology in an anatomic location remote to that of the primary diagnosis. Foot drop with central and proximal localisations are important and under recognised. NCS\\/EMG is valuable and also reveals additional pathology which warrants investigation

  10. Sellar Chordoma Presenting as Pseudo-macroprolactinoma with Unilateral Third Cranial Nerve Palsy

    Institute of Scientific and Technical Information of China (English)

    Hai-feng Wang; Hong-xi Ma; Cheng-yuan Ma; Yi-nan Luo; Peng-fei Ge

    2012-01-01

    We described a 61-year-old female with a sellar chordoma,which presented as pseudo-macroprolactinoma with unilateral third cranial nerve palsy.Physical examination revealed that her right upper lid could not be raised by itself,right eyeball movement limited to the abduction direction,right pupil dilated to 4.5 mm with negative reaction to light,and hemianopsia in bitemporal sides.CT scanning showed a hyperdense lesion at sellar region without bone destruction.Magnetic resonance imaging (MRI) revealed the tumor was 2.3 cm×1.8 cm×2.6 cm,with iso-intensity on T1WI,hyper-intensity on T2WI and heterogeneous enhancement on contrast imaging.Endocrine examination showed her serum prolactin level increased to 1,031.49 mlU/ml.The tumor was sub-totally resected via pterional craniotomy under microscope and was histologically proven to be a chordoma.Postoperatively,she recovered uneventfully but ptosis and hemianopsia remained at the 6th month.

  11. Ultrasound-guided platelet-rich plasma injections for the treatment of common peroneal nerve palsy associated with multiple ligament injuries of the knee.

    Science.gov (United States)

    Sánchez, M; Yoshioka, T; Ortega, M; Delgado, D; Anitua, E

    2014-05-01

    Peroneal nerve palsy in traumatic knee dislocations associated with multiple ligament injuries is common. Several surgical approaches are described for this lesion with less-than-optimal outcomes. The present case represents the application of plasma rich in growth factors (PRGF) technology for the treatment of peroneal nerve palsy with drop foot. This technology has already been proven its therapeutic potential for various musculoskeletal disorders. Based on these results, we hypothesized that PRGF could stimulate the healing process of traumatic peroneal nerve palsy with drop foot. The patient was a healthy 28-year-old man. He suffered peroneal nerve palsy with drop foot after multiple ligament injuries of the knee. PRGF was prepared according to the manufactured instruction. Eleven months after the trauma with severe axonotmesis, serial intraneural infiltrations of PRGF were started using ultrasound guidance. The therapeutic effect was assessed by electromyography (EMG), echogenicity of the peroneal nerve under ultrasound (US) and manual muscle testing. Twenty-one months after the first injection, not complete but partial useful recovery is obtained. He is satisfied with walking and running without orthosis. Sensitivity demonstrates almost full recovery in the peroneal nerve distribution area. EMG controls show complete reinnervation for the peroneus longus and a better reinnervation for the tibialis anterior muscle, compared with previous examinations. Plasma rich in growth factors (PRGF) infiltrations could enhance healing process of peroneal nerve palsy with drop foot. This case report demonstrates the therapeutic potential of this technology for traumatic peripheral nerve palsy and the usefulness of US-guided PRGF. V.

  12. Common Peroneal Nerve Palsy with Multiple-Ligament Knee Injury and Distal Avulsion of the Biceps Femoris Tendon

    Directory of Open Access Journals (Sweden)

    Takeshi Oshima

    2015-01-01

    Full Text Available A multiple-ligament knee injury that includes posterolateral corner (PLC disruption often causes palsy of the common peroneal nerve (CPN, which occurs in 44% of cases with PLC injury and biceps femoris tendon rupture or avulsion of the fibular head. Approximately half of these cases do not show functional recovery. This case report aims to present a criteria-based approach to the operation and postoperative management of CPN palsy that resulted from a multiple-ligament knee injury in a 22-year-old man that occurred during judo. We performed a two-staged surgery. The first stage was to repair the injuries to the PLC and biceps femoris. The second stage involved anterior cruciate ligament reconstruction. The outcomes were excellent, with a stable knee, excellent range of motion, and improvement in the palsy. The patient was able to return to judo competition 27 weeks after the injury. To the best of our knowledge, this is the first case report describing a return to sports following CPN palsy with multiple-ligament knee injury.

  13. Análise quantitativa das fibras mielínicas dos nervos laríngeos em humanos de acordo com a idade Quantitative analysis of myelinic fibers in human laryngeal nerves according to age

    Directory of Open Access Journals (Sweden)

    Romualdo Suzano Louzeiro Tiago

    2008-02-01

    Full Text Available INTRODUÇÃO E OBJETIVO: Realizar análise morfométrica das fibras mielínicas dos nervos laríngeos com a finalidade de verificar modificações quantitativas decorrentes do processo de envelhecimento. FORMA DE ESTUDO: Clínico e experimental. Material e Método: Foi coletado fragmento de 1cm dos nervos laríngeos superiores e nervos laríngeos recorrentes de 12 cadáveres do sexo masculino. A amostra foi dividida em dois grupos: idade inferior a 60 anos (Adulto e idade igual ou superior a 60 anos (Idoso. O material foi avaliado em microscópio de luz acoplado a sistema analisador de imagem. RESULTADOS: O número total de fibras mielínicas do nervo laríngeo superior foi semelhante nos dois grupos etários, mas com tendência para o maior número de fibras de 1µm no grupo adulto (p=0,0744. O grupo adulto apresentou maior número total de fibras mielínicas no nervo laríngeo recorrente (p=0,0006, e esta diferença ocorreu nas fibras com diâmetros de 1-3µm (pINTRODUCTION AND AIM: To carry out a morphometric analysis of myelinic fibers in laryngeal nerves aiming to identify quantitative changes as a result of aging. Study design: Clinical and experimental. MATERIAL AND METHOD: A 1cm fragment was collected from the superior laryngeal nerves and recurrent laryngeal nerves taken from twelve male cadavers. The sample was divided into two groups: those aged below 60 years (Adult and those aged 60 years or more (Elderly. The material was evaluated under light microscopy coupled with an image analysis system. RESULTS: The total number of myelinic fibers from the superior laryngeal nerve was similar in both age groups; there was, however, a trend for a higher number of 1μm fibers in the adult group (p=0.0744. The adult group had a higher total number of myelinic fibers in the recurrent laryngeal nerve (p=0.0006, and this difference was seen in fibers with diameters betwee 1-3μm (p<0.007. The adult group had a higher total number of myelinic fibers

  14. The management of peripheral facial nerve palsy: "paresis" versus "paralysis" and sources of ambiguity in study designs.

    Science.gov (United States)

    Linder, Thomas E; Abdelkafy, Wael; Cavero-Vanek, Sandra

    2010-02-01

    , independent of the treatment regimen. In the Bell's paralysis group, 38 patients (70%) recovered completely after 1 year, including 94% of patients with a denervation by ENoG of less than 90%. Thirty percent of Bell's paralysis patients recovered incompletely, revealing the worst outcome in patients with a 100% denervation on ENoG. None of the 4 patients with HZO and ENoG denervation of more than 90% recovered to normal facial function. We found a highly significant difference regarding the time course and final outcome in patients with incomplete palsies versus total paralysis; however, only 3 of 250 studies make this distinction. The time course for improvement and the extent of recovery is significantly different in patients presenting with an incomplete facial nerve paresis compared with patients with a total paralysis. Whereas the term "palsy" includes both entities, the term "paralysis" should only be used to describe total loss of nerve function. Patients with incomplete acute Bell's palsy (paresis) should start to improve their facial function early (1-2 wk after onset) and are expected to recover completely within 3 months. These patients do not benefit from antiviral medications and most likely do not profit from systemic steroids. Mixing patients with different severity of palsies will always lead to controversial results.

  15. Unilateral Superior Laryngeal Nerve Lesion in an Animal Model of Dysphagia and Its Effect on Sucking and Swallowing

    Science.gov (United States)

    Campbell-Malone, Regina; Holman, Shaina D.; Lukasik, Stacey L.; Fukuhara, Takako; Gierbolini-Norat, Estela M.; Thexton, Allan J.; German, Rebecca Z.

    2013-01-01

    We tested two hypotheses relating to the sensory deficit that follows a unilateral superior laryngeal nerve (SLN) lesion in an infant animal model. We hypothesized that it would result in (1) a higher incidence of aspiration and (2) temporal changes in sucking and swallowing. We ligated the right-side SLN in six 2–3-week-old female pigs. Using videofluoroscopy, we recorded swallows in the same pre- and post-lesion infant pigs. We analyzed the incidence of aspiration and the duration and latency of suck and swallow cycles. After unilateral SLN lesioning, the incidence of silent aspiration during swallowing increased from 0.7 to 41.5 %. The durations of the suck containing the swallow, the suck immediately following the swallow, and the swallow itself were significantly longer in the post-lesion swallows, although the suck prior to the swallow was not different. The interval between the start of the suck containing a swallow and the subsequent epiglottal movement was longer in the post-lesion swallows. The number of sucks between swallows was significantly greater in post-lesion swallows compared to pre-lesion swallows. Unilateral SLN lesion increased the incidence of aspiration and changed the temporal relationships between sucking and swallowing. The longer transit time and the temporal coordinative dysfunction between suck and swallow cycles may contribute to aspiration. These results suggest that swallow dysfunction and silent aspiration are common and potentially overlooked sequelae of unilateral SLN injury. This validated animal model of aspiration has the potential for further dysphagia studies. PMID:23417250

  16. Unilateral blindness with third cranial nerve palsy and abnormal enhancement of extraocular muscles on magnetic resonance imaging of orbit after the ingestion of methanol.

    Science.gov (United States)

    Chung, Tae Nyoung; Kim, Sun Wook; Park, Yoo Seok; Park, Incheol

    2010-05-01

    Methanol is generally known to cause visual impairment and various systemic manifestations. There are a few reported specific findings for methanol intoxication on magnetic resonance imaging (MRI) of the brain. A case is reported of unilateral blindness with third cranial nerve palsy oculus sinister (OS) after the ingestion of methanol. Unilateral damage of the retina and optic nerve were confirmed by fundoscopy, flourescein angiography, visual evoked potential and electroretinogram. The optic nerve and extraocular muscles (superior rectus, medial rectus, inferior rectus and inferior oblique muscle) were enhanced by gadolinium-DTPA on MRI of the orbit. This is the first case report of permanent monocular blindness with confirmed unilateral damage of the retina and optic nerve, combined with third cranial nerve palsy after methanol ingestion.

  17. Primary position and listing's law in acquired and congenital trochlear nerve palsy.

    Science.gov (United States)

    Straumann, Dominik; Steffen, Heimo; Landau, Klara; Bergamin, Oliver; Mudgil, Ananth V; Walker, Mark F; Guyton, David L; Zee, David S

    2003-10-01

    In ocular kinematics, the primary position (PP) of the eye is defined by the position from which movements do not induce ocular rotations around the line of sight (Helmholtz). PP is mathematically linked to the orientation of Listing's plane. This study was conducted to determine whether PP is affected differently in patients with clinically diagnosed congenital (conTNP) and acquired (acqTNP) trochlear nerve palsy. Patients with unilateral conTNP (n = 25) and acqTNP (n = 9) performed a modified Hess screen test. Three-dimensional eye positions were recorded with dual search coils. PP in eyes with acqTNP was significantly more temporal (mean: 21.2 degrees ) than in eyes with conTNP (6.8 degrees ) or healthy eyes (7.2 degrees ). In the pooled data of all patients, the horizontal location of PP significantly correlated with vertical noncomitance with the paretic eye in adduction (R = 0.59). Using a computer model, PP in acqTNP could be reproduced by a neural lesion of the superior oblique (SO) muscle. An additional simulated overaction of the inferior oblique (IO) muscle moved PP back to normal, as in conTNP. Lengthening the SO and shortening the IO muscles could also simulate PP in conTNP. The temporal displacement of PP in acqTNP is a direct consequence of the reduced force of the SO muscle. The reversal of this temporal displacement of PP, which occurs in some patients with conTNP, can be explained by a secondary overaction of the IO muscle. Alternatively, length changes in the SO and IO muscles, or other anatomic anomalies within the orbit, without a neural lesion, may also explain the difference in location of PP between conTNP and acqTNP.

  18. Left is right and right is wrong: fluorodeoxyglucose uptake in left hemi-diaphragm due to right phrenic nerve palsy

    International Nuclear Information System (INIS)

    Joshi, Prathamesh; Lele, Vikram

    2013-01-01

    A 36-year-old Indian man, a recently diagnosed case of the right lung carcinoma underwent fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) for staging of the malignancy. PET/CT showed increased FDG uptake in the right lung mass, consistent with the known primary tumor. Right hemidiaphragm was found to be elevated on CT, suggesting right diaphragmatic paresis. The PET scan demonstrated asymmetric, intense FDG uptake in the left hemidiaphragm and accessory muscles of respiration, which was possibly due to compensatory increased workload related to contralateral right diaphragmatic paresis. The right diaphragmatic paresis was hypothesized to be caused by phrenic nerve palsy by right lung neoplasm. (author)

  19. Left is right and right is wrong: Fluorodeoxyglucose uptake in left hemi-diaphragm due to right phrenic nerve palsy.

    Science.gov (United States)

    Joshi, Prathamesh; Lele, Vikram

    2013-01-01

    A 36-year-old Indian man, a recently diagnosed case of the right lung carcinoma underwent fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) for staging of the malignancy. PET/CT showed increased FDG uptake in the right lung mass, consistent with the known primary tumor. Right hemidiaphragm was found to be elevated on CT, suggesting right diaphragmatic paresis. The PET scan demonstrated asymmetric, intense FDG uptake in the left hemidiaphragm and accessory muscles of respiration, which was possibly due to compensatory increased workload related to contralateral right diaphragmatic paresis. The right diaphragmatic paresis was hypothesized to be caused by phrenic nerve palsy by right lung neoplasm.

  20. [Invasive aspergillosis of sphenoidal sinus in a patient in Djibouti, revealed by palsy of cranial nerves: a case report].

    Science.gov (United States)

    Crambert, A; Gauthier, J; Vignal, R; Conessa, C; Lombard, B

    2013-05-01

    The authors report a case of invasive aspergillosis of a sphenoid sinus mucocele revealed in a patient with diabetes in Djibouti by homolateral palsy of the 3rd, 4th, 5th and 6th nerves. This rare condition occurs preferentially in immunodeficient subjects. Because of its clinical polymorphism, its diagnosis is difficult and is often not made until complications develop. Endonasal surgery with anatomopathological and mycological examination is both a diagnostic and therapeutic procedure. It must be performed early, to avoid functional or even life-threatening complications.

  1. Ulnar nerve dysfunction

    Science.gov (United States)

    Neuropathy - ulnar nerve; Ulnar nerve palsy; Mononeuropathy; Cubital tunnel syndrome ... Damage to one nerve group, such as the ulnar nerve, is called mononeuropathy . Mononeuropathy means there is damage to a single nerve. Both ...

  2. Radial nerve dysfunction

    Science.gov (United States)

    Neuropathy - radial nerve; Radial nerve palsy; Mononeuropathy ... Damage to one nerve group, such as the radial nerve, is called mononeuropathy . Mononeuropathy means there is damage to a single nerve. Both ...

  3. Visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy: what about the costs?

    Science.gov (United States)

    Dionigi, Gianlorenzo; Bacuzzi, Alessandro; Boni, Luigi; Rausei, Stefano; Rovera, Francesca; Dionigi, Renzo

    2012-04-01

    The objective of the present study was to evaluate costs for thyroidectomy performed with the aid of intraoperative neural monitoring (IONM), which has gained widespread acceptance during thyroid surgery as an adjunct to the gold standard of visual nerve identification. Through a micro-costing approach, the thyroidectomy patient-care process (with and without IONM) was analyzed by considering direct costs (staff time, consumables, equipment, drugs, operating room, and general expenses). Unit costs were collected from hospital accounting and standard tariff lists. To assess the impact of the IONM technology on hospital management, three macro-scenarios were considered: (1) traditional thyroidectomy; (2) thyroidectomy with IONM in a high-volume setting (5 procedures per week); and (3) thyroidectomy with IONM in a low-volume setting (1 procedure per week). Energy-based devices (EBD) for hemostasis and dissection in thyroidectomy were also evaluated, as well as the reimbursement made by the Italian Healthcare System on the basis of diagnosis related groups (DRGs), about €2,600. Comparison between costs and the DRG fee shows an underfunding of total hospitalization costs for all thyroidectomies, regardless of IONM use (scenario 1: €3,471). The main cost drivers are consumables and technologies (25%), operating room (16%), and staff (14%). Hospitalization costs for a thyroidectomy with IONM range from €3,713 to €3,770 (scenarios 2 and 3), 5–7% higher than those for traditional thyroidectomy. Major economic differences emerge when an EBD is used (€3,969). The regional DRG tariff for thyroid surgery is barely sufficient to cover conventional surgery costs. Intraoperative neural monitoring accounts for 5–7% of the hospitalization costs for a thyroidectomy.

  4. Treatment of Cervical Internal Carotid Artery Spontaneous Dissection with Pseudoaneurysm and Unilateral Lower Cranial Nerves Palsy by Two Silk Flow Diverters

    Energy Technology Data Exchange (ETDEWEB)

    Zelenak, Kamil, E-mail: zelenak@unm.sk [University Hospital, Department of Radiology (Slovakia); Zelenakova, Jana [University Hospital, Department of Neurology (Slovakia); DeRiggo, Julius [University Hospital, Department of Neurosurgery (Slovakia); Kurca, Egon; Kantorova, Ema [University Hospital, Department of Neurology (Slovakia); Polacek, Hubert [University Hospital, Department of Radiology (Slovakia)

    2013-08-01

    Internal carotid artery (ICA) lesions in the parapharyngeal space (a dissection and a pseudoaneurysm) may present as isolated lower cranial nerves (IX, X, XI, and XII) palsy (Collet-Sicard syndrome). Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Extreme vessel tortuosity makes the treatment by a stent graft impossible. Two Silk stents were used in a 46 year-old man with left lower cranial nerves (IX-XII) palsy for the treatment of left ICA spontaneous dissection with pseudoaneurysm. A follow-up angiogram 5 months later confirmed pseudoaneurysm thrombosis and patency of the left ICA. The patient recovered completely from the deficits.

  5. Treatment of Cervical Internal Carotid Artery Spontaneous Dissection with Pseudoaneurysm and Unilateral Lower Cranial Nerves Palsy by Two Silk Flow Diverters

    International Nuclear Information System (INIS)

    Zeleňák, Kamil; Zeleňáková, Jana; DeRiggo, Július; Kurča, Egon; Kantorová, Ema; Poláček, Hubert

    2013-01-01

    Internal carotid artery (ICA) lesions in the parapharyngeal space (a dissection and a pseudoaneurysm) may present as isolated lower cranial nerves (IX, X, XI, and XII) palsy (Collet–Sicard syndrome). Some arteriopathies such as fibromuscular dysplasia and tortuosity make a vessel predisposed to dissection. Extreme vessel tortuosity makes the treatment by a stent graft impossible. Two Silk stents were used in a 46 year-old man with left lower cranial nerves (IX–XII) palsy for the treatment of left ICA spontaneous dissection with pseudoaneurysm. A follow-up angiogram 5 months later confirmed pseudoaneurysm thrombosis and patency of the left ICA. The patient recovered completely from the deficits

  6. An unusual presentation of adenoid cystic carcinoma of the minor salivary glands with cranial nerve palsy: a case study

    International Nuclear Information System (INIS)

    Abdul-Hussein, Amal; Morris, Pierre A; Markova, Tsveti

    2007-01-01

    Adenoid Cystic Carcinoma (ACC) is a rare tumor entity and comprises about 1% of all malignant tumor of the oral and maxillofacial region. It is slow growing but a highly invasive cancer with a high recurrence rate. Intracranial ACC is even more infrequent and could be primary or secondary occurring either by direct invasion, hematogenous spread, or perineural spread. We report the first case of the 5 th and 6 th nerve palsy due to cavernous sinus invasion by adenoid cystic carcinoma. A 49-year-old African American female presented to the emergency room complaining of severe right-sided headache, photophobia, dizziness and nausea, with diplopia. The patient had a 14 year history migraine headaches, hypertension, and mild intermittent asthma. Physical examination revealed right lateral rectus muscle palsy with esotropia. There was numbness in all three divisions of the right trigeminal nerve. Motor and sensory examination of extremities was normal. An MRI of the brain/brain stem was obtained which showed a large mass in the clivus extending to involve the nasopharynx, pterygoid plate, sphenoid and right cavernous sinuses. Biopsy showed an ACC tumor with a cribriform pattern of the minor salivary glands. The patient underwent total gross surgical resection and radiation therapy. This is a case of ACC of the minor salivary glands with intracranial invasion. The patient had long history of headaches which changed in character during the past year, and symptoms of acute 5 th and 6 th cranial nerve involvement. Our unique case demonstrates direct invasion of cavernous sinus and could explain the 5 th and 6 th cranial nerve involvement as histopathology revealed no perineural invasion

  7. Lyme disease with facial nerve palsy: rapid diagnosis using a nested polymerase chain reaction-restriction fragment length polymorphism analysis.

    Science.gov (United States)

    Hashimoto, Y; Takahashi, H; Kishiyama, K; Sato, Y; Nakao, M; Miyamoto, K; Iizuka, H

    1998-02-01

    A 64-year-old woman with Lyme disease and manifesting facial nerve palsy had been bitten by a tick on the left frontal scalp 4 weeks previously. Erythema migrans appeared on the left forehead, accompanied by left facial paralysis. Nested polymerase chain reaction-restriction fragment length polymorphism analysis (nested PCR-RFLP) was performed on DNA extracted from a skin biopsy of the erythema on the left forehead. Borrelia flagellin gene DNA was detected and its RFLP pattern indicated that the organism was B. garinii, Five weeks later, B. garinii was isolated by conventional culture from the erythematous skin lesion, but not from the cerebrospinal fluid. After treatment with ceftriaxone intravenously for 10 days and oral administration of minocycline for 7 days, both the erythema and facial nerve palsy improved significantly. Nested PCR and culture taken after the lesion subsided, using skin samples obtained from a site adjacent to the original biopsy, were both negative. We suggest that nested PCR-RFLP analysis might be useful for the rapid diagnosis of Lyme disease and for evaluating therapy.

  8. Ptosis as partial oculomotor nerve palsy due to compression by infundibular dilatation of posterior communicating artery, visualized with three-dimensional computer graphics: case report.

    Science.gov (United States)

    Fukushima, Yuta; Imai, Hideaki; Yoshino, Masanori; Kin, Taichi; Takasago, Megumi; Saito, Kuniaki; Nakatomi, Hirofumi; Saito, Nobuhito

    2014-01-01

    Oculomotor nerve palsy (ONP) due to internal carotid-posterior communicating artery (PcomA) aneurysm generally manifests as partial nerve palsy including pupillary dysfunction. In contrast, infundibular dilatation (ID) of the PcomA has no pathogenic significance, and mechanical compression of the cranial nerve is extremely rare. We describe a 60-year-old woman who presented with progressive ptosis due to mechanical compression of the oculomotor nerve by an ID of the PcomA. Three-dimensional computer graphics (3DCG) accurately visualized the mechanical compression by the ID, and her ptosis was improved after clipping of the ID. ID of the PcomA may cause ONP by mechanical compression and is treatable surgically. 3DCG are effective for the diagnosis and preoperative simulation.

  9. [Bilateral traumatic abducens nerve palsy without skull fracture or intracranial hematoma-a report of 3 cases and consideration of the mechanism of injury (author's transl)].

    Science.gov (United States)

    Takagi, H; Miyasaka, Y; Kuramae, T; Ohwada, T; Tsunoda, M

    1976-10-01

    Three cases of bilateral traumatic abducens nerve palsy were presented and the mechanism of damage to the abducens nerve was discussed in relation to the analysis of traumatic force at the time of impact and topographical anatomy of the abducens nerve in detail. Case 1. A 70 year old man sustained a traffic accident with one hour loss of consciousness. Physical examination revealed a contused area on the medial side of his right forehead. Neurological examination revealed bilateral abducens nerve palsy (Fig. 1). There were no ther cranial nerve abnormalities. Roentgenograms of the skull, including views of the base and orbit showed no fracture. At follow up examination 12 months later, bilateral Duane's retraction syndrome could be noticed with slight increase in size of the pupil on each side of lateral gaze (Fig. 2). Case 2. A 32 year old women sustained a traffic accident with 31 days of loss of consciousness. At the time of admission, bilateral abducens nerve palsy and slight left hemiparesis were noticed in semicomatose condition. Right carotid angiogtam showed no evidence of intracranial hematoma. One month later, the right eye began to abduct and 2 months later, the left eye began to abduct. Three months after the injury, bilateral abducens nerve palsy could no longer be demonstrated. No retraction syndrome was observed during this period. Case 3. A 3 year old boy sustained a traffic accident with 32 days of loss of consciousness. At the time of admission, neurological examination showed bilateral abducens palsy and left sided decerebrate posture in comatose condition. At the time of discharge 3 months after admission, bilateral abducens palsy, right hemiataxia, left spastic hemiparesis and scanning speach were noticed. Three months later, right eye began to abduct and 4 months later, the left eye began to abduct. At follow up examination 6 months later, there was no evidence of abducens nerve palsy. Topographical details of anatomy of the abducens nerve are

  10. Wisdom tooth extraction causing lingual nerve and styloglossus muscle damage: a mimic of multiple cranial nerve palsies

    OpenAIRE

    Carr, A. S.; Evans, M.; Shah, S.; Catania, S.; Warren, J. D.; Gleeson, M. J.; Reilly, M. M.

    2017-01-01

    The combination of tongue hemianaesthesia, dysgeusia, dysarthria and dysphagia suggests the involvement of multiple cranial nerves. We present a case with sudden onset of these symptoms immediately following wisdom tooth extraction and highlight the clinical features that allowed localisation of the lesion to a focal, iatrogenic injury of the lingual nerve and adjacent styloglossus muscle.

  11. Morphometric study of the upper intercostal nerves: practical application for neurotizations in traumatic brachial plexus palsies.

    Science.gov (United States)

    Asfazadourian, H; Tramond, B; Dauge, M C; Oberlin, C

    1999-01-01

    The aim of the study was a morphometric evaluation of the intercostal nerves at different levels along their course in order to determine their adequacy in neurotizing the recipient nerves. The intercostal nerves were harvested from 5 cadavers. A biopsy of the nerve was obtained at 2 levels for each nerve in the parasternal region and at the level of the mid-axillary line. The musculocutaneous nerve was isolated at its origin from the lateral cord. Each harvested specimen was embedded in paraffin and sections were made using a microtome. These sections were then stained histochemically using HPS (Hematein, Phloxine, Safran). Real-time digitalisation of the video image under the microscope was performed. The sum of the different fascicular zones is the effective sensorimotor surface of the nerve at the level being studied. Direct suture of the upper three intercostal nerves to the musculocutaneous nerve is always possible upto the axillary fossa. The sixth intercostal nerve can be delivered upto this level in only 50% of cases without dissection of the musculocutaneous nerve upto its entry into the coracobrachialis. The musculocutaneous nerve presents a mean surface area of 2.64 mm2 while the nerve to the biceps has a mean surface area of 0.34 mm2 i.e. a ration of 1/8. The mean surface area of the intercostal nerves at the parasternal level is 0.23 mm2 while that at the axillary level is 0.34 mm2. Thus a loss of 33% in surface area occurs between the axillary and the parasternal levels. Our study confirms the insufficiency between the surface area of the intercostal nerves and the different nerve trunks to be neurotized. The relationship between the surface area of the musculocutaneous nerve and the three intercostal nerves is 26.72% with a minimum of 17.2%. If a fourth intercostal nerve is added, this ratio nerves appears to be a superior technique. We were able to deliver the sixth intercostal nerve for a direct suture to the musculocutaneous nerve in only half

  12. Tendon transfers in radial nerve palsy with fractures of the humerus ...

    African Journals Online (AJOL)

    regarding nerve repair or tendon transfers. b). Stabilisation of the fracture by internal fixation protects the radial nerve from further damage. c). Early exploration is technically easier and safer. Khan and Birch in their study of iatropathic injuries of peripheral nerves 26 out of 48 (56%) developed lesion following open reduction ...

  13. Laryngeal neuropathy of Charcot-Marie-Tooth disease: further observations and novel mutations associated with vocal fold paresis.

    Science.gov (United States)

    Benson, Brian; Sulica, Lucian; Guss, Joel; Blitzer, Andrew

    2010-02-01

    To describe and define laryngeal neuropathy in Charcot-Marie-Tooth (CMT) disease. Retrospective record review from a university laryngology practice. Four adult CMT patients presented with laryngeal symptoms. Three patients exhibited bilateral vocal fold palsy, in each case with more severe hypomobility on the left. One case exhibited an isolated left vocal fold palsy. All patients complained of hoarseness and stridor, three had dyspnea, two patients had dysphagia, and one had obstructive sleep apnea (OSA). One patient has required airway surgery to date. Genetic testing revealed known sequence alterations in one case and sequence alterations previously not associated with laryngeal dysfunction in two cases. One case was familial and two were sporadic; information is not available in a fourth. The clinical course of the cases suggests slowly progressive neuropathy that appears to be nerve length dependent. The lack of severe respiratory distress despite dense bilateral paresis is consistent with existing reports and with the reported low rate of tracheostomy in adults with laryngeal manifestations of CMT. Genetic testing does not currently inform expectations or management of laryngeal disease. Dyspnea, dysphagia, and OSA symptoms in patients with CMT require careful laryngologic evaluation.

  14. Long-term resolution of delayed onset hypoglossal nerve palsy following occipital condyle fracture: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Sudhakar Vadivelu

    2017-01-01

    Full Text Available The authors present the case of a patient that demonstrates resolution of delayed onset hypoglossal nerve palsy (HNP subsequent to occipital condyle fracture following a motor vehicle accident. Decompression of the hypoglossal nerve and craniocervical fixation led to satisfactory long-term (>5 years outcome. There is a scarcity of literature in recognizing HNPs following trauma and a lack of pathophysiological understanding to both a delayed presentation and to resolution versus persistence. This is the first report demonstrating long-term resolution of hypoglossal nerve injury following trauma to the craniocervical junction.

  15. Handlebar palsy--a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking.

    Science.gov (United States)

    Capitani, Daniel; Beer, Serafin

    2002-10-01

    We describe 3 patients who developed a severe palsy of the intrinsic ulnar supplied hand muscles after bicycle riding. Clinically and electrophysiologically all showed an isolated lesion of the deep terminal motor branch of the ulnar nerve leaving the hypothenar muscle and the distal sensory branch intact. This type of lesion at the canal of Guyon is quite unusual, caused in the majority of cases by chronic external pressure over the ulnar palm. In earlier reports describing this lesion in bicycle riders, most patients experienced this lesion after a long distance ride. Due to the change of riding position and shape of handlebars (horn handle) in recent years, however, even a single bicycle ride may be sufficient to cause a lesion of this ulnar branch. Especially in downhill riding, a large part of the body weight is supported by the hand on the corner of the handlebar leading to a high load at Guyon's canal. As no sensory fibres are affected, the patients are not aware of the ongoing nerve compression until a severe lesion develops. Individual adaptation of the handlebar and riding position seems to be crucial for prevention of this type of nerve lesion.

  16. Laryngeal dysfunction after thyroid surgery: diagnostic and treatments

    OpenAIRE

    FINCK, Camille

    2006-01-01

    Vocal fold hypomobility after thyroidectomy is a frequent complication of thyroidectomy. Laryngeal nerve paresis or paralysis may present with various symptoms like dysphagia, aspiration, voice alteration or dyspnea. Are described: the normal anatomophysiology of the larynx, the symptoms of nerve trauma following thyroidectomy, techniques of thoroughfull laryngeal and voice examination, some clinical entities( unilateral recurrent nerve paralysis, bilateral recurrent nerve paralysis, superior...

  17. Pre-pharyngeal swallow effects of recurrent laryngeal nerve lesion on bolus shape and airway protection in an infant pig model

    Science.gov (United States)

    Gould, Francois D. H.; Yglesias, B.; Ohlemacher, J.; German, R. Z.

    2016-01-01

    Recurrent laryngeal nerve (RLN) damage in infants leads to increased dysphagia and aspiration pneumonia. Recent work has shown that intra oral transport and swallow kinematics change following RLN lesion, suggesting potential changes in bolus formation prior to the swallow. In this study we used geometric morphometrics to understand the effect of bolus shape on penetration and aspiration in infants with and without RLN lesion. We hypothesized 1) that geometric bolus properties are related to airway protection outcomes and 2) that in infants with RLN lesion, the relationship between geometric bolus properties and dysphagia is changed. In five infant pigs, dysphagia in 188 swallows was assessed using the Infant Mammalian Penetration Aspiration Score (IMPAS). Using images from high-speed VFSS, bolus shape, bolus area, and tongue outline were quantified digitally. Bolus shape was analyzed using elliptical Fourier analysis, and tongue outline using polynomial curve fitting. Despite large inter-individual differences, significant within individual effects of bolus shape and bolus area on airway protection exist. The relationship between penetration-aspiration score and both bolus area and shape changed post lesion. Tongue shape differed between pre and post lesion swallows, and between swallows with different IMPAS scores. Bolus shape and area affect airway protection outcomes. RLN lesion changes that relationship, indicating that proper bolus formation and control by the tongue requires intact laryngeal sensation. The impact of RLN lesion on dysphagia is pervasive. PMID:27873091

  18. Wisdom tooth extraction causing lingual nerve and styloglossus muscle damage: a mimic of multiple cranial nerve palsies.

    Science.gov (United States)

    Carr, Aisling S; Evans, Matthew; Shah, Sachit; Catania, Santi; Warren, Jason D; Gleeson, Michael J; Reilly, Mary M

    2017-06-01

    The combination of tongue hemianaesthesia, dysgeusia, dysarthria and dysphagia suggests the involvement of multiple cranial nerves. We present a case with sudden onset of these symptoms immediately following wisdom tooth extraction and highlight the clinical features that allowed localisation of the lesion to a focal, iatrogenic injury of the lingual nerve and adjacent styloglossus muscle. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Transient isolated lingual nerve neuropraxia associated with general anaesthesia and laryngeal mask use: two case reports and a review of the literature.

    LENUS (Irish Health Repository)

    Foley, E

    2012-02-01

    BACKGROUND: Transient, isolated lingual nerve neuropraxia is a rare complication following general anaesthesia. Reports implicate airway manipulation and we describe two new cases associated with laryngeal mask airway (LMA) and review the related English language literature. RESULTS: Unilateral numbness and loss of taste on the anterior tongue were the characteristic symptoms. Collation of literature data (median and range) with that from the new cases showed: patient age was 38 (20-61) years and female to male ratio was 1.2:1. Surgery time was 62.5 (20-150) min and symptom duration was 28 (7-120) days. CONCLUSION: Lingual neuropraxias reported have been transient and patients can be advised, despite disturbing symptoms, that recovery is anticipated in about 1 month. Lingual neuropraxia reports are becoming more frequent, perhaps associated with increasing LMA use. Research is recommended as modification to LMA cuff volume, pressure and\\/or position within the oral cavity might ameliorate the entity.

  20. Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery.

    Science.gov (United States)

    Haerle, Stephan; Sidler, D; Linder, Th; Mueller, W

    2008-12-01

    The aims were to assess the technical feasibility of using a single electrode in the posterior arytenoid muscles (PAM) for intraoperative monitoring of the recurrent laryngeal nerve (RLN) in thyroid surgery, to validate the new method against the insertion of electrodes placed in the vocal cord muscle, and to report the results of the clinical application of the new concept. A total of 52 patients were enrolled. The handling and safety of RLN monitoring was tested by simultaneous registration of the EMG response from vocal fold electrodes and PAM electrodes. Acoustically and electromyographically we found nearly the same values for the arytenoid muscles as for the vocal folds, although the signals taken from the vocal folds were slightly stronger. PAM recording using a single bipolar electrode is technically feasible and as reliable compared to the standard vocal cord monitoring.

  1. Effect of fascicle composition on ulnar to musculocutaneous nerve transfer (Oberlin transfer) in neonatal brachial plexus palsy.

    Science.gov (United States)

    Smith, Brandon W; Chulski, Nicholas J; Little, Ann A; Chang, Kate W C; Yang, Lynda J S

    2018-06-01

    OBJECTIVE Neonatal brachial plexus palsy (NBPP) continues to be a problematic occurrence impacting approximately 1.5 per 1000 live births in the United States, with 10%-40% of these infants experiencing permanent disability. These children lose elbow flexion, and one surgical option for recovering it is the Oberlin transfer. Published data support the use of the ulnar nerve fascicle that innervates the flexor carpi ulnaris as the donor nerve in adults, but no analogous published data exist for infants. This study investigated the association of ulnar nerve fascicle choice with functional elbow flexion outcome in NBPP. METHODS The authors conducted a retrospective study of 13 cases in which infants underwent ulnar to musculocutaneous nerve transfer for NBPP at a single institution. They collected data on patient demographics, clinical characteristics, active range of motion (AROM), and intraoperative neuromonitoring (IONM) (using 4 ulnar nerve index muscles). Standard statistical analysis compared pre- and postoperative motor function improvement between specific fascicle transfer (1-2 muscles for either wrist flexion or hand intrinsics) and nonspecific fascicle transfer (> 2 muscles for wrist flexion and hand intrinsics) groups. RESULTS The patients' average age at initial clinic visit was 2.9 months, and their average age at surgical intervention was 7.4 months. All NBPPs were unilateral; the majority of patients were female (61%), were Caucasian (69%), had right-sided NBPP (61%), and had Narakas grade I or II injuries (54%). IONM recordings for the fascicular dissection revealed a donor fascicle with nonspecific innervation in 6 (46%) infants and specific innervation in the remaining 7 (54%) patients. At 6-month follow-up, the AROM improvement in elbow flexion in adduction was 38° in the specific fascicle transfer group versus 36° in the nonspecific fascicle transfer group, with no statistically significant difference (p = 0.93). CONCLUSIONS Both specific and

  2. May the Inferior Petrosal Sinus Recanalization During Endovascular Treatment for Carotid-Cavernous Fistulas Increase the Risk of Sixth Nerve Palsy?

    Science.gov (United States)

    Robert, Thomas; Valsecchi, Daniele; Sylvestre, Philippe; Blanc, Raphaël; Ciccio, Gabriele; Smajda, Stanislas; Redjem, Hocine; Piotin, Michel

    2018-05-03

    Sixth nerve palsy is a common complication of endovascular treatment for carotid-cavernous fistulas (CCF). Two hypotheses are evoked: the spontaneous venous congestion into the cavernous sinus and the direct compression of the nerve by the embolic agent into the cavernous sinus. Nevertheless, the evidence is still uncertain. Knowing the vicinity of the sixth nerve with the inferior petrosal sinus (IPS) in the Dorello canal, we hypothesized that the recanalization of the IPS increased the risk of nerve damage. We analyzed a prospective database of patients treated for CCFs from March 2009 to April 2016. We excluded patients who did not need treatment, cases of high-flow CCF, and patients lost to follow-up, obtaining a homogeneous population of 82 patients with indirect CCFs. This population was divided in 2 groups: patients without new-onset/worsening of sixth nerve palsy and patients with this postprocedural complication. Our main endpoints were the potential differences between patients with or without recanalization of IPS and between those who underwent or not an embolization with Onyx-18. We did not find any statistically meaningful difference between the 2 groups concerning the necessity of IPS recanalization (P > 0.999, odds ratio 0.97, 95% confidence interval 0.32-2.96) or with the use of Onyx-18 as an embolic agent (P = 0.56; odds ratio 1.41, 95% confidence interval 0.41-2.45). The recanalization of a thrombosed IPS does not increase the risk of procedural sixth nerve damage. The initial injury seems to relate with development/worsening of a sixth nerve palsy. Copyright © 2018 Elsevier Inc. All rights reserved.

  3. Peripheral (Seventh Nerve Palsy and Multiple Sclerosis: A Diagnostic Dilemma - A Case Report

    Directory of Open Access Journals (Sweden)

    Christian Saleh

    2016-01-01

    Full Text Available During the last decades, only a few cases on the association between peripheral demyelinating diseases and multiple sclerosis (MS have been reported. We describe the case of a young man who was initially diagnosed with Bell's palsy, and only after performing a brain MRI was the diagnosis of MS made. We review the literature and discuss some pitfalls which may lead to missing the diagnosis of MS.

  4. Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?

    Directory of Open Access Journals (Sweden)

    Souvik Chaudhuri

    2012-01-01

    Full Text Available Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and salbutamol nebulization. Chest X-ray revealed elevated right hemidiaphragm confirming unilateral phrenic nerve paresis.

  5. Isolated hypoglossal nerve palsy due to skull base metastasis from breast cancer

    International Nuclear Information System (INIS)

    Pavithran, K.; Doval, D.C.; Hukku, S.; Jena, A.

    2001-01-01

    We describe a 44-year-old woman who presented with an isolated unilateral hypoglossal nerve paralysis caused by a skull base metastasis from breast cancer. The patient had a modified radical mastectomy followed by local radiotherapy and adjuvant chemotherapy. Fourteen months later she presented with difficulty in speaking. Physical examination revealed an isolated left hypoglossal nerve paralysis. The MRI scan showed a mass lesion involving the left occipital condyle extending into hypoglossal canal. Copyright (2001) Blackwell Science Pty Ltd

  6. Apoplexy of a pituitary macroadenoma with reversible third, fourth and sixth cranial nerve palsies following administration of hypothalamic releasing hormones: MR features

    International Nuclear Information System (INIS)

    Riedl, Michaela; Clodi, Martin; Kotzmann, Harald; Hainfellner, Johann A.; Schima, Wolfgang; Reitner, Andreas; Czech, Thomas; Luger, Anton

    2000-01-01

    Pituitary apoplexy in patients with pituitary macroadenomas can occur either spontaneously or following various interventions. We present a case of a 71-year-old woman who developed third, fourth, and sixth cranial nerve palsies following administration of the four hypothalamic releasing hormones for routine preoperative testing of pituitary function. The MR examination showed interval tumor growth with impression of the floor of the third ventricle. There were also changes in signal intensity characteristics of the mass, suggestive of intratumoral bleeding. A transsphenoidal surgery with subtotal resection of the pituitary adenoma was performed. Microscopical examination revealed large areas of necrosis and blood surrounded by adenomatous tissue. Third, fourth, and sixth cranial nerve palsies completely resolved within 4 months. We conclude that MR imaging is useful in the demonstration of pituitary apoplexy following preoperative stimulation tests, but we suggest that these tests should be abandoned in patients with pituitary macroadenomas

  7. Apoplexy of a pituitary macroadenoma with reversible third, fourth and sixth cranial nerve palsies following administration of hypothalamic releasing hormones: MR features

    Energy Technology Data Exchange (ETDEWEB)

    Riedl, Michaela E-mail: michaela.riedl@akh-wien.ac.at; Clodi, Martin; Kotzmann, Harald; Hainfellner, Johann A.; Schima, Wolfgang; Reitner, Andreas; Czech, Thomas; Luger, Anton

    2000-10-01

    Pituitary apoplexy in patients with pituitary macroadenomas can occur either spontaneously or following various interventions. We present a case of a 71-year-old woman who developed third, fourth, and sixth cranial nerve palsies following administration of the four hypothalamic releasing hormones for routine preoperative testing of pituitary function. The MR examination showed interval tumor growth with impression of the floor of the third ventricle. There were also changes in signal intensity characteristics of the mass, suggestive of intratumoral bleeding. A transsphenoidal surgery with subtotal resection of the pituitary adenoma was performed. Microscopical examination revealed large areas of necrosis and blood surrounded by adenomatous tissue. Third, fourth, and sixth cranial nerve palsies completely resolved within 4 months. We conclude that MR imaging is useful in the demonstration of pituitary apoplexy following preoperative stimulation tests, but we suggest that these tests should be abandoned in patients with pituitary macroadenomas.

  8. Vascular endothelial growth factor gene therapy improves nerve regeneration in a model of obstetric brachial plexus palsy.

    Science.gov (United States)

    Hillenbrand, Matthias; Holzbach, Thomas; Matiasek, Kaspar; Schlegel, Jürgen; Giunta, Riccardo E

    2015-03-01

    The treatment of obstetric brachial plexus palsy has been limited to conservative therapies and surgical reconstruction of peripheral nerves. In addition to the damage of the brachial plexus itself, it also leads to a loss of the corresponding motoneurons in the spinal cord, which raises the need for supportive strategies that take the participation of the central nervous system into account. Based on the protective and regenerative effects of VEGF on neural tissue, our aim was to analyse the effect on nerve regeneration by adenoviral gene transfer of vascular endothelial growth factor (VEGF) in postpartum nerve injury of the brachial plexus in rats. In the present study, we induced a selective crush injury to the left spinal roots C5 and C6 in 18 rats within 24 hours after birth and examined the effect of VEGF-gene therapy on nerve regeneration. For gene transduction an adenoviral vector encoding for VEGF165 (AdCMV.VEGF165) was used. In a period of 11 weeks, starting 3 weeks post-operatively, functional regeneration was assessed weekly by behavioural analysis and force measurement of the upper limb. Morphometric evaluation was carried out 8 months post-operatively and consisted of a histological examination of the deltoid muscle and the brachial plexus according to defined criteria of degeneration. In addition, atrophy of the deltoid muscle was evaluated by weight determination comparing the left with the right side. VEGF expression in the brachial plexus was quantified by an enzyme-linked immunosorbent assay (ELISA). Furthermore the motoneurons of the spinal cord segment C5 were counted comparing the left with the right side. On the functional level, VEGF-treated animals showed faster nerve regeneration. It was found less degeneration and smaller mass reduction of the deltoid muscle in VEGF-treated animals. We observed significantly less degeneration of the brachial plexus and a greater number of surviving motoneurons (P reason for these effects. The clinical use

  9. Clipping Versus Coiling in the Management of Posterior Communicating Artery Aneurysms with Third Nerve Palsy: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Gaberel, Thomas; Borha, Alin; di Palma, Camille; Emery, Evelyne

    2016-03-01

    To compare surgical clipping with endovascular coiling in terms of recovery from oculomotor nerve palsy (ONP) in the management of posterior communicating artery (PCoA) aneurysms causing third nerve palsy. We conducted a systematic review of the literature and meta-analysis. The meta-analysis included 11 relevant studies involving 384 patients with third nerve palsy caused by PCoA aneurysms at baseline, of whom 257 (67.0%) were treated by clipping and 127 were treated by coiling (33.0%). Pooled odds ratios of the impact of clipping or coiling on complete ONP recovery, lack of ONP recovery, and procedure-related death were calculated. The overall complete ONP recovery rate was 42.5% in the coiling group compared with 83.6% in the clipping group. The increase in complete ONP recovery in the clipping group corresponds to an overall pooled Mantel-Haenszel odds ratio of 4.44 (95% confidence interval = 1.66-11.84). Subgroup analysis revealed a clear benefit of clipping over coiling in patients with ruptured aneurysms, but not in patients with unruptured aneurysms. No procedure-related deaths were reported by any of the 11 studies. Surgical clipping of PCoA aneurysms causing third nerve palsy achieves better ONP recovery than endovascular coiling; this could be particularly true in the case of ruptured aneurysms. In view of the purely observational data, statements about this effect should be made with great caution. A randomized trial would better address the therapeutic dilemma, but pending the results of such a trial, we recommend treating PCoA aneurysms causing ONP with surgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. The effect of fibrosis in the upper neck on radiation-related cranial nerve palsy in patients with nasopharyngeal carcinoma

    International Nuclear Information System (INIS)

    Kong Lin; Zhang Youwang; Hu Chaosu; Wu Yongru; Guo Xiaomao

    2007-01-01

    Objective: To analyse the effect of fibrosis in the upper neck on the development of radiation-induced cranial nerve palsy (CNP) in nasopharyngeal carcinoma (NPC) patients after radiation treatment. Methods: Between Feb. 2000 and Feb. 2002, 317 consecutive patients with NPC who survival at least 5 years came to our radiotherapy center for follow-up, who were analyzed in this study. Patients who received re-irradiation were excluded. All patients received definitive external beam radiotherapy (EBRT) with either Cobalt-60 or megavoltage linear accelerators. The median radiotherapy dose was 71 Gy (range 55-86 Gy) to the primary disease, 61 Gy (range 34-72 Gy) to the upper neck. High-dose-rate brachytherapy with Ir-192 source was used in 24 patients either as part of definitive treatment or as a boost for residual disease in the nasopharynx. Forty-five patients also received chemotherapy with various regimens. Results: The median follow-up was 11.4 years (range 5.1-38.0 years). A total of 81 patients (25.5%) developed radiation-induced posterior CN group (CN IX-XII) palsy with an average annual rate of 1.8%. The cumulative incidence of CNP was 5.7%, 17.4% and 37.3% at 5-, 10- and 20-year respectively. Fifty-four (17%) patients showed severe fibrosis (G3-4) in the upper neck. Univariate and multivariate analysis showed that the total dose of radiation to the nasopharynx and upper neck fibrosis were independent risk factors for developing CNP after RT for NPC. Neck severe fibrosis was associated with approximately two-fold risk of developing CNP (RR=1.936, 95% CI: 1.521-2.466, P 70 Gy to the nasopharynx were associated with increased risk of developing CNP. Other factors, including gender, age, N classifications, chemotherapy, unconventional fractionation radiation, total radiation dose to the upper neck, and brachytherapy did not influence the risk of CNP. Conclusions: Patients who had severe fibrosis in the upper neck may be at increased risk of radiation

  11. Cranial nerve palsies in metastatic prostate cancer--results of base of skull radiotherapy

    International Nuclear Information System (INIS)

    O'Sullivan, Joe M.; Norman, Andrew R.; McNair, Helen; Dearnaley, David P.

    2004-01-01

    We studied the rate of response to palliative external beam radiation therapy (20 Gy/5 or 30 Gy/10 fractions) to the base of skull in 32 prostate cancer patients with cranial nerve dysfunction. Sixteen patients (50%; 95% CI, 34-66%) had a useful response to therapy. The median survival post-therapy was 3 months

  12. Reversal of rocuronium-induced neuromuscular blockade by sugammadex allows for optimization of neural monitoring of the recurrent laryngeal nerve.

    Science.gov (United States)

    Lu, I-Cheng; Wu, Che-Wei; Chang, Pi-Ying; Chen, Hsiu-Ya; Tseng, Kuang-Yi; Randolph, Gregory W; Cheng, Kuang-I; Chiang, Feng-Yu

    2016-04-01

    The use of neuromuscular blocking agent may effect intraoperative neuromonitoring (IONM) during thyroid surgery. An enhanced neuromuscular-blockade (NMB) recovery protocol was investigated in a porcine model and subsequently clinically applied during human thyroid neural monitoring surgery. Prospective animal and retrospective clinical study. In the animal experiment, 12 piglets were injected with rocuronium 0.6 mg/kg and randomly allocated to receive normal saline, sugammadex 2 mg/kg, or sugammadex 4 mg/kg to compare the recovery of laryngeal electromyography (EMG). In a subsequent clinical application study, 50 patients who underwent thyroidectomy with IONM followed an enhanced NMB recovery protocol-rocuronium 0.6 mg/kg at anesthesia induction and sugammadex 2 mg/kg at the operation start. The train-of-four (TOF) ratio was used for continuous quantitative monitoring of neuromuscular transmission. In our porcine model, it took 49 ± 15, 13.2 ± 5.6, and 4.2 ± 1.5 minutes for the 80% recovery of laryngeal EMG after injection of saline, sugammadex 2 mg/kg, and sugammadex 4 mg/kg, respectively. In subsequent clinical human application, the TOF ratio recovered from 0 to >0.9 within 5 minutes after administration of sugammadex 2 mg/kg at the operation start. All patients had positive and high EMG amplitude at the early stage of the operation, and intubation was without difficulty in 96% of patients. Both porcine modeling and clinical human application demonstrated that sugammadex 2 mg/kg allows effective and rapid restoration of neuromuscular function suppressed by rocuronium. Implementation of this enhanced NMB recovery protocol assures optimal conditions for tracheal intubation as well as IONM in thyroid surgery. NA. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  13. Acute necrosis after Gamma Knife surgery in vestibular schwannoma leading to multiple cranial nerve palsies.

    Science.gov (United States)

    Kapitza, Sandra; Pangalu, Athina; Horstmann, Gerhard A; van Eck, Albert T; Regli, Luca; Tarnutzer, Alexander A

    2016-08-01

    We discuss a rare acute complication after Gamma Knife therapy (Elekta AB, Stockholm, Sweden) in a single patient. A 52-year-old woman presented with vertigo, facial weakness and hearing loss emerging 48hours following Gamma Knife radiosurgery for a right-sided vestibular schwannoma. Neurological examination 6days after symptom onset showed right-sided facial palsy, spontaneous left-beating nystagmus and pathologic head-impulse testing to the right. Pure-tone audiogram revealed right-sided sensorineural hearing loss. A diagnosis of acute vestibulocochlear and facial neuropathy was made. Brain MRI demonstrated focal contrast sparing within the schwannoma, likely related to acute radiation necrosis. Acute multiple cranial neuropathies of the cerebellopontine angle after Gamma Knife treatment should raise suspicion of acute tissue damage within the schwannoma and should result in urgent MRI. Treatment with steroids may be considered based on accompanying swelling and edema. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Radiation-Induced Cranial Nerve Palsy: A Cross-Sectional Study of Nasopharyngeal Cancer Patients After Definitive Radiotherapy

    International Nuclear Information System (INIS)

    Kong, Lin; Lu, Jiade J.; Liss, Adam L.; Hu Chaosu; Guo Xiaomao; Wu Yongru; Zhang Youwang

    2011-01-01

    Purpose: To address the characteristics and the causative factors of radiation-induced cranial nerve palsy (CNP) in nasopharyngeal carcinoma (NPC) patients with an extensive period of followed-up. Patients and Methods: A total of 317 consecutive and nonselected patients treated with definitive external-beam radiotherapy between November 1962 and February 1995 participated in this study. The median doses to the nasopharynx and upper neck were 71 Gy (range, 55-86 Gy) and 61 Gy (range, 34-72 Gy), respectively. Conventional fractionation was used in 287 patients (90.5%). Forty-five patients (14.2%) received chemotherapy. Results: The median follow-up was 11.4 years (range, 5.1-38.0 years). Ninety-eight patients (30.9%) developed CNP, with a median latent period of 7.6 years (range, 0.3-34 years). Patients had a higher rate of CNP (81 cases, 25.5%) in lower-group cranial nerves compared with upper group (44 cases, 13.9%) (χ 2 = 34.444, p 2 = 4.661, p = 0.031). The cumulative incidences of CNP were 10.4%, 22.4%, 35.5%, and 44.5% at 5, 10, 15, and 20 years, respectively. Multivariate analyses revealed that CNP at diagnosis, chemotherapy, total radiation dose to the nasopharynx, and upper neck fibrosis were independent risk factors for developing radiation-induced CNP. Conclusion: Radiation-induced fibrosis may play an important role in radiation-induced CNP. The incidence of CNP after definitive radiotherapy for NPC remains high after long-term follow-up and is dose and fractionation dependent.

  15. Measurement of facial movements with Photoshop software during treatment of facial nerve palsy*

    Science.gov (United States)

    Pourmomeny, Abbas Ali; Zadmehr, Hassan; Hossaini, Mohsen

    2011-01-01

    BACKGROUND: Evaluating the function of facial nerve is essential in order to determine the influences of various treatment methods. The aim of this study was to evaluate and assess the agreement of Photoshop scaling system versus the facial grading system (FGS). METHODS: In this semi-experimental study, thirty subjects with facial nerve paralysis were recruited. The evaluation of all patients before and after the treatment was performed by FGS and Photoshop measurements. RESULTS: The mean values of FGS before and after the treatment were 35 ± 25 and 67 ± 24, respectively (p Photoshop assessment, mean changes of face expressions in the impaired side relative to the normal side in rest position and three main movements of the face were 3.4 ± 0.55 and 4.04 ± 0.49 millimeter before and after the treatment, respectively (p Photoshop was more objective than using FGS. Therefore, it may be recommended to use this method instead. PMID:22973325

  16. Measurement of facial movements with Photoshop software during treatment of facial nerve palsy.

    Science.gov (United States)

    Pourmomeny, Abbas Ali; Zadmehr, Hassan; Hossaini, Mohsen

    2011-10-01

    Evaluating the function of facial nerve is essential in order to determine the influences of various treatment methods. The aim of this study was to evaluate and assess the agreement of Photoshop scaling system versus the facial grading system (FGS). In this semi-experimental study, thirty subjects with facial nerve paralysis were recruited. The evaluation of all patients before and after the treatment was performed by FGS and Photoshop measurements. The mean values of FGS before and after the treatment were 35 ± 25 and 67 ± 24, respectively (p Photoshop assessment, mean changes of face expressions in the impaired side relative to the normal side in rest position and three main movements of the face were 3.4 ± 0.55 and 4.04 ± 0.49 millimeter before and after the treatment, respectively (p Photoshop was more objective than using FGS. Therefore, it may be recommended to use this method instead.

  17. Sixth nerve palsy - Window to a dreaded brain tumor in children (pontine glioma

    Directory of Open Access Journals (Sweden)

    Sujit Das

    2017-01-01

    Full Text Available Pontine glioma is a rare tumor and exclusively occurs in children. It originates from the glial (connective/supporting cells of the brain. In children, they are the leading cause of deaths from brain tumors. The usual age of presentation is later half of first decade. Most of the children die within 18 months of diagnosis. It mostly affects 6th and 7th cranial nerves along with hearing defect.

  18. Surgical Anatomy of the Radial Nerve at the Elbow and in the Forearm: Anatomical Basis for Intraplexus Nerve Transfer to Reconstruct Thumb and Finger Extension in C7 - T1 Brachial Plexus Palsy.

    Science.gov (United States)

    Zhang, Lei; Dong, Zhen; Zhang, Chun-Lin; Gu, Yu-Dong

    2016-11-01

    Background  C7 - T1 palsy results in complete loss of finger motion and poses a surgical challenge. This study investigated the anatomy of the radial nerve in the elbow and forearm and the feasibility of intraplexus nerve transfer to restore thumb and finger extension. Methods  The radial nerves were dissected in 28 formalin-fixed upper extremities. Branching pattern, length, diameter, and number of myelinated fibers were recorded. Results  Commonly, the branching pattern (from proximal to distal) was to the brachioradialis, extensor carpi radialis longus, superficial sensory proximal to the lateral epicondyle, extensor carpi radialis brevis, supinator, extensor digitorum communis, extensor digiti minimi, extensor carpi ulnaris, abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, and extensor indicis distal to the lateral epicondyle. Conclusions  Branches to the brachioradialis, extensor carpi radialis longus, and supinator can be transferred to the posterior interosseous nerve to restore hand movement in patients with C7 - T1 brachial plexus palsies; the supinator branch is probably the best choice in this regard. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  19. A higher quality of life with cross-face-nerve-grafting as an adjunct to a hypoglossal-facial nerve jump graft in facial palsy treatment

    NARCIS (Netherlands)

    van Veen, Martinus M.; Dijkstra, Pieter U.; Werker, Paul M. N.

    2017-01-01

    Nerve reconstructions are the preferred technique for short-standing facial paralysis, most commonly using the contralateral facial nerve or ipsilateral hypoglossal nerve. The hypoglossal nerve provides a strong motor signal, whereas the signal of a cross-face nerve graft is weaker but spontaneous.

  20. Abductor dysfunction and related sciatic nerve palsy, a new complication of metal-on-metal arthroplasty.

    Science.gov (United States)

    Beaver, Walter B; Fehring, Thomas K

    2012-08-01

    The optimal bearing for use in young patients with hip arthritis remains elusive. Current options include metal-on-cross-linked polyethylene, ceramic-on-cross-linked polyethylene, ceramic on ceramic, and metal on metal. Each of these bearing couples has advantages and disadvantages. Metal-on-metal designs allow the use of large heads that decrease impingement and improve stability. This fact has made this bearing an attractive option for surgeons and patients alike. This case report will illustrate a severe adverse reaction to metal debris with necrosis of soft tissues and subsequent damage to the sciatic nerve. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Extramedullary hematopoiesis within the clivus: an unusual cause of lower cranial nerve palsy.

    Science.gov (United States)

    Reames, Davis L; Lindstrom, Katherine; Raghavan, Prashant; Jane, John

    2010-12-01

    We report one year follow up of a case of extramedullary hematopoiesis within the clivus. The imaging findings, brief clinical course, and endoscopic transphenoidal approach are described. A 29-year-old female with thalassemia developed worsening cranial nerve signs. After imaging studies discovered a large clival mass, she underwent endoscopic transphenoidal biopsy of the lesion. Neural compression from exuberant erythrogenesis within tissue normally quiescent of red blood cell production was found to be the etiology of her neural deficit. Treatment for this condition is generally non-operative unless significant neural compression is present. Radiotherapy and anti-neoplastic agents have been used with success.

  2. Facial Nerve Palsy: An Unusual Presenting Feature of Small Cell Lung Cancer

    Directory of Open Access Journals (Sweden)

    Ozcan Yildiz

    2011-01-01

    Full Text Available Lung cancer is the second most common type of cancer in the world and is the most common cause of cancer-related death in men and women; it is responsible for 1.3 million deaths annually worldwide. It can metastasize to any organ. The most common site of metastasis in the head and neck region is the brain; however, it can also metastasize to the oral cavity, gingiva, tongue, parotid gland and lymph nodes. This article reports a case of small cell lung cancer presenting with metastasis to the facial nerve.

  3. Report of a child with acute herpes zoster ophthalmicus induced partial third nerve palsy

    Directory of Open Access Journals (Sweden)

    AR Suraida

    2015-06-01

    Full Text Available Herpes zoster is a reactivation of the varicella zoster virus (VZV, which may remain dormant in the dorsal root ganglion of the trigeminal nerve for decades after the patient's initial exposure. The ophthalmic branch of the trigeminal nerve, i.e., the innervation to the ocular structures, is one of the most commonly involved dermatomes, giving rise to herpes zoster ophthalmicus (HZO. A 10-year-old indigenous Malaysian girl presented with a complaint of painful blurring of vision in the right eye for one week. It was followed a few days later by cutaneous vesicular eruptions over the right side of her face and nose and drooping of the right upper lid, associated with double vision. In children, the disease usually follows a mild course, resolving without residual damage. However, this child achieved a best corrected visual acuity of only 6/36 in the affected eye due to corneal scarring. The rashes healed by formation of disfiguring keloids over the right nasal area. This is another rarely reported complication of HZO in immunocompetent individuals.

  4. Third nerve palsy caused by compression of the posterior communicating artery aneurysm does not depend on the size of the aneurysm, but on the distance between the ICA and the anterior-posterior clinoid process.

    Science.gov (United States)

    Anan, Mitsuhiro; Nagai, Yasuyuki; Fudaba, Hirotaka; Kubo, Takeshi; Ishii, Keisuke; Murata, Kumi; Hisamitsu, Yoshinori; Kawano, Yoshihisa; Hori, Yuzo; Nagatomi, Hirofumi; Abe, Tatsuya; Fujiki, Minoru

    2014-08-01

    Third nerve palsy (TNP) caused by a posterior communicating artery (PCoA) aneurysm is a well-known symptom of the condition, but the characteristics of unruptured PCoA aneurysm-associated third nerve palsy have not been fully evaluated. The aim of this study was to analyze the anatomical features of PCoA aneurysms that caused TNP from the viewpoint of the relationship between the ICA and the skull base. Forty-eight unruptured PCoA aneurysms were treated surgically between January 2008 and September 2013. The characteristics of the aneurysms were evaluated. Thirteen of the 48 patients (27%) had a history of TNP. The distance between the ICA and the anterior-posterior clinoid process (ICA-APC distance) was significantly shorter in the TNP group (pPCoA aneurysms can cause third nerve palsy if the ICA runs close to the skull base. Copyright © 2014 Elsevier B.V. All rights reserved.

  5. Bell's Palsy (For Kids)

    Science.gov (United States)

    ... palsy was named after a Scottish doctor, Sir Charles Bell, who studied the two facial nerves that ... who focuses on how the nervous system works — will do a test called electromyography (say: eh-lek- ...

  6. Clinical value and indication for the dissection of lymph nodes posterior to the right recurrent laryngeal nerve in papillary thyroid carcinoma.

    Science.gov (United States)

    Luo, Ding-Cun; Xu, Xiao-Cheng; Ding, Jin-Wang; Zhang, Yu; Peng, You; Pan, Gang; Zhang, Wo

    2017-10-03

    Lymph nodes posterior to the right recurrent laryngeal nerve (LN-prRLN) are common sites of nodal recurrence after the resection of papillary thyroid carcinoma (PTC). However, the indication for LN-prRLN dissection remains debatable. We therefore studied the relationships between LN-prRLN metastasis and the clinicopathological characteristics in 306 patients with right or bilateral PTC who underwent LN-prRLN dissection. We found that LN-prRLN metastasis occurred in 16.67% of PTC and was associated with a number of the clinicopathological features. The receiver-operator characteristic (ROC) analysis showed that the areas under the ROC curves for the prediction of LN-prRLN metastasis by the risk factors age right tumor size > 0.85 cm, lymph node (right cervical central VI-1) number > 1.5, metastatic lymph node (right cervical central VI-1) size > 0.45 cm, and lymph node number in the right cervical lateral compartment > 0.5 were 0.601, 0.815, 0.813, 0.725, and 0.743, respectively. In conclusion, the risk factors for LN-prRLN metastasis in patients suffering right thyroid lobe or bilateral PTC include age ≤ 35.5 years, right tumor size ≥ 0.85 cm, capsular invasion, metastatic lymph node (right cervical central VI-1) number ≥ 2, metastatic lymph node (right cervical central VI-1) size ≥ 0.45 cm, and metastatic lymph node number in the right cervical lateral compartment ≥ 1. In patients whose risk factors can be identified pre-operatively or intraoperatively, the dissection of LN-pr-RLN should be considered during right cervical central compartment dissection.

  7. Posterior cricoarytenoid muscle electrophysiologic changes are predictive of vocal cord paralysis with recurrent laryngeal nerve compressive injury in a canine model.

    Science.gov (United States)

    Puram, Sidharth V; Chow, Harold; Wu, Che-Wei; Heaton, James T; Kamani, Dipti; Gorti, Gautham; Chiang, Feng Yu; Dionigi, Gianlorenzo; Barczynski, Marcin; Schneider, Rick; Dralle, Henning; Lorenz, Kerstin; Randolph, Gregory W

    2016-12-01

    Injury to the recurrent laryngeal nerve (RLN) is a dreaded complication of endocrine surgery. Intraoperative neural monitoring (IONM) has been increasingly utilized to assess the functional status of the RLN. Although the posterior cricoarytenoid muscle (PCA) is innervated by the RLN as the abductor of the larynx, PCA electromyography (EMG) is infrequently recorded during IONM and PCA activity after RLN compressive injury remains poorly characterized. Single-subject prospective animal study. We employed a canine model to identify postcricoid EMG correlates of postoperative vocal cord paralysis (VCP). Postcricoid electrode recordings were obtained before and after compressive RLN injury associated with VCP. Normative postcricoid recordings revealed mean amplitude of 1288 microvolt (μV) and latency of 8.2 millisecond (ms) with maximum (1 milliamp [mA]) vagal stimulation, and mean amplitude of 1807 μV and latency of 3.5 ms with maximum (1 mA) RLN stimulation. Following injury that was associated with VCP, there was 62.1% decrement in postcricoid EMG amplitude with maximum vagal stimulation and 80% decrement with maximum RLN stimulation. Threshold stimulation of the vagus increased by 23%, and there was a corresponding 42% decrease in amplitude. For RLN stimulation, latency increased by 17.3% following injury, whereas threshold stimulation increased by 61% with 35.5% decrement in EMG amplitude. Thus, if RLN amplitude decreases by ≥ 80%, with absolute amplitude of ≤ 300 μV or less and latency increase of ≥ 10%, RLN injury is likely associated with VCP. Our results predict postoperative VCP based on postcricoid electromyographic IONM and may guide surgical decision making. NA Laryngoscope, 126:2744-2751, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  8. Laryngeal Leishmaniasis

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    Moraes, Bruno Teixeira de

    2012-01-01

    Full Text Available Introduction: Leishmaniasis is classified into three clinical presentations: visceral, coetaneous and mucocutaneous. The latter is usually secondary to hematogenous spread after months or years of skin infection and can manifest as infiltrative lesions, ulcerated or vegetating in nose, pharynx, larynx and mouth, associated or not with ganglionics infarction. Laryngeal involvement is part of the differential diagnosis of lesions in this topography as nonspecific chronic laryngitis, granulomatosis and even tumors of the upper aerodigestive tract presenting atypical evolution. Sometimes it is difficult for the correct diagnosis of Leishmaniasis, with description of cases in the literature were conducted improperly. Objective: The objective of this study is to report a case of laryngeal Leishmaniasis addressing the difficulty of diagnosis, complications and treatment applied. Case Report: A patient with pain throat, dysphagia, odynophagia, dysphonia and weight loss, with no improvement with symptomatic medication. At telelaringoscopy, infiltrative lesion showed nodular supraglottis. He underwent a tracheotomy for airway obstruction and biopsy with immunohistochemical study for a definitive diagnosis of laryngeal Leishmaniasis. The patient was referred to the infectious diseases that initiated treatment with N-methylglucamine antimoniate with satisfactory response to therapy. Final Comments: Faced with a clinical suspicion of granulomatous diseases, it is essential to follow protocol laboratory evaluation associated with histological injury, to get a precise definition etiological without prolonging the time of diagnosis. Medical treatment for mucosal Leishmaniasis, recommended by the World Health Organization, was adequate in the case of laryngeal disorders, with complete resolution of symptoms.

  9. Antiviral Agents Added to Corticosteroids for Early Treatment of Adults With Acute Idiopathic Facial Nerve Paralysis (Bell Palsy).

    Science.gov (United States)

    Sullivan, Frank; Daly, Fergus; Gagyor, Ildiko

    Compared with oral corticosteroids alone, are oral antiviral drugs associated with improved outcomes when combined with oral corticosteroids in patients presenting within 72 hours of the onset of Bell palsy? Compared with oral corticosteroids alone, the addition of acyclovir, valacyclovir, or famcyclovir to oral corticosteroids for treatment of Bell palsy was associated with a higher proportion of people who recovered at 3- to 12-month follow-up. The quality of evidence is limited by heterogeneity, imprecision of the result estimates, and risk of bias.

  10. Detection of third and sixth cranial nerve palsies with a novel method for eye tracking while watching a short film clip.

    Science.gov (United States)

    Samadani, Uzma; Farooq, Sameer; Ritlop, Robert; Warren, Floyd; Reyes, Marleen; Lamm, Elizabeth; Alex, Anastasia; Nehrbass, Elena; Kolecki, Radek; Jureller, Michael; Schneider, Julia; Chen, Agnes; Shi, Chen; Mendhiratta, Neil; Huang, Jason H; Qian, Meng; Kwak, Roy; Mikheev, Artem; Rusinek, Henry; George, Ajax; Fergus, Robert; Kondziolka, Douglas; Huang, Paul P; Smith, R Theodore

    2015-03-01

    Automated eye movement tracking may provide clues to nervous system function at many levels. Spatial calibration of the eye tracking device requires the subject to have relatively intact ocular motility that implies function of cranial nerves (CNs) III (oculomotor), IV (trochlear), and VI (abducent) and their associated nuclei, along with the multiple regions of the brain imparting cognition and volition. The authors have developed a technique for eye tracking that uses temporal rather than spatial calibration, enabling detection of impaired ability to move the pupil relative to normal (neurologically healthy) control volunteers. This work was performed to demonstrate that this technique may detect CN palsies related to brain compression and to provide insight into how the technique may be of value for evaluating neuropathological conditions associated with CN palsy, such as hydrocephalus or acute mass effect. The authors recorded subjects' eye movements by using an Eyelink 1000 eye tracker sampling at 500 Hz over 200 seconds while the subject viewed a music video playing inside an aperture on a computer monitor. The aperture moved in a rectangular pattern over a fixed time period. This technique was used to assess ocular motility in 157 neurologically healthy control subjects and 12 patients with either clinical CN III or VI palsy confirmed by neuro-ophthalmological examination, or surgically treatable pathological conditions potentially impacting these nerves. The authors compared the ratio of vertical to horizontal eye movement (height/width defined as aspect ratio) in normal and test subjects. In 157 normal controls, the aspect ratio (height/width) for the left eye had a mean value ± SD of 1.0117 ± 0.0706. For the right eye, the aspect ratio had a mean of 1.0077 ± 0.0679 in these 157 subjects. There was no difference between sexes or ages. A patient with known CN VI palsy had a significantly increased aspect ratio (1.39), whereas 2 patients with known CN III

  11. [Bell's palsy].

    Science.gov (United States)

    Prud'hon, S; Kubis, N

    2018-03-30

    Idiopathic peripheral facial palsy, also named Bell's palsy, is the most common cause of peripheral facial palsy in adults. Although it is considered as a benign condition, its social and psychological impact can be dramatic, especially in the case of incomplete recovery. The main pathophysiological hypothesis is the reactivation of HSV 1 virus in the geniculate ganglia, leading to nerve edema and its compression through the petrosal bone. Patients experience an acute (less than 24 hours) motor deficit involving ipsilateral muscles of the upper and lower face and reaching its peak within the first three days. Frequently, symptoms are preceded or accompanied by retro-auricular pain and/or ipsilateral face numbness. Diagnosis is usually clinical but one should look for negative signs to eliminate central facial palsy or peripheral facial palsy secondary to infectious, neoplastic or autoimmune diseases. About 75% of the patients will experience spontaneous full recovery, this rate can be improved with oral corticotherapy when introduced within the first 72 hours. To date, no benefit has been demonstrated by adding an antiviral treatment. Hemifacial spasms (involuntary muscles contractions of the hemiface) or syncinesia (involuntary muscles contractions elicited by voluntary ones, due to aberrant reinnervation) may complicate the disease's course. Electroneuromyography can be useful at different stages: it can first reveal the early conduction bloc, then estimate the axonal loss, then bring evidence of the reinnervation process and, lastly, help for the diagnosis of complications. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  12. Relation between functional dysphagia and vocal cord palsy after transhiatal oesophagectomy.

    Science.gov (United States)

    Pierie, J P; Goedegebuure, S; Schuerman, F A; Leguit, P

    2000-03-01

    To assess the incidence, natural course, and possible pathogenesis of dysphagia that is not caused by anastomotic stricture, after transhiatal oesophagectomy and gastric tube reconstruction. Prospective study. District teaching hospital, The Netherlands. 22 patients who had transhiatal oesophagectomy and gastric tube reconstruction for cancer. Incidence of dysphagia that is not caused by anastomotic stricture one week after operation, and presence of this functional dysphagia and correlation with vocal cord palsy at 4, 8, 12, and 16 weeks postoperatively. The incidence of functional dysphagia was 7 out of 22 (32%); it was self-limiting in 5 out of 7 (71%) of the cases and associated with the incidence of vocal cord palsy (p = 0.0006). Functional dysphagia after transhiatal oesophagectomy occurs frequently, but is self-limiting in most patients. Injury to branches of the recurrent laryngeal nerve is a likely cause.

  13. Agreement between the Facial Nerve Grading System 2.0 and the House-Brackmann Grading System in Patients with Bell Palsy.

    Science.gov (United States)

    Lee, Ho Yun; Park, Moon Suh; Byun, Jae Yong; Chung, Ji Hyun; Na, Se Young; Yeo, Seung Geun

    2013-09-01

    We have analyzed the correlation between the House-Brackmann (HB) scale and Facial Nerve Grading System 2.0 (FNGS 2.0) in patients with Bell palsy, and evaluated the usefulness of the new grading system. Sixty patients diagnosed with Bell palsy from May 2009 to December 2010 were evaluated using the HB scale and FNGS 2.0 scale during their initial visit, and after 3 and 6 weeks and 3 months. The overall intraclass correlation coefficient (ICC) was 0.908 (P=0.000) and the Spearman correlation coefficient (SCC) was 0.912 (P<0.05). ICC and SCC displayed differences over time, being 0.604 and 0.626, respectively, at first visit; 0.834 and 0.843, respectively, after 3 weeks; 0.844 and 0.848, respectively, after 6 weeks; and 0.808 and 0.793, respectively, after 3 months. There was a significant difference in full recovery, depending on the scale used (HB, P=0.000; FNGS 2.0, P<0.05). The exact agreements between regional assessment and FNGS 2.0 for the mouth, eyes, and brow were 72%, 63%, and 52%, respectively. FNGS 2.0 shows moderate agreement with HB grading. Regional assessment, rather than HB grading, yields stricter evaluation, resulting in better prognosis and determination of grade.

  14. Delayed recurrent nerve paralysis following post-traumatic aortic pseudoaneurysm

    Directory of Open Access Journals (Sweden)

    Mesolella Massimo

    2016-01-01

    Full Text Available Blunt trauma to the neck or to the chest are increasingly observed in the emergency clinical practice. They usually follow motor vehicle accidents or may be work or sports related. A wide pattern of clinical presentation can be potentially encountered. We report the uncommon case of a patient who was referred to our observation presenting with hoarseness and disphagia. Twenty days before he had sustained a car accident with trauma to the chest, neck and the mandible. Laryngoscopy showed a left recurrent laryngeal nerve palsy. Further otolaryngo-logical examination showed no other abnormality. At CT and MR imaging a post-traumatic aortic pseudoaneurysm was revealed. The aortic pseudoaneurysm was consequently repaired by implantation of an endovascular stent graft under local anesthesia. The patient was discharged 10 days later. At 30-days follow-up laryngoscopy the left vocal cord palsy was completely resolved.

  15. Isolated laryngeal myasthenia gravis for 26 years.

    Science.gov (United States)

    Renard, Dimitri; Hedayat, Amir; Gagnard, Corinne

    2015-02-01

    Laryngeal myasthenia gravis is a relatively rare variant of myasthenia gravis. A vast portion of patients with initial laryngeal myasthenia gravis develop involvement of ocular and/or extra-ocular muscles during the years after symptom onset although a minority of laryngeal myasthenia gravis patients continues to have isolated laryngeal muscle involvement for several years. We present a 58-year-old woman with recurrent episodic isolated dysphonia (associated with diffuse bilateral vocal cord paresis on laryngoscopy) since the age of 32. Dysphonia became permanent since 6 months. A diagnosis of laryngeal myasthenia gravis was made based on abnormal single-fiber electromyography and spectacular response to pyridostigmine treatment. Repetitive nerve stimulation was normal and anti-acetylcholine receptor and anti-muscle specific tyrosine kinase antibodies were absent. This case shows that laryngeal myasthenia gravis can be isolated during 26 years of follow-up. We propose that even when myasthenia gravis seems unlikely as underlying mechanism of isolated dysphonia (because of lack of antibodies, normal repetitive nerve stimulation, and absence of extra-laryngeal involvement after years of follow-up), single-fiber electromyography should be performed and myasthenia gravis treatment should be tried. Copyright © 2014 Elsevier B.V. All rights reserved.

  16. [Damage to cranial and peripheral nerves following patency restoration of the internal carotid artery].

    Science.gov (United States)

    Myrcha, P; Ciostek, P; Szopiński, P; Noszczyk, W

    2001-01-01

    The aim of the study was an assessment of the incidence of injury to cranial and peripheral nerves as complication of patency restoration of the internal carotid artery, and analysis of the effect of peripheral nerve injury on the results of carotid patency restoration. From Oct 1987 to Sept 1999 543 procedures were carried out for restoration of patency of the internal carotid artery. After the operation hypoglossus nerve injury was found in 7 cases (1.4%), vagus injury in 9 (1.8%). Signs of exclusively recurrent laryngeal nerve damage were found in 6 cases (1.2%). Glossopharyngeus nerve was damaged in 2 cases (0.4%), transient phrenic nerve palsy as a result of conduction anaesthesia was noted in 2 cases (0.4%). Damage to the transverse cervical nerve was found in 96 cases (60%). In 2 patients (1.2%) lower position of mouth angle was due to section of the mandibular ramus of the facial nerve. In another 2 cases skin sensation disturbances were a consequence of lesion of the auricularis magnus nerve and always they coexisted with signs of transverse cervical nerve damage. damage to the cranial nerves during operation for carotid patency restoration are frequent but mostly they are not connected with any health risks and often they regress spontaneously.

  17. Aerodynamic and Nonlinear Dynamic Acoustic Analysis of Tension Asymmetry in Excised Canine Larynges

    Science.gov (United States)

    Devine, Erin E.; Bulleit, Erin E.; Hoffman, Matthew R.; McCulloch, Timothy M.; Jiang, Jack J.

    2012-01-01

    Purpose: To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. Method: SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension…

  18. Quantitative PCR Analysis of Laryngeal Muscle Fiber Types

    Science.gov (United States)

    Van Daele, Douglas J.

    2010-01-01

    Voice and swallowing dysfunction as a result of recurrent laryngeal nerve paralysis can be improved with vocal fold injections or laryngeal framework surgery. However, denervation atrophy can cause late-term clinical failure. A major determinant of skeletal muscle physiology is myosin heavy chain (MyHC) expression, and previous protein analyses…

  19. Neurophysiology and Clinical Implications of the Laryngeal Adductor Reflex.

    Science.gov (United States)

    Domer, Amanda S; Kuhn, Maggie A; Belafsky, Peter C

    2013-09-01

    The laryngeal adductor reflex (LAR) is an involuntary protective response to stimuli in the larynx. The superior laryngeal nerve (SLN) acts as the afferent limb and the recurrent laryngeal nerve (RLN) as the efferent limb of this reflex, which is modulated by the central nervous system. Perhaps the most clinically significant application of the LAR is its use in laryngopharyngeal (LP) sensory discrimination testing. Importantly, aberrations in the LAR may predict dysphagia or portend clinical phenotypes of chronic cough, vocal cord dysfunction or pediatric apneas. LP sensation is a potential target for interventions addressing the aforementioned conditions though currently remains an area of active investigation.

  20. ANCA-Negative Granulomatosis with Polyangiitis Presenting with Hypertrophic Cranial Pachymeningitis, Abducens Nerve Palsy, and Stenosis of the Internal Carotid Artery

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    Shohei Harabuchi

    2017-01-01

    Full Text Available We report a rare case of granulomatosis with polyangiitis (GPA presenting with hypertrophic cranial pachymeningitis (HCP, abducens nerve palsy, and stenosis of the internal carotid artery (ICA. A 59-year-old Japanese man presented with a year history of nasal obstruction and a 2-month history of slight headache. Histopathological examination of the granulomatous mucosa in the ethmoid sinuses resected by endoscopic sinus surgery revealed necrotizing vasculitis with multinucleated giant cells. The patient was diagnosed with the limited form of GPA as a result of the systemic examination. He declined immunosuppressive treatment. Eighteen months after the diagnosis of GPA, he presented with diplopia and severe headache. Though nasal findings indicating GPA were not observed in the nasal cavity, CT scan revealed a lesion of the right sphenoid sinus eroding the bone of the clivus. Gadolinium-enhanced MRI of the brain showed thickening of the dura mater around the right cavernous sinus and clivus. Magnetic resonance angiography and cerebral angiography revealed narrowing at the C5 portion of the ICA. Intravenous methylprednisolone pulse therapy followed by oral prednisolone and cyclophosphamide resolved headache and dramatically improved HCP and stenosis of the ICA.

  1. Radiation-related vocal fold palsy in patients with head and neck carcinoma.

    Science.gov (United States)

    Jaruchinda, Pariyanan; Jindavijak, Somjin; Singhavarach, Natchavadee

    2012-05-01

    Recurrent laryngeal nerve damage is a rare complication after receiving conventional radiotherapy for treatment of head and neck cancers and will always be underestimated. The purpose of the present study was to focus on the prevalence of vocal cord paralysis after irradiation and the natural history in those patients. All patients who received more than 60 Gy radiation dose of convention radiotherapy for treatment of head and neck carcinoma from Phramongkutklao Hospital and Nation Cancer Institute of Thailand were recruited in the present study duringfollow-up period between May 2006-December 2007. The subjects had to have good mobility of bilateral vocal cords with no recurrence or persistent tumor before the enrollment. Baseline characteristic and the associated symptoms of the recurrent laryngeal nerve paralysis were recorded. Laryngeal examinations were done byfiberoptic laryngoscope and in suspicious cases; stroboscope and/or laryngeal electromyography were also performed. The vocal fold paralysis was diagnosed by reviewing recorded VDO by 2 laryngologist who were not involved in the present study. 70 patients; 51 male and 19female were recruited. 5 patients (7.14%) were diagnosed to have vocal cord paralysis and 2 patients (2.86%) were found to have vocal cord paresis confirmed by electromyography. Most of them were the patients with nasopharyngeal cancers (6/7) with the only one had oropharyngeal cancer (1/7). All of the paralysis/paresis was unilateral lesion; 4 on the left and 3 on the right side. The duration from the patients completed radiotherapy to the time of the diagnosis of vocal cord palsy was 14-35 months. The measure of agreement or Kappa value with 95% CI was 0.818 +/- 0.245. Associated symptoms of vocal cord palsy are hoarseness (100%), dysphagia (28.6%) and aspiration (28.6%). A significant number of vocal fold palsy may occur in patients with head and neck carcinoma after receiving conventional radiotherapy. Subcutaneous fibrosis or

  2. Optimal learning in a virtual patient simulation of cranial nerve palsies: the interaction between social learning context and student aptitude.

    Science.gov (United States)

    Johnson, Teresa R; Lyons, Rebecca; Chuah, Joon Hao; Kopper, Regis; Lok, Benjamin C; Cendan, Juan C

    2013-01-01

    Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the neurological exam rehearsal virtual environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤ 50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students.

  3. Optimal learning in a virtual patient simulation of cranial nerve palsies: The interaction between social learning context and student aptitude

    Science.gov (United States)

    JOHNSON, TERESA R.; LYONS, REBECCA; CHUAH, JOON HAO; KOPPER, REGIS; LOK, BENJAMIN C.; CENDAN, JUAN C.

    2013-01-01

    Background Simulation in medical education provides students with opportunities to practice interviews, examinations, and diagnosis formulation related to complex conditions without risks to patients. Aim To examine differences between individual and team participation on learning outcomes and student perspectives through use of virtual patients (VPs) for teaching cranial nerve (CN) evaluation. Methods Fifty-seven medical students were randomly assigned to complete simulation exercises either as individuals or as members of three-person teams. Students interviewed, examined, and diagnosed VPs with possible CN damage in the Neurological Exam Rehearsal Virtual Environment (NERVE). Knowledge of CN abnormalities was assessed pre- and post-simulation. Student perspectives of system usability were evaluated post-simulation. Results An aptitude-treatment interaction (ATI) effect was detected; at pre-test scores ≤50%, students in teams scored higher (83%) at post-test than did students as individuals (62%, p = 0.02). Post-simulation, students in teams reported greater confidence in their ability to diagnose CN abnormalities than did students as individuals (p = 0.02; mean rating = 4.0/5.0 and 3.4/5.0, respectively). Conclusion The ATI effect allows us to begin defining best practices for the integration of VP simulators into the medical curriculum. We are persuaded to implement future NERVE exercises with small teams of medical students. PMID:22938679

  4. Enhanced MRI in patients with facial palsy

    International Nuclear Information System (INIS)

    Yanagida, Masahiro; Kato, Tsutomu; Ushiro, Koichi; Kitajiri, Masanori; Yamashita, Toshio; Kumazawa, Tadami; Tanaka, Yoshimasa

    1991-01-01

    We performed Gd-DTPA-enhanced magnetic resonance imaging (MRI) examinations at several stages in 40 patients with peripheral facial nerve palsy (Bell's palsy and Ramsay-Hunt syndrome). In 38 of the 40 patients, one and more enhanced region could be seen in certain portion of the facial nerve in the temporal bone on the affected side, whereas no enhanced regions were seen on the intact side. Correlations between the timing of the MRI examination and the location of the enhanced regions were analysed. In all 6 patients examined by MRI within 5 days after the onset of facial nerve palsy, enhanced regions were present in the meatal portion. In 3 of the 8 patients (38%) examined by MRI 6 to 10 days after the onset of facial palsy, enhanced areas were seen in both the meatal and labyrinthine portions. In 8 of the 9 patients (89%) tested 11 to 20 days after the onset of palsy, the vertical portion was enhanced. In the 12 patients examined by MRI 21 to 40 days after the onset of facial nerve palsy, the meatal portion was not enhanced while the labyrinthine portion, the horizontal portion and the vertical portion were enhanced in 5 (42%), 8 (67%) and 11 (92%), respectively. Enhancement in the vertical portion was observed in all 5 patients examined more than 41 days after the onset of facial palsy. These results suggest that the central portion of the facial nerve in the temporal bone tends to be enhanced in the early stage of facial nerve palsy, while the peripheral portion is enhanced in the late stage. These changes of Gd-DTPA enhanced regions in the facial nerve may suggest dromic degeneration of the facial nerve in peripheral facial nerve palsy. (author)

  5. Intramuscular myxoid lipoma in the proximal forearm presenting as an olecranon mass with superficial radial nerve palsy: a case report

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    Hildebrand Kevin A

    2011-07-01

    Full Text Available Abstract Background Extremity lipomas may occur in any location, including the proximal forearm. We describe a case of a patient with an intramuscular lipoma presenting as an unusual posterior elbow mass. Case presentation We discuss the case of a 57-year-old Caucasian man who presented with a tender, posterior elbow mass initially diagnosed as chronic olecranon bursitis. A minor sensory disturbance in the distribution of the superficial radial nerve was initially thought to be unrelated, but was likely caused by mass effect from the lipoma. No pre-operative advanced imaging was obtained because the diagnosis was felt to have already been made. At the time of surgery, a fatty mass originating in the volar forearm muscles was found to have breached the dorsal forearm fascia and displaced the olecranon bursa. Tissue diagnosis was made by histopathology as a myxoid lipoma with no aggressive features. Post-operative recovery was uneventful. Conclusion We present a case of an unusual elbow mass presenting with symptoms consistent with chronic olecranon bursitis, a relatively common condition. The only unexplained pre-operative finding was the non-specific finding of a transient superficial radial nerve deficit. We remind clinicians to be cautious when diagnosing soft tissue masses in the extremities when unexplained physical findings are present.

  6. Case report of physiotherapy care in patient with facial nervus palsy.

    OpenAIRE

    Zachová, Lenka

    2012-01-01

    Title: Case report of physiotherapy care in patient with facial nervus peripheral palsy. Objective: Summary of theoretical knowledge and working out the case report of patient diagnosed with peripheral palsy of right facial nerve. Methode and result: This thesis comprehensively summarizes the findings of peripheral facial nerve palsy and its treatment, especially with physiotherapeutic methods. It gives a wide view at the issue of physiotherapy in facial nerve palsy which is a symptom of many...

  7. Recurrences of Bell's palsy.

    Science.gov (United States)

    Cirpaciu, D; Goanta, C M; Cirpaciu, M D

    2014-01-01

    Bell's palsy in known as the most common cause of facial paralysis, determined by the acute onset of lower motor neuron weakness of the facial nerve with no detectable cause. With a lifetime risk of 1 in 60 and an annual incidence of 11-40/100,000 population, the condition resolves completely in around 71% of the untreated cases. Clinical trials performed for Bell's palsy have reported some recurrences, ipsilateral or contralateral to the side affected in the primary episode of facial palsy. Only few data are found in the literature. Melkersson-Rosenthal is a rare neuromucocutaneous syndrome characterized by recurrent facial paralysis, fissured tongue (lingua plicata), orofacial edema. We attempted to analyze some clinical and epidemiologic aspects of recurrent idiopathic palsy, and to develop relevant correlations between the existing data in literature and those obtained in this study. This is a retrospective study carried out on a 10-years period for adults and a five-year period for children. A number of 185 patients aged between 4 and 70 years old were analyzed. 136 of them were adults and 49 were children. 22 of 185 patients with Bell's palsy (12%) had a recurrent partial or complete facial paralysis with one to six episodes of palsy. From this group of 22 cases, 5 patients were diagnosed with Melkersson-Rosenthal syndrome. The patients' age was between 4 and 70 years old, with a medium age of 27,6 years. In the group studied, fifteen patients, meaning 68%, were women and seven were men. The majority of patients in our group with more than two facial palsy episodes had at least one episode on the contralateral side. Our study found a significant incidence of recurrences of idiopathic facial palsy. Recurrent idiopathic facial palsy and Melkersson-Rosenthal syndrome is diagnosed more often in young females. Recurrence is more likely to occur in the first two years from the onset, which leads to the conclusion that we should have a follow up of patients

  8. Bell's Palsy

    Science.gov (United States)

    Bell's palsy is the most common cause of facial paralysis. It usually affects just one side of the ... become inflamed. You are most likely to get Bell's palsy if you are pregnant, diabetic or sick with ...

  9. Cerebral Palsy

    Science.gov (United States)

    Cerebral palsy is a group of disorders that affect a person's ability to move and to maintain balance ... do not get worse over time. People with cerebral palsy may have difficulty walking. They may also have ...

  10. Relationship Between Laryngeal Electromyography and Video Laryngostroboscopy in Vocal Fold Paralysis.

    Science.gov (United States)

    Maamary, Joel A; Cole, Ian; Darveniza, Paul; Pemberton, Cecilia; Brake, Helen Mary; Tisch, Stephen

    2017-09-01

    The objective of this study was to better define the relationship of laryngeal electromyography and video laryngostroboscopy in the diagnosis of vocal fold paralysis. Retrospective diagnostic cohort study with cross-sectional data analysis METHODS: Data were obtained from 57 patients with unilateral vocal fold paralysis who attended a large tertiary voice referral center. Electromyographic findings were classified according to recurrent laryngeal nerve, superior laryngeal nerve, and high vagal/combined lesions. Video laryngostroboscopy recordings were classified according to the position of the immobile fold into median, paramedian, lateral, and a foreshortened/hooded vocal fold. The position of the paralyzed vocal fold was then analyzed according to the lesion as determined by electromyography. The recurrent laryngeal nerve was affected in the majority of cases with left-sided lesions more common than right. Vocal fold position differed between recurrent laryngeal and combined vagal lesions. Recurrent laryngeal nerve lesions were more commonly associated with a laterally displaced immobile fold. No fold position was suggestive of a combined vagal lesion. The inter-rater reliability for determining fold position was high. Laryngeal electromyography is useful in diagnosing neuromuscular dysfunction of the larynx and best practice recommends its continued implementation along with laryngostroboscopy. While recurrent laryngeal nerve lesions are more likely to present with a lateral vocal fold, this does not occur in all cases. Such findings indicate that further unknown mechanisms contribute to fold position in unilateral paralysis. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  11. Bell palsy in a neonate with rapid response to oral corticosteroids: a case report.

    Science.gov (United States)

    Saini, Arushi; Singhi, Pratibha; Sodhi, K S; Gupta, Ajit

    2013-04-01

    Idiopathic facial nerve palsy, also known as Bell palsy is rare in the neonatal age group. Other more common causes such as birth trauma; infections, especially otitis media; and congenital malformations need to be excluded. We present here a 4-week-old neonate with Bell palsy who responded rapidly to oral corticosteroids. Such an early presentation of idiopathic facial nerve palsy and use of corticosteroids in neonates is scarcely reported in the literature.

  12. Clinical practice guideline: Bell's palsy.

    Science.gov (United States)

    Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

    2013-11-01

    Bell's palsy, named after the Scottish anatomist, Sir Charles Bell, is the most common acute mono-neuropathy, or disorder affecting a single nerve, and is the most common diagnosis associated with facial nerve weakness/paralysis. Bell's palsy is a rapid unilateral facial nerve paresis (weakness) or paralysis (complete loss of movement) of unknown cause. The condition leads to the partial or complete inability to voluntarily move facial muscles on the affected side of the face. Although typically self-limited, the facial paresis/paralysis that occurs in Bell's palsy may cause significant temporary oral incompetence and an inability to close the eyelid, leading to potential eye injury. Additional long-term poor outcomes do occur and can be devastating to the patient. Treatments are generally designed to improve facial function and facilitate recovery. There are myriad treatment options for Bell's palsy, and some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, numerous diagnostic tests available are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy. The primary purpose of this guideline is to improve the accuracy of diagnosis for Bell's palsy, to improve the quality of care and outcomes for patients with Bell's palsy, and to decrease harmful variations in the evaluation and management of Bell's palsy. This guideline addresses these needs by encouraging

  13. Paralisia facial periférica bilateral na leucemia linfóide aguda: relato de caso Bilateral peripheric facial nerve palsy in acute linfoid leukemia: a case report

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    Marcos L. Antunes

    2004-04-01

    Full Text Available A mímica facial é fundamental para a expressão e comunicação humana, que são possíveis apenas através da integridade do nervo facial. Sendo assim, a paralisia facial periférica (PFP pode deixar seqüelas estéticas, funcionais e psicológicas. A causa mais comum é a paralisia de Bell (50 a 80%, onde a maioria dos pacientes apresenta manifestação unilateral. O acometimento bilateral simultâneo é raro, sendo a leucemia a neoplasia que com maior freqüência pode resultar nesse tipo de manifestação. A seguir, relatamos o caso de um paciente de dezoito anos de idade apresentando leucemia linfóide aguda (LLA e PFP simultânea, ambas refratárias ao tratamento quimioterápico, culminando com o óbito cinco meses após o início da PFP. Realizou-se considerações importantes sobre a fisiopatologia da PFP na LLA, além de uma revisão da literatura.The facial mimic is very important to the human expression and communication, which depend on the integrity of the facial nerve. So, the peripheric facial palsy (PFP can leave esthetics, functional and psychological sequelae. The more common etiology is Bell's palsy (50 to 80% and most of the patients show a unilateral manifestation. The simultaneous bilateral PFP is rare, and the leukemia is the neoplasia that can often that kind of manifestation. We present a clinical case of an 18-year-old patient with acute lymphoid leukemia and simultaneous bilateral facial palsy, who did not recover after the chemotherapy treatment, and died five months after the initial manifestation of the facial palsy. Important considerations were accomplished about the physiopathology of PFP in acute lymphoid leukemia, besides literature review.

  14. To wait for a spontaneous recovery of the third cranial nerve palsy occurring after the coiling of a PcomA aneurysm or to implement surgical treatment? A case report

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    Peulić Miodrag

    2017-01-01

    Full Text Available Introduction. In the last two decades a method of endovascular embolization has been imposed as a method of choice in the treatment of unruptured intracranial aneurysms. Therefore, the problem of treating posterior communicating artery (PComA aneurysms presenting with the third cranial nerve (TCN palsy has become even more complex. The case of a patient reported in the paper itself has presented a dilemma of whether to wait for spontaneous resolution of ophthalmoplegia developed after the coiling of a PComA aneurysm or whether to implement an early surgical treatment. Case report. An unruptured saccular aneurysm, directed inferolaterally in the right internal carotid artery (ICA segment in the position of the PcomA origin, was diagnosed in a 58-year-old male patient. The aneurysm was measuring 9 mm in diameter while the neck was measuring 5 mm. The day before the planned embolization, the patient developed ipsilateral ophthalmoparesis, whereas the first day after the endovascular procedure was completed, the patient developed right-sided complete ophthalmoplegia. Ten weeks after the endovascular embolization our team decided to perform a microsurgical treatment including aneurysm clipping and coil extraction. Eighteen months after the surgery, the patient made a full recovery of the functions of musculus (m levator palpabrae, m. rectus medialis and pupillary function, with a partial recovery of the functions of m. obliqus inferior, m. rectus inferior and m. rectus superior. Conclusion. According to medical research and literature, the partial recovery of the TCN palsy is expected to happen in the first few weeks after embolization. Despite the completion of endovascular treatment progression of ophthalmoparesis to ophthalmoplegia without any simptoms of clinical improvement after 10 weeks is considered to be an indicator of longstanding TCN compression, which can lead to irreversible nerve damage. Despite the increase in the use of an

  15. Laryngeal schwannoma: a case report with emphasis on sonographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Luis Ronan Marquez Ferreira de, E-mail: luisronan@gmail.com [Universidade Federal do Triangulo Mineiro (UFTM), Uberaba, MG (Brazil); De Nicola, Harley; Yamasaki, Rosiane; Pedroso, Jose Eduardo; Brasil, Osiris de Oliveira Campones do; Yamashita, Helio [Universidade Federal de Sao Paulo (EPM/UNIFESP), Sao Paulo, SP (Brazil). Escola Paulista de Medicina

    2014-05-15

    Schwannomas are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral, cranial and autonomic nerves. Twenty-five to forty-five percent of all schwannomas occur in the head and neck region, but location of such tumors in the larynx is rarely observed. The present report is aimed at describing a clinical case of laryngeal schwannoma, with emphasis on sonographic findings. (author)

  16. Laryngeal Electromyographic findings in patients with vocal fold motion asymmetry.

    Science.gov (United States)

    Woo, Peak; Isseroff, Tova F; Parasher, Arjun; Richards, Amanda; Sivak, Mark

    2016-08-01

    Vocal fold motion asymmetry (VFMA) is often attributed to vocal fold paresis or an anatomical variant. Although laryngeal electromyography (LEMG) may be used to evaluate patients with vocal fold paresis, electrodiagnostic findings in VFMA have not been well defined. Review of a case series Twenty-five symptomatic patients with VFMA were examined by LEMG, and the findings were analyzed. Although all were thought to have unilateral recurrent laryngeal nerve paresis, LEMG showed only nine to have unilateral recurrent nerve paresis. There were nine with both ipsilateral recurrent laryngeal nerve and superior laryngeal nerve paresis, four with bilateral paresis, and three were normal. Reduced total number of units, reduced recruitment, motor units firing fast, and polyphasic units were more common, whereas fibrillation potentials, fasciculation, positive sharp waves, and complex repetitive discharges were uncommon. The LEMG findings are most consistent with old, healed neuropathy. McNemar's test for the acute versus chronic denervation potentials showed significant differences. VFMA has a high incidence of vocal fold paresis that can be better defined by LEMG. The site and side of paresis is often wrong based on laryngoscopy findings alone. The LEMG findings of VFMA appear to be consistent with old, healed neuropathy 4 Laryngoscope, 126:E273-E277, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  17. Imaging of laryngeal trauma

    International Nuclear Information System (INIS)

    Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D.; Dulguerov, Pavel; Varoquaux, Arthur

    2014-01-01

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed

  18. [Laryngeal adduction reflex].

    Science.gov (United States)

    Ptok, M; Bonenberger, S; Miller, S; Kühn, D; Jungheim, M

    2014-07-01

    Laryngeal Adductor Reflex Background: A rapid closure of the vocal folds is necessary, whenever foreign materials or food particles penetrate into the larynx. Otherwise a passage of these particles into the trachea or the lower respiratory tract would be imminent. An aspiration could mechanically block the respiratory tract and cause severe dyspnoea or cause aspiration pneumonia. For this systematic review a selective literature research in PubMed and Scopus using the keywords "laryngeal adductor reflex" and "vocal fold closure" has been carried out. Apart from the oesophago-glottal and pharyngo-glottal closure reflexes, the laryngeal adductor reflex (LAR) has been investigated in particular. The LAR qualifies as a reflectory laryngeal adductor mechanism and involves early, presumably di- or oligosynaptic ipsilateral LAR1 as well as late polysynaptic ipsi- and contralateral LAR2 components. In clinical routine diagnostic settings of dysphagia, LAR is only assessed qualitatively and usually triggered by air pulses or tactile stimulation. Dysphagiologists often find that not only the laryngeal sensibility in general is impaired, but especially the protective laryngeal adduction mechanism, which results in a higher risk of aspiration. Thus, it appears mandatory to test the LAR not only qualitatively but also quantitatively. Unfortunately a valid and reliable method that can be employed in clinical practice has not yet been put forward. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Imaging of laryngeal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Becker, Minerva, E-mail: Minerva.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Leuchter, Igor, E-mail: Igor.Leuchter@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Platon, Alexandra, E-mail: Alexandra.Platon@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Becker, Christoph D., E-mail: Christoph.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Dulguerov, Pavel, E-mail: Pavel.Dulguerov@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Varoquaux, Arthur, E-mail: Arthur.Varoquaux@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland)

    2014-01-15

    External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.

  20. Rehabilitation of Bell's palsy patient with complete dentures

    OpenAIRE

    Muthuvignesh, J.; Kumar, N. Suman; Reddy, D. Narayana; Rathinavelu, Pradeep; Egammai, S.; Adarsh, A.

    2015-01-01

    Facial nerve disorders may be of sudden onset and more often of unknown etiology. Edema of the facial nerve within the fallopian canal results in Bell's palsy. This causes compression of the nerve and affects the microcirculation. Many authors have suggested treatment for facial nerve paralysis ranging from simple physiotherapy to complicated microvascular decompression. It more often results in symptoms like synkinesis and muscle spasm after the decompression surgery of the nerve because of ...

  1. Case report: partial relapse of Bell's palsy following superficial radiotherapy to a basal cell carcinoma in the temple

    International Nuclear Information System (INIS)

    Brincat, Stephen; Mantell, B.S.

    1986-01-01

    A patient who developed a partial relapse of Bell's palsy following superficial radiotherapy to a basal cell carcinoma in the temple is reported. Nerves injured by Bell's palsy may be more susceptible to radiation induced damage. (author)

  2. Bell's Palsy

    Science.gov (United States)

    ... or paralysis. Bell's palsy is named for Sir Charles Bell, a 19th century Scottish surgeon who described ... confirm diagnosis of the disorder. Generally, a physician will examine the individual for upper and lower facial ...

  3. Bell's Palsy

    Science.gov (United States)

    ... have been linked to Bell's palsy include the virus that causes: Cold sores and genital herpes (herpes simplex) Chickenpox and shingles (herpes zoster) Infectious mononucleosis (Epstein-Barr) Cytomegalovirus infections Respiratory illnesses (adenovirus) German measles (rubella) ...

  4. An Unusual Case of Neuralgic Amyotrophy Presenting with Bilateral Phrenic Nerve and Vocal Cord Paresis

    Directory of Open Access Journals (Sweden)

    F. Holtbernd

    2011-02-01

    Full Text Available Background: Neuralgic amyotrophy (brachial plexus neuropathy, brachial plexus neuritis, or Parsonage-Turner syndrome is an uncommon inflammatory condition typically characterized by acute and severe shoulder pain followed by paresis with muscle weakness and atrophy of the upper limb or shoulder girdle. We report an unusual clinical manifestation of neuralgic amyotrophy, namely bilateral phrenic nerve palsy with concomitant laryngeal paresis. Case Report: A 55-year-old male presented with orthopnea and aphonia after an episode of bilateral shoulder pain preceded by an upper respiratory tract infection. Spirometry, chest X-ray and videolaryngoscopy revealed bilateral and simultaneous paresis of the diaphragm and the vocal cords. Clinical examination at admission and at the 2-month follow-up did not show upper limb weakness or atrophy, except for a mild atrophy of the right supraspinatus muscle. An electromyography of the upper limb muscles and nerve conduction studies did not reveal signs of denervation. Analysis of the cerebrospinal fluid and an MRI of the neuraxis were unremarkable. After treatment with prednisolone, vocal cord function markedly improved within 8 weeks, whereas paresis of the diaphragm persisted. Conclusion: Shoulder pain followed by diaphragmatic paralysis with dyspnea and hoarseness may be a manifestation of neuralgic amyotrophy even if upper limb or shoulder girdle palsies are absent.

  5. Aberrant regeneration of the third cranial nerve.

    Science.gov (United States)

    Shrestha, U D; Adhikari, S

    2012-01-01

    Aberrant regeneration of the third cranial nerve is most commonly due to its damage by trauma. A ten-month old child presented with the history of a fall from a four-storey building. She developed traumatic third nerve palsy and eventually the clinical features of aberrant regeneration of the third cranial nerve. The adduction of the eye improved over time. She was advised for patching for the strabismic amblyopia as well. Traumatic third nerve palsy may result in aberrant regeneration of the third cranial nerve. In younger patients, motility of the eye in different gazes may improve over time. © NEPjOPH.

  6. Clinical studies on Bell's palsy

    International Nuclear Information System (INIS)

    Yamada, Yoshio

    1985-01-01

    The purpose of this study was to evaluate the diagnostic value of the salivary gland scintigraphy using sup(99m)Tc-pertechnetate for the prognosis of Bell's palsy. The salivary gland scintigraphy was performed in 40 patients with Bell's palsy and 15 normal subjects. After intravenous injection of 10 mCt of sup(99m)Tc-pertechnetate, sequential scintigrams were taken with a scintillation camera every one minute for 25 minutes. At 15 minutes after injection, both of normal subjects and patients were given ascorbic acid to stimulate the secretion of saliva. By the present method, the time activity curve was examined for the regions of interest over the parotid and submandibular glands and backgrounds. In normal subjects, values of the concentration and excretory ratio between the right and left sides of the parotid and submandibular glands were more than 80%. Some patients with Bell's palsy showed a decreased concentration and/or excretory ratio less than 80% between the normal and affected sides of the parotid glands. This suggests a functional involvement of the facial nerve in the salivary secretion from the parotid glands. On examination within 10 days of the onset of Bell's palsy, 31 cases with complete recovery showed values of the concentration ratio and/or excretory ratio more than 80% between the normal and affected sides of the submandibular glands. In contrast, 9 cases with imcomplete recovery showed low values of the concentration ratio and excretory ratio less than 80%. In the latter, more active treatments such as decompression operation should be considerd in the early stage of the palsy. The salivary scintigraphy using sup(99m)Tc-pertechnetate is more valuable as an early prognostic indicator for Bell's palsy compared with other prognostic tests such as the lid vibration test, the stapedial reflex test, the electrogustometry, the nerve excitability test and the evoked electromyography. (author)

  7. Congenital laryngeal anomalies,

    Directory of Open Access Journals (Sweden)

    Michael J. Rutter

    2014-12-01

    Full Text Available Introduction: It is essential for clinicians to understand issues relevant to the airway management of infants and to be cognizant of the fact that infants with congenital laryngeal anomalies are at particular risk for an unstable airway. Objectives: To familiarize clinicians with issues relevant to the airway management of infants and to present a succinct description of the diagnosis and management of an array of congenital laryngeal anomalies. Methods: Revision article, in which the main aspects concerning airway management of infants will be analyzed. Conclusions: It is critical for clinicians to understand issues relevant to the airway management of infants.

  8. Tinjauan Anatomi Klinik dan Manajemen Bell's Palsy

    OpenAIRE

    Nur Mujaddidah

    2017-01-01

    Bell's Palsy is a peripheral facial nerve weakness (facial nerve) with acute onset on one side of the face. This condition causes the inability of the patient to move half of his face consciously (volunter) on the affected side. The Bell's Palsy incidence is 20-30 cases out of 100.000 people and accounts for 60-70% of all cases of unilateral facial paralysis. The disease is self-limited, but causes great suffering for patients who are not treated properly. Controversy in the management is sti...

  9. DIABETES MELLITUS AND BELL’S PALSY IN IRANIAN POPULATION

    Directory of Open Access Journals (Sweden)

    A. R Karimi-Yazdi

    2008-08-01

    Full Text Available "nDuring last decades many researchers have focused on the conditions associated with Bell's palsy including diabetes mellitus, hypertension, and viral infections. This study was performed to evaluate correlation of diabetes mellitus and Bell's palsy and some relevant features not discussed in the literature in an Iranian population. The presence of diabetes mellitus was evaluated in a total number of 275 subjects (75 patients with Bell's palsy and 200 control subjects. Diabetes mellitus was noted in 10 (13.3% patients with Bell's palsy among which 6 case were diagnosed as new cases of diabetes. Previous history of Bell's palsy was present in 10.67% of the subjects with Bell's palsy. Symptoms of other cranial nerves revealed higher figures in Bell's palsy patients with underlying diabetes. Such studies in developing countries may reveal some unknown features of the disease. This study confirms the correlation of diabetes mellitus and Bell's palsy for the first time in an Iranian population. The results also suggest that diabetic patients with Bell's palsy suffer from more cranial nerve symptoms. We offer screening tests of diabetes as a routine process in the management of Bell's palsy especially in developing countries.

  10. Laryngeal adenocystic carcinoma treated by proton therapy

    International Nuclear Information System (INIS)

    Sugiyama, Tomonori; Araki, Mamika; Fukukita, Kouhei; Yamada, Hiroyuki

    2013-01-01

    Adenocystic carcinoma most commonly develops in the major salivary glands, on the other hand it is rare for adenocystic carcinoma to develop in the larynx. We report a case of adenocystic carcinoma in the larynx. A 54-year-old male was hospitalized with symptoms of hoarseness and dyspnea on exertion. He presented a tumor that developed at the base of the right arytenoid, and covered over the glottis. It was confirmed to be adenocystic carcinoma (solid type) by biopsy. Positron emission tomography (PET)-CT also revealed a left cervical lymph node metastasis and multiple pulmonary metastases (T1N2cM1). He was treated with proton therapy to the larynx to prevent airway obstruction by growth of the tumor and to preserve the larynx because he had uncontrollable pulmonary metastasis. Although the tumor vanished after the treatment, one month later he had halitosis, dyspnea and bilateral vocal cord palsy. Despite administration of an antibacterial drug and steroid, there was no improvement to the narrowness of the glottis. A tracheotomy was therefore performed three months after the proton therapy. PET-CT, which was performed after the tracheotomy, suggested growth of the residual tumor or laryngeal radionecrosis. This study confirmed that proton therapy is effective for adenocystic carcinoma in the larynx. However, proton therapy also was found to cause laryngeal radionecrosis. These results indicate the importance of evaluating the side effects of radiation therapy and providing that information to the patient. (author)

  11. Electrophysiology of Cranial Nerve Testing: Cranial Nerves IX and X.

    Science.gov (United States)

    Martinez, Alberto R M; Martins, Melina P; Moreira, Ana Lucila; Martins, Carlos R; Kimaid, Paulo A T; França, Marcondes C

    2018-01-01

    The cranial nerves IX and X emerge from medulla oblongata and have motor, sensory, and parasympathetic functions. Some of these are amenable to neurophysiological assessment. It is often hard to separate the individual contribution of each nerve; in fact, some of the techniques are indeed a composite functional measure of both nerves. The main methods are the evaluation of the swallowing function (combined IX and X), laryngeal electromyogram (predominant motor vagal function), and heart rate variability (predominant parasympathetic vagal function). This review describes, therefore, the techniques that best evaluate the major symptoms presented in IX and X cranial nerve disturbance: dysphagia, dysphonia, and autonomic parasympathetic dysfunction.

  12. Inducible laryngeal obstruction

    DEFF Research Database (Denmark)

    Halvorsen, Thomas; Walsted, Emil Schwarz; Bucca, Caterina

    2017-01-01

    Inducible laryngeal obstruction (ILO) describes an inappropriate, transient, reversible narrowing of the larynx in response to external triggers. ILO is an important cause of a variety of respiratory symptoms and can mimic asthma. Current understanding of ILO has been hampered by imprecise nomenc...

  13. Laryngitis (For Kids)

    Science.gov (United States)

    ... to change your diet and give up some foods that make the problem worse. Can I Prevent It? To prevent laryngitis, try not to talk or yell in a way that hurts your voice. A humidifier that puts more water into the air may also help keep your throat from drying out. Also, never smoke and try not to ...

  14. Peripheral facial weakness (Bell's palsy).

    Science.gov (United States)

    Basić-Kes, Vanja; Dobrota, Vesna Dermanović; Cesarik, Marijan; Matovina, Lucija Zadro; Madzar, Zrinko; Zavoreo, Iris; Demarin, Vida

    2013-06-01

    Peripheral facial weakness is a facial nerve damage that results in muscle weakness on one side of the face. It may be idiopathic (Bell's palsy) or may have a detectable cause. Almost 80% of peripheral facial weakness cases are primary and the rest of them are secondary. The most frequent causes of secondary peripheral facial weakness are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immune disorders, drugs, degenerative diseases of the central nervous system, etc. The diagnosis relies upon the presence of typical signs and symptoms, blood chemistry tests, cerebrospinal fluid investigations, nerve conduction studies and neuroimaging methods (cerebral MRI, x-ray of the skull and mastoid). Treatment of secondary peripheral facial weakness is based on therapy for the underlying disorder, unlike the treatment of Bell's palsy that is controversial due to the lack of large, randomized, controlled, prospective studies. There are some indications that steroids or antiviral agents are beneficial but there are also studies that show no beneficial effect. Additional treatments include eye protection, physiotherapy, acupuncture, botulinum toxin, or surgery. Bell's palsy has a benign prognosis with complete recovery in about 80% of patients, 15% experience some mode of permanent nerve damage and severe consequences remain in 5% of patients.

  15. Bell's Palsy Treatment

    Science.gov (United States)

    ... Stories Español Eye Health / Eye Health A-Z Bell's Palsy Sections What Is Bell's Palsy? Bell's Palsy Symptoms Bell's Palsy Treatment Bell's Palsy Treatment Leer en Español: Tratamiento de la parálisis ...

  16. Bell's Palsy Symptoms

    Science.gov (United States)

    ... Stories Español Eye Health / Eye Health A-Z Bell's Palsy Sections What Is Bell's Palsy? Bell's Palsy Symptoms Bell's Palsy Treatment Bell's Palsy Symptoms Leer en Español: Síntomas de la parálisis ...

  17. http://www.bioline.org.br/js 101 Aetiological Profile of Facial Nerve ...

    African Journals Online (AJOL)

    jen

    Background: Facial nerve abnormalities represent a broad spectrum of lesions which are commonly seen by the otolaryngologist. The aim of this paper is to highlight the aetiologic profile of facial nerve palsy. Methods: A retrospective study of patients with facial nerve palsy seen in the Ear, Nose and Throat clinic for 5 years.

  18. Uncommon Dorsal Radiocarpal Fracture Dislocation Complicated With Median Nerve Palsy: Case Report, Review of the Literature, and a New Classification System Guiding the Management

    Directory of Open Access Journals (Sweden)

    Hing-Cheong Wong

    2012-06-01

    Full Text Available We report the case of a 36-year-old lorry driver who sustained left dorsal radiocarpal fracture dislocation and left median nerve injury in a traffic accident in 2010. Emergency operation of closed reduction, cross-wrist-bridging external fixation, percutaneous transradial styloid Kirschner wire fixation, decompression of left median nerve, and repair of the partially torn palmar radiocarpal ligament were performed under general anaesthesia. Because of the persistent depressed dorsal articular rim fracture of left distal radius, another operation of open reduction, corticocancellous bone grafting, and dorsal buttress plating was performed 5 days after the initial operation. Six months after the operation, the patient enjoyed good range of wrist motion but weak twisting power, especially in supination. There was no radiological feature of radiocarpal subluxation.

  19. CT findings of laryngeal tuberculosis : comparison with laryngeal carcinoma

    International Nuclear Information System (INIS)

    Kim, Man Deuk; Kim, Dong Ik; Lee, Byung Hee; Sung, Ki Joon; Jung, Tae Sub; Cho, Jae Min; Yune, Heun Yune; Kim, Sun Yong

    1996-01-01

    To determine the value of CT(Computerized Tomography) in the diagnosis of laryngeal tuberculosis and to assess to what extent its characteristic findings different from those of laryngeal carcinoma. CT scans of twelve patients with laryngeal tuberculosis were reviewed and compared with those of fifteen patients with laryngeal cancer, retrospectively. Clinical symptoms, laryngoscopic examinations and the presence of pulmonary tuberculosis chest radiographs were also reviewed. In laryngeal tuberculosis, bilateral symmetric or asymmetric involvement was noted in nine(75%) patients, while unilateral involvement was seen in three(25%). This was significantly different from laryngeal cancer in which unilateral involvement was noted in twelve patients(80%). Diffuse thickening of the free margin of the epiglottis was a characteristic and frequent finding in tuberculosis(n=6, 50%). No deep submucosal infiltration of preepiglottic and paralaryngeal fat spaces is seen in tuberculosis in spite of large areas of involvement of laryngeal mucosa, while twelve patients(80%) with laryngeal cancer showed thickened deep infiltration which resulted in a submucosal mass. CT was useful in the diagnosis of laryngeal tuberculosis and its CT findings were characterized by bilateral involvement, thickening of the free margin of the epiglottis and good preservation of preepiglottic and paralaryngeal fat spaces in spite of large areas of involvement

  20. United Cerebral Palsy

    Science.gov (United States)

    ... your local affiliate Find your local affiliate United Cerebral Palsy United Cerebral Palsy (UCP) is a trusted resource for individuals with Cerebral Palsy and other disabilities and their networks. Individuals with ...

  1. Employees with Cerebral Palsy

    Science.gov (United States)

    ... Resources Home | Accommodation and Compliance Series: Employees with Cerebral Palsy (CP) By Eddie Whidden, MA Preface Introduction Information ... SOAR) at http://AskJAN.org/soar. Information about Cerebral Palsy (CP) What is CP? Cerebral palsy is a ...

  2. Birth Defects: Cerebral Palsy

    Science.gov (United States)

    ... Loss > Birth defects & other health conditions > Cerebral palsy Cerebral palsy E-mail to a friend Please fill in ... this page It's been added to your dashboard . Cerebral palsy (also called CP) is a group of conditions ...

  3. A general practice approach to Bell's palsy.

    Science.gov (United States)

    Phan, Nga T; Panizza, Benedict; Wallwork, Benjamin

    2016-11-01

    Bell's palsy is characterised by an acute onset of unilateral, lower motor neuron weakness of the facial nerve in the absence of an identifiable cause. Establishing the correct diagnosis is imperative and choosing the correct treatment options can optimise the likelihood of recovery. This article summarises our understanding of Bell's palsy and the evidence-based management options available for adult patients. The basic assessment should include a thorough history and physical examination as the diagnosis of Bell's palsy is based on exclusion. For confirmed cases of Bell's palsy, corticosteroids are the mainstay of treatment and should be initiated within 72 hours of symptom onset. Antiviral therapy in combination with corticosteroid therapy may confer a small benefit and may be offered on the basis of shared decision making. Currently, no recommendations can be made for acupuncture, physical therapy, electrotherapy or surgical decompression because well-designed studies are lacking and available data are of low quality.

  4. Facial Palsy Following Embolization of a Juvenile Nasopharyngeal Angiofibroma.

    Science.gov (United States)

    Tawfik, Kareem O; Harmon, Jeffrey J; Walters, Zoe; Samy, Ravi; de Alarcon, Alessandro; Stevens, Shawn M; Abruzzo, Todd

    2018-05-01

    To describe a case of the rare complication of facial palsy following preoperative embolization of a juvenile nasopharyngeal angiofibroma (JNA). To illustrate the vascular supply to the facial nerve and as a result, highlight the etiology of the facial nerve palsy. The angiography and magnetic resonance (MR) imaging of a case of facial palsy following preoperative embolization of a JNA is reviewed. A 13-year-old male developed left-sided facial palsy following preoperative embolization of a left-sided JNA. Evaluation of MR imaging studies and retrospective review of the angiographic data suggested errant embolization of particles into the petrosquamosal branch of the middle meningeal artery (MMA), a branch of the internal maxillary artery (IMA), through collateral vasculature. The petrosquamosal branch of the MMA is the predominant blood supply to the facial nerve in the facial canal. The facial palsy resolved since complete infarction of the nerve was likely prevented by collateral blood supply from the stylomastoid artery. Facial palsy is a potential complication of embolization of the IMA, a branch of the external carotid artery (ECA). This is secondary to ischemia of the facial nerve due to embolization of its vascular supply. Clinicians should be aware of this potential complication and counsel patients accordingly prior to embolization for JNA.

  5. Multiple Cranial Nerve Involvement In Cryptococcal Meningitis

    Directory of Open Access Journals (Sweden)

    Mahadevan A

    2000-01-01

    Full Text Available Cryptococcal meningitis is an uncommon cause of multiple cranial nerve palsies. This case report illustrates one such case of cryptococcal meningitis clinically manifesting with extensive cranial nerve involvement in an HIV seronegative individual. Histology revealed infiltration of the cranial nerves by cryptococci causing axonal disruption with secondary demyelination in the absence of any evidence of inflammation or vasculitis. We believe that axonal damage underlies the pathogenesis of cranial nerve involvement in cryptococcal meningitis.

  6. Immediate Postoperative Bell's Palsy: Viral Etiology or Post-Traumatic Phenomena?

    Directory of Open Access Journals (Sweden)

    Mohammad Ghasem Shams

    2010-12-01

    Full Text Available Introduction: Bell’s palsy is a sudden unilateral paralysis of the facial nerve. Postoperative Bell’s palsy following surgery is rare. It occurs in less than 1% of operations. The hypothesis: We premise that the main cause of immediate postoperative Bell's palsy is latent herpes viruses (herpes simplex virus type 1 and herpes zoster virus, which are reactivated from cranial nerve ganglia. Inflammation of the nerve initially results in a reversible neurapraxia, but ultimately Wallerian degeneration ensues. The palsy is often sudden in onset and evolves rapidly, with maximal facial weakness developing within two days. Associated symptoms of-ten seen in idiopathic Bell’s palsy are tearing problems, hyperacusis and altered taste.Evaluation of the hypothesis: Facial paralysis presenting postoperatively is distressing and poses a diagnostic chal-lenge. A complete interruption of the facial nerve at the sty-lomastoid foramen paralyzes all the muscles of facial expression. Taste sensation may be lost unilaterally and hye-racusis may be present. Idiopathic Bell’s palsy is due to inflammation of the facial nerve in the facial canal. Bell’s palsy may also occur from lesions that invade the temporal bone (carotid body, cholesteatoma, dermoid cyst, acoustic neu-romas. Although traumatic Bell’s palsy cannot be ruled out, it seems logic to postulate that the main cause of immediate postoperative Bell's palsy is latent herpes viruses.

  7. Laryngeal neurinoma. Differential diagnosis of submucosal laryngeal tumors

    International Nuclear Information System (INIS)

    Higuera, A.; Palomo, V.; Munoz, R.; Sanchez, F.

    2002-01-01

    Laryngeal neurinoma is a rare benign tumor that appears as a submucosal mass, generally in the supraglottic region. We report the case of a patient with dysphonia of long evolution caused by a neurinoma. We discuss the radiological findings of the tumor and the value of computed tomography (CT) in the diagnosis of this and other submucosal laryngeal lesions. (Author) 16 refs

  8. Gadolinium-enhanced MRI for evaluation of peripheral nerve neuropathy

    International Nuclear Information System (INIS)

    Hayakawa, Katsuhiko; Kobayashi, Shigeru; Suzuki, Katsuji; Yamada, Mitsuko; Kojima, Motohiro.

    1995-01-01

    We carried out enhanced MRI for the carpal tunnel syndrome, cubital tunnel syndrome, tarsal tunnel syndrome and anterior interosseous nerve palsy that is entrapment neuropathy. The affected nerve was enhanced in entrapment point. Carpal tunnel syndrome: The enhancement of affected nerve was apparent in 41 of 52 cases (79%). Cubital tunnel syndrome: The enhancement of affected nerve was apparent in 4 of 5 cases (80%). Tarsal tunnel syndrome: The enhancement of affected nerve was apparent in 1 of 1 case. Anterior interosseous nerve palsy: The enhancement of affected nerve was apparent in 3 of 4 cases (75%). The affected nerve was strongly enhanced by Gd-DTPA, indicating the blood-nerve barrier in the affected nerve to be broken and intraneural edema to be produced, e.i., the ability of Gd-DTPA to selectively contrast-enhance a pathologic focus within the peripheral nerve is perhaps its most important clinical applications. (author)

  9. Gadolinium-enhanced MRI for evaluation of peripheral nerve neuropathy

    Energy Technology Data Exchange (ETDEWEB)

    Hayakawa, Katsuhiko [Aikoh Orthopaedic Hospital, Nagoya (Japan); Kobayashi, Shigeru; Suzuki, Katsuji; Yamada, Mitsuko; Kojima, Motohiro

    1995-11-01

    We carried out enhanced MRI for the carpal tunnel syndrome, cubital tunnel syndrome, tarsal tunnel syndrome and anterior interosseous nerve palsy that is entrapment neuropathy. The affected nerve was enhanced in entrapment point. Carpal tunnel syndrome: The enhancement of affected nerve was apparent in 41 of 52 cases (79%). Cubital tunnel syndrome: The enhancement of affected nerve was apparent in 4 of 5 cases (80%). Tarsal tunnel syndrome: The enhancement of affected nerve was apparent in 1 of 1 case. Anterior interosseous nerve palsy: The enhancement of affected nerve was apparent in 3 of 4 cases (75%). The affected nerve was strongly enhanced by Gd-DTPA, indicating the blood-nerve barrier in the affected nerve to be broken and intraneural edema to be produced, e.i., the ability of Gd-DTPA to selectively contrast-enhance a pathologic focus within the peripheral nerve is perhaps its most important clinical applications. (author).

  10. Contralateral reinnervation of midline muscles in nonidiopathic facial palsy.

    NARCIS (Netherlands)

    Gilhuis, H.J.; Beurskens, C.H.G.; Vries, J. de; Marres, H.A.M.; Hartman, E.H.M.; Zwarts, M.J.

    2003-01-01

    The purpose of this study was to analyze contralateral reinnervation of the facial nerve in eight patients with complete facial palsy after surgery or trauma and seven healthy volunteers. All patients had contralateral reinnervation of facial muscles as demonstrated by electrical nerve stimulation

  11. Cellular immune response in prognosis of Bell's palsy and its ...

    African Journals Online (AJOL)

    Objective: To determine the cellular immune response in Bell's palsy (BP) and its prognostic value in relation to clinical and electrophysiological findings. Methods: Twenty patients with BP were subjected to: Facial nerve paralysis assessment according to House–Brackmann (H&B) grading system, bilateral facial nerve ...

  12. [Bell and his palsy].

    Science.gov (United States)

    van Gijn, Jan; Gijselhart, Joost P

    2011-01-01

    Unlike his eponymous fame suggests, Sir Charles Bell (1774-1842) was an anatomist, draughtsman and surgeon rather than purely a physiologist. He was born and educated in Edinburgh but spent most of his working life in London (1804 to 1836). It was there he started a School of Anatomy, alongside a fledgling surgical practice, just as his elder brother John had done in Edinburgh. In 1814 he joined the surgical staff at the Middlesex Hospital. In 1810 he surmised from occasional animal experiments that the anterior and posterior spinal roots differed in function. Yet it was left to the Frenchman Magendie to identify that these functions were motor and sensory: a discovery that induced Bell into an ungentlemanly feud. Bell also slightly erred on the functions of the trigeminal and facial nerve, but his description of the features of idiopathic facial palsy is unrivalled.

  13. Common questions about Bell palsy.

    Science.gov (United States)

    Albers, Janet R; Tamang, Stephen

    2014-02-01

    Bell palsy is an acute affliction of the facial nerve, resulting in sudden paralysis or weakness of the muscles on one side of the face. Testing patients with unilateral facial paralysis for diabetes mellitus or Lyme disease is not routinely recommended. Patients with Lyme disease typically present with additional manifestations, such as arthritis, rash, or facial swelling. Diabetes may be a comorbidity of Bell palsy, but testing is not needed in the absence of other indications, such as hypertension. In patients with atypical symptoms, magnetic resonance imaging with contrast enhancement can be used to rule out cranial mass effect and to add prognostic value. Steroids improve resolution of symptoms in patients with Bell palsy and remain the preferred treatment. Antiviral agents have a limited role, and may improve outcomes when combined with steroids in patients with severe symptoms. When facial paralysis is prolonged, surgery may be indicated to prevent ocular desiccation secondary to incomplete eyelid closure. Facial nerve decompression is rarely indicated or performed. Physical therapy modalities, including electrostimulation, exercise, and massage, are neither beneficial nor harmful.

  14. Gadolinium-enhanced MR imaging in evaluation of Bell palsy

    International Nuclear Information System (INIS)

    Wang, A.M.; Wesolowski, D.P.; Bojrab, D.I.; Ernstoff, R.M.; Farah, J.

    1989-01-01

    Eight patients with Bell palsy were evaluated with Gd-DTPA (Magnevist)-enhanced MR imaging in a 1.0-T Siemen's Magnetom unit. Axial pre-and postcontrast and coronal postcontrast T1-weighted MR images of facial nerves were studied. Significant unilateral enhancement of the facial nerve within the internal auditory canal, with or without involvement of the geniculate ganglia, was found in six patients. Three of these patients without satisfactory response to medical treatment underwent surgical decompression, with excellent recovery of facial nerve function. The authors believe that gadolinium-enhanced MR imaging is valuable in the evaluation and management of Bell palsy

  15. Bell's Palsy (For Teens)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Bell's Palsy KidsHealth / For Teens / Bell's Palsy What's in this ... Print en español Parálisis de Bell What Is Bell's Palsy? Bell's palsy is a temporary weakness or paralysis ...

  16. Cerebral Palsy (For Teens)

    Science.gov (United States)

    ... Staying Safe Videos for Educators Search English Español Cerebral Palsy KidsHealth / For Teens / Cerebral Palsy What's in this ... do just what everyone else does. What Is Cerebral Palsy? Cerebral palsy (CP) is a disorder of the ...

  17. A case of laryngeal neurofibroma associated with neurofibromatosis type 2

    International Nuclear Information System (INIS)

    Cihangiroglu, M.; Yilmaz, S.; Yildirim, H.; Ozdemir, H.; Altinsoy, B.; Ogur, E.

    2002-01-01

    Purpose: Laryngeal neurofibromas have been reported in 16 patients with NF1, and schwannomas, in two patient with NF1 and 2 patients with NF2. To the best our knowledge our case is the first to document a laryngeal neurofibroma in a patient with NF2. Another unique feature of our case is the coexistence of multiple intramedullary tumors, which has not previously been reported in a patient with a laryngeal neurofibroma. Material and methods: A 32-year-old woman presented with a history of cataract, hoarseness and dysphonia since childhood, which had recently become worse. The patient also had hearing disability for low frequencies. Results: Laryngoscopy revealed a 2x2x3.5 cm smooth-surfaced submucosal supraglottic mass. On CT of the neck, the lesion was seen as a round and well-defined hypopharyngeal mass extended through and obliterating the left supraglottic space. It was hypodense on unenhanced CT images and slightly enhanced with IV contrast administration. On MR imaging, the mass was heterogeneously hypointense on T1-weighted images and hyperintense on T2-weighted images, with moderate homogenous enhancement after gadolinium administration. Bilateral vestibular schwannomas and multiple intramedullary masses (presumed to be ependymoma or astrocytoma) were delineated on these MR images The patient was diagnosed as having NF-2 and the laryngeal mass was totally resected. On histopathological examination, the mass were consistent with neurofibroma. Conclusion: Dysphonia and hoarseness may be the only presenting symptoms suggesting the possibility of a laryngeal nerve sheath tumor, and neurofibroma should be included in differential diagnosis of laryngeal masses in patients with NF2. (authors)

  18. ['Laryngeal neuropathy' and 'irritable larynx syndrome': synonyms or distinct entities?].

    Science.gov (United States)

    Meyer, S; Ptok, M

    2012-10-01

    The term 'laryngeal neuropathy' (LN) has first been used in veterinary medicine to describe an idiopathic and typically exercise induced inspiratory noise in horses.Nowadays, the term is often used in relation with intermittent vocal cord pareses in humans. Some authors use the term 'irritable larynx syndrome' (ILS) in a similar context. This article reviews the state of knowledge regarding LN and ILS and discusses the somewhat confusing terminology.For this systematic review a selective literature research in PubMed has been carried out.35 articles were found, which report on LN in animals and 17 articles reported on humans. 4 of these articles used the term 'irritable larynx syndrome'.Laryngeal neuropathy in horses usually affects the left recurrent laryngeal nerve and results in decreased vocal cord abduction and an inspiratory roaring or whistling noise, particularly during exercise. In dogs LN has been reported to also occur bilaterally. In association with humans LN has not been defined clearly in the literature. The term ILS on the other hand has only been used in relation to humans. The term describes a hypersensitivity of the laryngeal structures towards external stimuli, which causes symptoms such as dyspnea or cough among others. Sufficient knowledge does not exist for either of the 2 diseases, ILS or LN. As of yet, the term LN should not be used in human medicine to describe according symptoms of unknown aetiology. The term 'laryngeal movement disorder' seems a lot more appropriate. The symptom oriented term irritable larynx syndrome also seems suitable to describe laryngeal hypersensitivity appropriately. © Georg Thieme Verlag KG Stuttgart · New York.

  19. Enhanced MRI in patients with facial palsy; Study of time-related enhancement

    Energy Technology Data Exchange (ETDEWEB)

    Yanagida, Masahiro; Kato, Tsutomu; Ushiro, Koichi; Kitajiri, Masanori; Yamashita, Toshio; Kumazawa, Tadami; Tanaka, Yoshimasa (Kansai Medical School, Moriguchi, Osaka (Japan))

    1991-03-01

    We performed Gd-DTPA-enhanced magnetic resonance imaging (MRI) examinations at several stages in 40 patients with peripheral facial nerve palsy (Bell's palsy and Ramsay-Hunt syndrome). In 38 of the 40 patients, one and more enhanced region could be seen in certain portion of the facial nerve in the temporal bone on the affected side, whereas no enhanced regions were seen on the intact side. Correlations between the timing of the MRI examination and the location of the enhanced regions were analysed. In all 6 patients examined by MRI within 5 days after the onset of facial nerve palsy, enhanced regions were present in the meatal portion. In 3 of the 8 patients (38%) examined by MRI 6 to 10 days after the onset of facial palsy, enhanced areas were seen in both the meatal and labyrinthine portions. In 8 of the 9 patients (89%) tested 11 to 20 days after the onset of palsy, the vertical portion was enhanced. In the 12 patients examined by MRI 21 to 40 days after the onset of facial nerve palsy, the meatal portion was not enhanced while the labyrinthine portion, the horizontal portion and the vertical portion were enhanced in 5 (42%), 8 (67%) and 11 (92%), respectively. Enhancement in the vertical portion was observed in all 5 patients examined more than 41 days after the onset of facial palsy. These results suggest that the central portion of the facial nerve in the temporal bone tends to be enhanced in the early stage of facial nerve palsy, while the peripheral portion is enhanced in the late stage. These changes of Gd-DTPA enhanced regions in the facial nerve may suggest dromic degeneration of the facial nerve in peripheral facial nerve palsy. (author).

  20. Tinjauan Anatomi Klinik dan Manajemen Bell's Palsy

    Directory of Open Access Journals (Sweden)

    Nur Mujaddidah

    2017-07-01

    Full Text Available Bell's Palsy is a peripheral facial nerve weakness (facial nerve with acute onset on one side of the face. This condition causes the inability of the patient to move half of his face consciously (volunter on the affected side. The Bell's Palsy incidence is 20-30 cases out of 100.000 people and accounts for 60-70% of all cases of unilateral facial paralysis. The disease is self-limited, but causes great suffering for patients who are not treated properly. Controversy in the management is still debated, and the cause is still unknown. The underlying hypothesis is ischemic, vascular, viral, bacterial, hereditary, and immunologic. Therapy done so far is to improve facial nerve function and healing process. The management of the therapy used will be closely related to the structure of the anatomy and its functions and associated abnormalities. The modalities of Bell's Palsy therapy are with corticosteroids and antivirals, facial exercises, electrostimulation, physiotherapy and decompression operations. Approximately 80-90% of patients with Bell's palsy recover completely within 6 months, even in 50-60% of cases improved within 3 weeks. Approximately 10% experienced persistent facial muscle asymmetry, and 5% experienced severe sequelae, and 8% of cases were recurrent.

  1. Primary laryngeal tuberculosis mimicking laryngeal carcinoma: CT scan features

    International Nuclear Information System (INIS)

    El Kettani, N Ech-Cherif; El Hassani, MR; Chakir, N; Jiddane, M

    2010-01-01

    Laryngeal tuberculosis is a rare disease. It is almost always associated with pulmonary tuberculosis. It occurs generally in adults without BCG vaccination or in cases of the acquired immune deficiency syndrome. On laryngoscopy and imaging, it often simulates laryngeal carcinoma, and confirmation is always histological. We report the case of a 36-year-old man who presented to our hospital with dysphonia and dysphagia. Laryngoscopy revealed a lesion of the left vocal cord and the ventricular strip. CT scan found focal, regular thickening of the left vocal cord, associated with irregular thickening of the posterior laryngeal wall. A biopsy confirmed the diagnosis of tuberculosis

  2. Cerebral palsy

    International Nuclear Information System (INIS)

    Truwit, C.L.; Barkovich, A.J.; Koch, T.; Ferreiro, D.

    1990-01-01

    This paper reviews cranial MR findings in patients with cerebral palsy (CP) to clarify and categorize this disorder. The MR images of 40 patients with clinical CP were retrospectively reviewed. All patients suffered either varying spastic plegias, hypotonicity, or choreoathetosis. Concomitantly, the patients suffered from static encephalopathy, developmental delay, and/or microcephaly. Twenty-four patients were born at or near term, 10 were premature, and incomplete birth histories were available in six. The MR images revealed mild to severe degrees of white matter damage in 24 patients (12 term, nine premature, three unknown)

  3. Laser Phototherapy As Modality of Clinical Treatment in Bell's Palsy

    Science.gov (United States)

    Marques, A. M. C.; Soares, L. G. P.; Marques, R. C.; Pinheiro, A. L. B.; Dent, M.

    2011-08-01

    Bell's palsy is defined as a peripheral facial nerve palsy, idiophatic, and sudden onset and is considered the most common cause of this pathology. It is caused by damage to cranial nerves VII, resulting in complete or partial paralysis of the facial mimic. May be associated with taste disturbances, salivation, tearing and hyperacusis. It is diagnosed after ruling out all possible etiologies, because its cause is not fully understood.Some researches shows that herpes virus may cause this type of palsy due to reactivation of the virus or by imunnomediated post-viral nerve demielinization. Physical therapy, corticosteroids and antiviral therapy have become the most widely accepted treatments for Bell's palsy. Therapy with low-level laser (LLLT) may induce the metabolism of injured nerve tissue for the production of proteins associated with its growth and to improve nerve regeneration. The success of the treatment of Bell's palsy by using laser phototherapy isolated or in association with other therapeutic approach has been reported on the literature. In most cases, the recovery occurs without uneventfully (complications), the acute illness is not associated with serious disorders. We will present a clinical approach for treating this condition.

  4. Carotid endarterectomy significantly improves postoperative laryngeal sensitivity.

    Science.gov (United States)

    Hammer, Georg Philipp; Tomazic, Peter Valentin; Vasicek, Sarah; Graupp, Matthias; Gugatschka, Markus; Baumann, Anneliese; Konstantiniuk, Peter; Koter, Stephan Herwig

    2016-11-01

    Iatrogenic injury of the vagus nerve or its branches during carotid endarterectomy (CEA) can result in globus sensation, dysphagia, and even vocal fold immobility. Knowledge of morphologic and functional laryngopharyngeal outcomes after CEA is poor. The present study was performed to determine potential iatrogenic damage to the laryngeal innervation after CEA. An area of particular interest was the supraglottic sensory threshold, which was examined by Fiberoptic Endoscopic Evaluation of Swallowing With Sensory Testing (FEESST; Pentax Medical Company, Montvale, NJ), a validated and safe method for the determination of the motor and sensory components of swallowing. FEESST was used preoperatively in 32 patients scheduled to undergo CEA and twice postoperatively to examine the motor and sensory components of swallowing. In this endolaryngeal examination, laryngopharyngeal sensory thresholds (in mm Hg) were defined as normal at 6.0 mm Hg APP, with a value >10.0 mm Hg APP indicating abolished laryngeal adductor reflex. Acoustic voice parameters were also analyzed for further functional changes of the larynx. The mean ± standard deviation preoperative FEESST measures showed no significant differences (P = .065) between the operated-on side (6.73 ± 1.73 mm Hg) and the opposite side (5.83 ± 1.68 mm Hg). At 2 days postoperatively, the threshold increased (P = .001) to 7.62 ± 1.98 mm Hg on the operated-on side. A laryngopharyngeal mucosal hematoma on the operated side was endoscopically detectable in eight patients (30.8%); in these patients, we found a markedly elevated (P = .021) measure of 9.50 ± 0.93 mm Hg. On the opposite (nonoperated-on) side of the laryngopharynx, the thresholds remained at the same level as preoperatively over all assessments (P >.05), whereas the differences between the operated and nonoperated-on sides and the hematoma and nonhematoma groups were highly significant (P = .004 and P = .001, respectively). Surprisingly, the

  5. Pattern of facial palsy in a typical Nigerian specialist hospital.

    Science.gov (United States)

    Lamina, S; Hanif, S

    2012-12-01

    Data on incidence of facial palsy is generally lacking in Nigeria. To assess six years' incidence of facial palsy in Murtala Muhammed Specialist Hospital (MMSH), Kano, Nigeria. The records of patients diagnosed as facial problems between January 2000 and December 2005 were scrutinized. Data on diagnosis, age, sex, side affected, occupation and causes were obtained. A total number of 698 patients with facial problems were recorded. Five hundred and ninety four (85%) were diagnosed as facial palsy. Out of the diagnosed facial palsy, males (56.2%) had a higher incidence than females; 20-34 years age group (40.3%) had a greater prevalence; the commonest cause of facial palsy was found out to be Idiopathic (39.1%) and was most common among business men (31.6%). Right sided facial palsy (52.2%) was predominant. Incidence of facial palsy was highest in 2003 (25.3%) and decreased from 2004. It was concluded that the incidence of facial palsy was high and Bell's palsy remains the most common causes of facial (nerve) paralysis.

  6. Artifacts produced during electrical stimulation of the vestibular nerve in cats. [autonomic nervous system components of motion sickness

    Science.gov (United States)

    Tang, P. C.

    1973-01-01

    Evidence is presented to indicate that evoked potentials in the recurrent laryngeal, the cervical sympathetic, and the phrenic nerve, commonly reported as being elicited by vestibular nerve stimulation, may be due to stimulation of structures other than the vestibular nerve. Experiments carried out in decerebrated cats indicated that stimulation of the petrous bone and not that of the vestibular nerve is responsible for the genesis of evoked potentials in the recurrent laryngeal and the cervical sympathetic nerves. The phrenic response to electrical stimulation applied through bipolar straight electrodes appears to be the result of stimulation of the facial nerve in the facial canal by current spread along the petrous bone, since stimulation of the suspended facial nerve evoked potentials only in the phrenic nerve and not in the recurrent laryngeal nerve. These findings indicate that autonomic components of motion sickness represent the secondary reactions and not the primary responses to vestibular stimulation.

  7. Section four: laryngitis and dysphonia.

    Science.gov (United States)

    Hueston, William J; Kaur, Dipinpreet

    2013-12-01

    Acute laryngitis is most often caused by viral illnesses through direct inflammation of the vocal cords or from irritation due to postnasal drainage. Bacterial infections, such as acute epiglottitis, also can cause dysphonia but typically have other systemic symptoms as well as respiratory distress. Chronic laryngitis is characterized by symptoms lasting more than 3 weeks. Chronic vocal cord issues can be related to overuse or stress on the vocal cords resulting in nodules or polyps. Individuals in certain occupations, such as singers, school teachers, and chemical workers, are at greater risk of chronic laryngitis. The diagnostic approach to chronic laryngitis should include visualization of the vocal cords to rule out potential malignant lesions. For acute and chronic overuse symptoms, the best treatment is vocal rest. The use of antibiotics or decongestants should be discouraged. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  8. Management of Advanced Laryngeal Cancer

    Directory of Open Access Journals (Sweden)

    Patrick Sheahan

    2014-04-01

    Full Text Available Squamous cell carcinoma of the larynx continues to be the commonest head and neck cancer in many Western countries. The larynx plays a key role for many essential functions, including breathing, voice production, airway protection, and swallowing. The goals of laryngeal cancer treatment are thus to provide best possible oncologic control, while optimizing functional outcomes. In recent decades, the treatment paradigm for advanced laryngeal cancer has shifted from one of primary surgery (total laryngectomy as gold standard, toward non-surgical organ-preserving treatment using radiotherapy or chemoradiotherapy. However, concerns have emerged regarding functional outcomes after chemoradiotherapy, as well as possible decreased overall survival in patients with laryngeal cancer. The purpose of the present review is to review surgical and non-surgical options for treatment of advanced laryngeal cancer, as well as the evidence supporting each of these.

  9. Bell palsy

    Science.gov (United States)

    ... in the face Other symptoms that may occur: Dry eye, which may lead to eye sores or infections ... Complications may include: Eye surface becoming dry, leading to eye sores, infections, and vision loss Swelling in the muscles due to loss of nerve function

  10. Gd-DTPA-enhanced MR imaging in facial nerve paralysis

    International Nuclear Information System (INIS)

    Tien, R.D.; Dillon, W.P.

    1989-01-01

    GD-DTPA-enhanced MR imaging was used to evaluate 11 patients with facial nerve paralysis (five acute idiopathic facial palsy (Bell palsy), three chronic recurrent facial palsy, one acute facial palsy after local radiation therapy, one chronic facial dyskinesia, and one facial neuroma). In eight of 11 patients, there was marked enhancement of the infratemporal facial nerve from the labyrinthine segment to the stylomastoid foramen. Two patients had additional contrast enhancement in the internal auditory canal segment. In one patient, enhancement persisted (but to a lesser degree) 8 weeks after symptoms had resolved. In one patient, no enhancement was seen 15 months after resolution of Bell palsy. The facial neuroma was seen as a focal nodular enhancement in the mastoid segment of the facial nerve

  11. A rare case of diaphragmatic paralysis due to isolated phrenic nerve ...

    African Journals Online (AJOL)

    2008-11-04

    Nov 4, 2008 ... Isolated phrenic nerve palsy is a rare condition resulting from birth injury, with many possible complications such as diaphragmatic paralysis, pulmonary infection, chronic lung disease, growth failure and even death.1-3 I report a case of neonatal isolated phrenic nerve palsy in an infant delivered.

  12. Bell's palsy: data from a study of 70 cases.

    Science.gov (United States)

    Cirpaciu, D; Goanta, C M

    2014-01-01

    Bell's palsy is a condition that affects the facial nerve, which is one of the twelve cranial nerves. Its main function is to control all the muscles of the facial expression. It is a unilateral, acute, partial or complete paralysis of the facial nerve. Bell's palsy remains the most common cause of facial nerve paralysis, more often encountered in females aged 17 to 30 years, recurrent in many cases and with poor associations with other pathologic conditions. In modern literature, the suspected etiology could be due to the reactivation of the latent herpes viral infections in the geniculate ganglia, and their subsequent migration to the facial nerve but, favorable outcome by using vasodilators, neurotrophic and corticosteroid therapy was recorded.

  13. [Bell's palsy and facial pain associated with toxocara infection].

    Science.gov (United States)

    Bachtiar, Arian; Auer, Herbert; Finsterer, Josef

    2012-10-01

    Toxocarosis involving cranial nerves is extremely rare and almost exclusively concerns the optic nerve. Toxocarosis involving the seventh cranial nerve has not been reported. A 33y male developed left-sided Bell's palsy two days after left-sided otalgia 6y before. Despite extensive diagnostic work-up at that time the cause of Bell's palsy remained unknown. During the following years Bell's palsy slightly improved but retromandibular pain remained almost unchanged and he developed enlarged lymph nodes along the jugular veins, submandibularly, and in the trigonum caroticum. Re-evaluation 6y later revealed an increased titer of serum antibodies against Toxocara canis and a positive Westernblot for Toxocara canis ES-antigen. Despite absent eosinophilia in the serum, toxocarosis was diagnosed and a therapy with albendazole initiated, with benefit for retromandibular pain, but hardly for Bell's palsy or enlarged lymph nodes. CSF investigations after albendazole revealed a positive Westernblot for antibodies against toxocara but absent pleocytosis or eosinophilia, and negative PCR for Toxocara canis. Visceral larva migrans due to Toxocara canis may be associated with Bell's palsy, retromandibular pain, and lymphadenopathy. A causal relation between Bell's palsy and the helminthosis remains speculative. Adequate therapy years after onset of the infestation may be of limited benefit.

  14. Multiple Cranial Nerve Involvement In Cryptococcal Meningitis

    OpenAIRE

    Mahadevan A; Kumar A; Santosh V; Satishchandra P; Shankar S.K

    2000-01-01

    Cryptococcal meningitis is an uncommon cause of multiple cranial nerve palsies. This case report illustrates one such case of cryptococcal meningitis clinically manifesting with extensive cranial nerve involvement in an HIV seronegative individual. Histology revealed infiltration of the cranial nerves by cryptococci causing axonal disruption with secondary demyelination in the absence of any evidence of inflammation or vasculitis. We believe that axonal damage underlies the pathogenesis of...

  15. The history of facial palsy and spasm

    Science.gov (United States)

    Sajadi, Mohamad-Reza M.; Tabatabaie, Seyed Mahmoud

    2011-01-01

    Although Sir Charles Bell was the first to provide the anatomic basis for the condition that bears his name, in recent years researchers have shown that other European physicians provided earlier clinical descriptions of peripheral cranial nerve 7 palsy. In this article, we describe the history of facial distortion by Greek, Roman, and Persian physicians, culminating in Razi's detailed description in al-Hawi. Razi distinguished facial muscle spasm from paralysis, distinguished central from peripheral lesions, gave the earliest description of loss of forehead wrinkling, and gave the earliest known description of bilateral facial palsy. In doing so, he accurately described the clinical hallmarks of a condition that we recognize as Bell palsy. PMID:21747074

  16. Bell's Palsy in Children: Role of the School Nurse in Early Recognition and Referral

    Science.gov (United States)

    Gordon, Shirley C.

    2008-01-01

    Bell's palsy is the most common condition affecting facial nerves. It is an acute, rapidly progressing, idiopathic, unilateral facial paralysis that is generally self-limiting and non-life threatening that occurs in all age groups (Okuwobi, Omole, & Griffith, 2003). The school nurse may be the first person to assess facial palsy and muscle…

  17. Nerve Blocks

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Nerve Blocks A nerve block is an injection to ... the limitations of Nerve Block? What is a Nerve Block? A nerve block is an anesthetic and/ ...

  18. Facial nerve paralysis in children

    Science.gov (United States)

    Ciorba, Andrea; Corazzi, Virginia; Conz, Veronica; Bianchini, Chiara; Aimoni, Claudia

    2015-01-01

    Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology. PMID:26677445

  19. The asymmetric facial skin perfusion distribution of Bell's palsy discovered by laser speckle imaging technology.

    Science.gov (United States)

    Cui, Han; Chen, Yi; Zhong, Weizheng; Yu, Haibo; Li, Zhifeng; He, Yuhai; Yu, Wenlong; Jin, Lei

    2016-01-01

    Bell's palsy is a kind of peripheral neural disease that cause abrupt onset of unilateral facial weakness. In the pathologic study, it was evidenced that ischemia of facial nerve at the affected side of face existed in Bell's palsy patients. Since the direction of facial nerve blood flow is primarily proximal to distal, facial skin microcirculation would also be affected after the onset of Bell's palsy. Therefore, monitoring the full area of facial skin microcirculation would help to identify the condition of Bell's palsy patients. In this study, a non-invasive, real time and full field imaging technology - laser speckle imaging (LSI) technology was applied for measuring facial skin blood perfusion distribution of Bell's palsy patients. 85 participants with different stage of Bell's palsy were included. Results showed that Bell's palsy patients' facial skin perfusion of affected side was lower than that of the normal side at the region of eyelid, and that the asymmetric distribution of the facial skin perfusion between two sides of eyelid is positively related to the stage of the disease (P Bell's palsy patients, and we discovered that the facial skin blood perfusion could reflect the stage of Bell's palsy, which suggested that microcirculation should be investigated in patients with this neurological deficit. It was also suggested LSI as potential diagnostic tool for Bell's palsy.

  20. Plasma Fibrinogen in Patients With Bell Palsy.

    Science.gov (United States)

    Zhao, Hua; Zhang, Xin; Tang, Yinda; Li, Shiting

    2016-10-01

    To determine the plasma fibrinogen level in patients with Bell palsy and explore the significances of it in Bell palsy. One hundred five consecutive patients with facial paralysis were divided into 3 groups: group I (Bell palsy), group II (temporal bone fractures), and group III (facial nerve schwannoma). In addition, 22 volunteers were defined as control group. Two milliliters fasting venous blood from elbow was collected, and was evaluated by CA-7000 Full-Automatic Coagulation Analyzer. The plasma fibrinogen concentration was significantly higher in the group of patients with Bell palsy (HB IV-VI) than that in the control group (P 0.05); similarly, there was also no marked difference between group III and control group (P >0.05). In group I, the plasma fibrinogen levels became higher with the HB grading increase. The plasma fibrinogen level of HB-VI was highest. Plasma fibrinogen has an important clinical meaning in Bell palsy, which should be used as routine examination items. Defibrinogen in treatment for patients with high plasma fibrinogen content also should be suggested.

  1. Intratemporal Facial Nerve Paralysis- A Three Year Study

    Directory of Open Access Journals (Sweden)

    Anirban Ghosh

    2016-08-01

    Full Text Available Introduction This study on intratemporal facial paralysis is an attempt to understand the aetiology of facial nerve paralysis, effect of different management protocols and the outcome after long-term follow-up. Materials and Methods A prospective longitudinal study was conducted from September 2005 to August 2008 at the Department of Otorhinolaryngology of a medical college in Kolkata comprising 50 patients of intratemporal facial palsy. All cases were periodically followed up for at least 6 months and their prognostic outcome along with different treatment options were analyzed. Result Among different causes of facial palsy, Bell’s palsy is the commonest cause; whereas cholesteatoma and granulation were common findings in otogenic facial palsy. Traumatic facial palsies were exclusively due to longitudinal fracture of temporal bone running through geniculate ganglion. Herpes zoster oticus and neoplasia related facial palsies had significantly poorer outcome. Discussion Otogenic facial palsy showed excellent outcome after mastoid exploration and facial decompression. Transcanal decompression was performed in traumatic facial palsies showing inadequate recovery. Complete removal of cholesteatoma over dehiscent facial nerve gave better postoperative recovery. Conclusion The stapedial reflex test is the most objective and reproducible of all topodiagnostic tests. Return of the stapedial reflex within 3 weeks of injury indicates good prognosis. Bell’s palsy responded well to conservative measures. All traumatic facial palsies were due to longitudinal fracture and 2/3rd of these patients showed favourable outcome with medical therapy.

  2. RECCURENT LARYNGEAL PAPILLOMA

    Directory of Open Access Journals (Sweden)

    Nyilo Purnami

    2012-01-01

    Full Text Available A case of respiratory papillomatosis was reported. The patient suffered from the disease since eight months old with chief complaint progressive hoarseness and dyspnea. It was diagnosed with respiratory papillomatosis and scheduled for performing tracheotomy and continued with the first microlaryngeal surgery (MLS. Decanulation was taken after 2nd surgery of removing papillomas. Finally was reported she got serial of surgery for 22 times during 18 years of age. It was costly and deteriorating quality of life. The problem remains persisted because of frequent recurrences and need for repetitive surgeries. Specimen biopsy for histologic examination was shown the signs of HPV infection, papilomatic coated squamous epithel with mild dysplasia and coilocytosis. The threatening of upper airway obstruction is the main important reason for patient's coming. The patency of airway assessed by Direct Laryngoscopy then the next treatment was decided with schedule of Micro Laryngeal Surgery (MLS. Finally the MLS treatment is just only for temporarily recovery. A further research to define the proper treatment in the future is required, especially for prevention of the diseases related to the viral causes of infection.

  3. Ionising rays and laryngeal carcinomas

    International Nuclear Information System (INIS)

    Martin, G.; Glanz, H.; Kleinsasser, O.

    1979-01-01

    Review of the literature and report of a new case of laryngeal cancer after irradiation of a benign lesion of the neck. These cases obviously become rare since benign lesions are no longer irradiated. Today the risk of inducing a second carcinoma by a successful irradiation of the first tumor becomes more important. A study of 109 patients, irradiated for laryngeal carcinoma and surviving with no evidence of disease for a period of at least 5 years has been performed. 8 of these patients developed a second primary in the previously irradiated area after 7-15 years. These second carcinomas are not rare if one considers that most patients with laryngeal carcinoma are 60-70 years old and therefore the life expectance on an average is low. These facts should be taken into consideration when deciding between surgical or radiation therapy in younger patients with high life expectance. (orig.) [de

  4. Septal graft in laryngeal reconstruction

    International Nuclear Information System (INIS)

    Bahannan, Abdulrahman; Slavicek, A.; Taudy, M.; Chovanec, M.

    2006-01-01

    A 62-year-old woman presented with symptoms of dyspnea. Ultrasonography and computed tomography examinations revealed mass extending from the cricoid cartilage to the left lobe of thyroid gland and thyroid cartilage. Cytology revealed possibility of cartilaginous origin, which was proven to be chondrosarcoma (Grade 1) from the biopsy specimen obtained during panendosopy. She underwent one stage radical resection and immediate reconstruction of laryngeal skeleton defect by mucocartilaginous graft from the nasal septum. Her postoperative course was optimal with preservation of the laryngeal functions. Twenty-eight months postoperatively, she had to undergo total laryngectomy as a salvage procedure for the advanced local recurrence. We report on the relatively easy technique for functional reconstruction of the large laryngeal defect with the employment cartilage graft from the nasal septum. (author)

  5. Tendon transfer for median nerve palsy

    Directory of Open Access Journals (Sweden)

    K Sridhar

    2011-01-01

    Full Text Available The article describes the approach practiced by the author from 1995. Mainly Hansen′s patients and lower forearm injuries formed the bulk of these. In Opponen′s transfer ECU was used only when others were not available as the wrist developed a tendency to radial deviation even when FCU was acting. PL with palmar aponeurosis as extension was used again in limited cases. The main stay was FDS and EIP. The Guyan′s canal and lower end of ulna were the common pulleys. APB and EPL two slip inserts yielded good results. The approach describes the procedure under three distinct headings of choosing motor, Pulley and insert. Varying combinations of these can be used as per requirement.

  6. Bilateral Facial Nerve Palsy: A Diagnostic Dilemma

    Directory of Open Access Journals (Sweden)

    Sohil Pothiawala

    2012-01-01

    Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant.

  7. Rehabilitation of Bell's palsy patient with complete dentures.

    Science.gov (United States)

    Muthuvignesh, J; Kumar, N Suman; Reddy, D Narayana; Rathinavelu, Pradeep; Egammai, S; Adarsh, A

    2015-08-01

    Facial nerve disorders may be of sudden onset and more often of unknown etiology. Edema of the facial nerve within the fallopian canal results in Bell's palsy. This causes compression of the nerve and affects the microcirculation. Many authors have suggested treatment for facial nerve paralysis ranging from simple physiotherapy to complicated microvascular decompression. It more often results in symptoms like synkinesis and muscle spasm after the decompression surgery of the nerve because of the inability to arrange the nerve fibers within the canal. The treatment choice also depends on patient's age, extent of the nerve damage, and patient's needs and desires. Many patients who cannot be rehabilitated functionally can be treated for esthetics of the involved muscles. This case report elaborates about a patient who was rehabilitated for esthetics and to some extent for function.

  8. Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma

    OpenAIRE

    Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M.; Ginsberg, Lawrence E.; Gidley, Paul W.

    2014-01-01

    Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomograph...

  9. The Clinical Study on Bell's Palsy Patients with TCD Measurement

    Directory of Open Access Journals (Sweden)

    Lee Hyun

    2003-06-01

    Full Text Available Objective : This study was carried to make out the connection between cerebral artery blood flow velocity and ischemic theory that presumed the cause of Bell's palsy. Method : We measured cerebral artery blood flow velocity each external carotid artery, internal carotid artery, common carotid artery, siphon, superficial temporal artery by TCD to 20 patients who diagnosed as facial nerve palsy from march 2001 to July 2001 and all objectives devided two groups as palsy side. A group is right side facial nerve palsy and B group is left facial nerve palsy. Results : 1. There is no effective change of blood flow in external carotid artery either A, B group. 2. There is no effective change of blood flow in internal carotid artery either A, B group. 3. There is no effective change of blood flow in common carotid artery either A, B group. 4. There is no effective change of blood flow in siphon artery either A, B group. 5. There is no effective change of blood flow in superficial temporal artery either A, B group.

  10. 伽玛刀治疗垂体瘤致迟发性动眼神经麻痹1例报告%Delayed oculomotor cranial nerve palsy caused by pituitury tumor after gamma knife stereotactic radiation:a case report

    Institute of Scientific and Technical Information of China (English)

    吴慧; 刘华; 林洁

    2015-01-01

    尽管罕见,垂体瘤患者接受伽玛刀治疗后仍可发生颅神经损伤,临床上应予重视。本文报告1例垂体瘤患者在接受伽玛刀治疗后8年出现动眼神经麻痹的临床资料、包括诊断及可能的病理机制。%Patient undergoing gamma knife stereotactic radiation may get cranial nerve palsy though it is rare, to which great attention must be paid. Clinic date on such a case occurred 8 years after the patient was treated with gamma knife stereotactic radiation was reported, in which its diagnose and pathological mechanisms were included.

  11. Bilateral Bell palsy as a presenting sign of preeclampsia.

    Science.gov (United States)

    Vogell, Alison; Boelig, Rupsa C; Skora, Joanna; Baxter, Jason K

    2014-08-01

    Bell palsy is a facial nerve neuropathy that is a rare disorder but occurs at higher frequency in pregnancy. Almost 30% of cases are associated with preeclampsia or gestational hypertension. Bilateral Bell palsy occurs in only 0.3%-2.0% of cases of facial paralysis, has a poorer prognosis for recovery, and may be associated with a systemic disorder. We describe a case of a 24-year-old primigravid woman with a twin gestation at 35 weeks diagnosed initially with bilateral facial palsy and subsequently with preeclampsia. She then developed partial hemolysis, elevated liver enzymes, and low platelet count syndrome, prompting the diagnosis of severe preeclampsia, and was delivered. Bilateral facial palsy is a rare entity in pregnancy that may be the first sign of preeclampsia and suggests increased severity of disease, warranting close monitoring.

  12. Diagnosis and management of patients with Bell's palsy.

    Science.gov (United States)

    Mooney, Tracy

    Bell's palsy (idiopathic facial paralysis) is the most common cause of acute unilateral facial nerve paralysis. Although it is usually a self-limiting condition, it can be distressing for the patient. Many people who experience one-sided facial paralysis fear that it is a symptom of stroke. However, there are subtle differences between Bell's palsy and stroke. This article discusses potential causes of the condition and identifies the differences between Bell's palsy and stroke. In addition, appropriate strategies for the care of patients with the condition are suggested. Management includes antiviral medication, corticosteroid therapy, eye care, botulinum toxin type A injection, physiotherapy, surgery and acupuncture. Psychological and emotional care of these patients is also important because any facial disability caused by facial nerve paralysis can result in anxiety and stress.

  13. Pediatric mumps with laryngeal edema.

    Science.gov (United States)

    Hattori, Yujiro; Oi, Yasufumi; Matsuoka, Ryo; Daimon, Yumi; Ito, Asami; Kubota, Wataru; Konishi, Kyoko; Onguchi, Toshimi; Sato, Akihiro; Yamashita, Yukio; Ishihara, Jun

    2013-10-01

    Mumps virus infection primarily affects the salivary glands and may incur various complications. Laryngeal edema is such a rare complication that few adult cases have been reported. We report the first known pediatric patient with mumps with laryngeal edema. An 8-year-old boy developed dyspnea after a rapidly progressive swelling of his face and neck. Laryngoscopy revealed edematous changes in the supraglottic and subglottic regions, and computed tomography confirmed significant laryngeal edema in addition to swelling of the cervical soft tissue and the salivary glands. Laboratory findings revealed a high serum amylase level and confirmed the diagnosis of mumps. Intravenous steroid administration alleviated the dyspnea, although the patient required temporary tracheal intubation to maintain airway patency. He did not need tracheotomy and did not experience any other complications. Laryngeal edema must be regarded as a rare, potentially life-threatening complication of mumps. When mumps is diagnosed with significant swelling of the neck, an emergency airway should be established to prevent airway obstruction.

  14. ‘ SILENT’ LARYNGEAL FOREIGN BODY

    OpenAIRE

    Chandrasekhar; Sreenivas

    2015-01-01

    Laryngeal foreign bodies in adults are rare. The foreign bodies accidentally entering the larynx are symptomatic in the form of choking , stridor or even death. We are presenting a rare case of foreign body in the larynx in a 42 year old male who was symptom free except for dysphonia. The foreign body was removed successfully under local anesthesia.

  15. Pseudotumoural hypertrophic neuritis of the facial nerve

    OpenAIRE

    Zanoletti, E; Mazzoni, A; Barbò, R

    2008-01-01

    In a retrospective study of our cases of recurrent paralysis of the facial nerve of tumoural and non-tumoural origin, a tumour-like lesion of the intra-temporal course of the facial nerve, mimicking facial nerve schwannoma, was found and investigated in 4 cases. This was defined as, pseudotumoral hypertrophic neuritis of the facial nerve. The picture was one of recurrent acute facial palsy with incomplete recovery and imaging of a benign tumour. It was different from the well-known recurrent ...

  16. Comprehensive visual impairment evaluation for cerebral palsy children

    Directory of Open Access Journals (Sweden)

    Ping Wang

    2015-01-01

    Full Text Available AIM: To evaluate the visual impairment in cerebral palsy children with series objective indicators, and conclude their clinical features of visual function.METHODS: Objective tests including following pursuing test, optokinetic nystagmus(OKNdrum test, refractive error examination, fundus examination, ocular deviation examination, pattern visual evoked potential(P-VEPtests and brain magnetic resonance imaging(MRIwere carried out in 43 cerebral palsy children(86 eyeswith ocular visual dysfunction; The visual impairment data of the cerebral palsy children were collected, and the clinical features and possible mechanism were analyzed.RESULTS: 1. Of the 43 cerebral palsy children(86 eyeswith the visual impairment presented diversified, 25(50 eyes, 58.1%of refractive error, 24(48 eyes, 55.8%of strabismus, 12(24 eyes, 27.9%with nystagmus, 19(38 eyes, 44.2%of optical nerve atrophy or hyperplasia, 35(70 eyes, 81.4%of VEP abnormality. Among children with spastic cerebral palsy, the incidence of visual impairment was statistically significant difference compared with other groups(PP>0.05, no nystagmus in patients with severe occipital cortex damage.CONCLUSION: Cerebral palsy children were usually with visual impairment, and presented with special clinical features; Comprehensive objective visual tests are accurate and reliable for evaluation of the visual function in cerebral palsy children.

  17. Neuronal Activation in the Medulla Oblongata during Selective Elicitation of the Laryngeal Adductor Response

    Science.gov (United States)

    Ambalavanar, Ranjinidevi; Tanaka, Yasumasa; Selbie, W. Scott; Ludlow, Christy L.

    2008-01-01

    Swallow and cough are complex motor patterns elicited by rapid and intense electrical stimulation of the internal branch of the superior laryngeal nerve (ISLN). The laryngeal adductor response (LAR) includes only a laryngeal response, is elicited by single stimuli to the ISLN, and is thought to represent the brain stem pathway involved in laryngospasm. To identify which regions in the medulla are activated during elicitation of the LAR alone, single electrical stimuli were presented once every 2 s to the ISLN. Two groups of 5 cats each were studied; an experimental group with unilateral ISLN stimulation at 0.5 Hz and a surgical control group. Three additional cats were studied to evaluate whether other oral, pharyngeal or respiratory muscles were activated during ISLN stimulation eliciting LAR. We quantified up to 22 sections for each of 14 structures in the medulla to determine if regions had increased Fos-like immunoreactive neurons in the experimental group. Significant increases (p medulla. PMID:15212423

  18. SWALLOWING IN PATIENTS WITH LARYNGITIS

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    Isabela MODA

    Full Text Available ABSTRACT BACKGROUND: Dysphagia is described as a complaint in 32% of patients with laryngitis. OBJECTIVE: The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. METHODS: Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin. The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. RESULTS: The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. CONCLUSION: A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

  19. SWALLOWING IN PATIENTS WITH LARYNGITIS.

    Science.gov (United States)

    Moda, Isabela; Ricz, Hilton Marcos Alves; Aguiar-Ricz, Lilian Neto; Dantas, Roberto Oliveira

    2018-01-01

    Dysphagia is described as a complaint in 32% of patients with laryngitis. The objective of this investigation was to evaluate oral and pharyngeal transit of patients with laryngitis, with the hypothesis that alteration in oral-pharyngeal bolus transit may be involved with dysphagia. Videofluoroscopic evaluation of the swallowing of liquid, paste and solid boluses was performed in 21 patients with laryngitis, 10 of them with dysphagia, and 21 normal volunteers of the same age and sex. Two swallows of 5 mL liquid bolus, two swallows of 5 mL paste bolus and two swallows of a solid bolus were evaluated in a random sequence. The liquid bolus was 100% liquid barium sulfate and the paste bolus was prepared with 50 mL of liquid barium and 4 g of food thickener (starch and maltodextrin). The solid bolus was a soft 2.2 g cookie coated with liquid barium. Durations of oral preparation, oral transit, pharyngeal transit, pharyngeal clearance, upper esophageal sphincter opening, hyoid movement and oral-pharyngeal transit were measured. All patients performed 24-hour distal esophageal pH evaluation previous to videofluoroscopy. The evaluation of 24-hour distal esophageal pH showed abnormal gastroesophageal acid reflux in 10 patients. Patients showed longer oral preparation for paste bolus and a faster oral transit time for solid bolus than normal volunteers. Patients with laryngitis and dysphagia had longer preparation for paste and solid boluses, and a faster oral transit time with liquid, paste and solid boluses. A longer oral preparation for paste and solid boluses and a faster transit through the mouth are associated with dysphagia in patients with laryngitis.

  20. Prognosis and MRI findings in patients with peripheral facial palsy

    International Nuclear Information System (INIS)

    Mineta, Masayuki; Saitoh, Yasuhiro; Yoshikawa, Daihei; Yamada, Tomonori; Aburano, Tamio; Matoba, Mitsuaki.

    1997-01-01

    We examined a series of 21 peripheral facial palsy patients attempted to ( 17 Bell's palsy, 4 Hunt syndrome) with Gd-DTPA-enhanced MRI and attempted to determine the relation between prognosis and MRI findings. We divided patients into two groups based on facial palsy scores of Japanese facial nerve research; a good group (G-Group) and a bad group (B-group). The G-group scored over 20 points on the 20th day after the first visit and the B-group under 20 points. G-group consisted of 9 Bell's palsy and 1 Hunt syndrome patients, and the B-group of 8 Bell's palsy and 3 Hunt syndrome patients. The averaged facial palsy score of both groups was analyzed every week during 4 weeks. Recovery from the palsy was better in the G-group than the B-group (P<0.05); the scores at the 4th week of the G- and B-groups were 32.6±15.2 and 7.8±7.4, respectively. The MRI findings of both groups were examined retrospectively. Nine of 10 G-group and nine of 11 B-group patients had abnormal contrast enhancement. The result of enhanced facial nerve segment was as follows: G-group, auditory canal 1, labyrinthine/geniculate 7, tympanic 7, mastoid 7: B-group, auditory canal 2, labyrinthine/geniculate 8, tympanic 8, mastoid 7. Our results indicate no relation between the prognosis and the MRI findings. Therefore, it is impossible to predict the prognosis of facial palsy from the results of Gd-DTPA-enhanced MRI. (author)

  1. Prognosis and MRI findings in patients with peripheral facial palsy

    Energy Technology Data Exchange (ETDEWEB)

    Mineta, Masayuki; Saitoh, Yasuhiro; Yoshikawa, Daihei; Yamada, Tomonori; Aburano, Tamio [Asahikawa Medical College, Hokkaido (Japan); Matoba, Mitsuaki

    1997-02-01

    We examined a series of 21 peripheral facial palsy patients attempted to ( 17 Bell`s palsy, 4 Hunt syndrome) with Gd-DTPA-enhanced MRI and attempted to determine the relation between prognosis and MRI findings. We divided patients into two groups based on facial palsy scores of Japanese facial nerve research; a good group (G-Group) and a bad group (B-group). The G-group scored over 20 points on the 20th day after the first visit and the B-group under 20 points. G-group consisted of 9 Bell`s palsy and 1 Hunt syndrome patients, and the B-group of 8 Bell`s palsy and 3 Hunt syndrome patients. The averaged facial palsy score of both groups was analyzed every week during 4 weeks. Recovery from the palsy was better in the G-group than the B-group (P<0.05); the scores at the 4th week of the G- and B-groups were 32.6{+-}15.2 and 7.8{+-}7.4, respectively. The MRI findings of both groups were examined retrospectively. Nine of 10 G-group and nine of 11 B-group patients had abnormal contrast enhancement. The result of enhanced facial nerve segment was as follows: G-group, auditory canal 1, labyrinthine/geniculate 7, tympanic 7, mastoid 7: B-group, auditory canal 2, labyrinthine/geniculate 8, tympanic 8, mastoid 7. Our results indicate no relation between the prognosis and the MRI findings. Therefore, it is impossible to predict the prognosis of facial palsy from the results of Gd-DTPA-enhanced MRI. (author)

  2. Pretreatment Hematologic Findings as Novel Predictive Markers for Facial Palsy Prognosis.

    Science.gov (United States)

    Wasano, Koichiro; Kawasaki, Taiji; Yamamoto, Sayuri; Tomisato, Shuta; Shinden, Seiichi; Ishikawa, Toru; Minami, Shujiro; Wakabayashi, Takeshi; Ogawa, Kaoru

    2016-10-01

    To examine the relationship between prognosis of 2 different facial palsies and pretreatment hematologic laboratory values. Multicenter case series with chart review. Three tertiary care hospitals. We examined the clinical records of 468 facial palsy patients who were treated with an antiviral drug in combination with either oral or intravenous corticosteroids in participating hospitals between 2010 and 2014. Patients were divided into a Bell's palsy group or a Hunt's palsy group. We used the Yanagihara facial nerve grading system to grade the severity of facial palsy. "Recovery" from facial palsy was defined as achieving a Yanagihara score ≥36 points within 6 months of onset and having no accompanying facial contracture or synkinesis. We collected information about pretreatment hematologic findings, demographic data, and electrophysiologic test results of the Bell and Hunt group patients who recovered and those who did not. We then compared these data across the 2 palsy groups. In the Bell's palsy group, recovered and unrecovered patients differed significantly in age, sex, electroneuronography score, stapedial muscle reflex, neutrophil rate, lymphocyte rate, neutrophil-to-lymphocyte ratio, and initial Yanagihara score. In the Hunt's palsy group, recovered and unrecovered patients differed in age, electroneuronography score, stapedial muscle reflex, monocyte rate, platelet count, mean corpuscular volume, and initial Yanagihara score. Pretreatment hematologic findings, which reflect the severity of inflammation and bone marrow dysfunction caused by a virus infection, are useful for predicting the prognosis of facial palsy. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.

  3. Isolated long thoracic nerve paralysis - a rare complication of anterior spinal surgery: a case report

    Directory of Open Access Journals (Sweden)

    Ameri Ebrahim

    2009-06-01

    Full Text Available Abstract Introduction Isolated long thoracic nerve injury causes paralysis of the serratus anterior muscle. Patients with serratus anterior palsy may present with periscapular pain, weakness, limitation of shoulder elevation and scapular winging. Case presentation We present the case of a 23-year-old woman who sustained isolated long thoracic nerve palsy during anterior spinal surgery which caused external compressive force on the nerve. Conclusion During positioning of patients into the lateral decubitus position, the course of the long thoracic nerve must be attended to carefully and the nerve should be protected from any external pressure.

  4. Facial Nerve Schwannoma Involving Middle Cranial Fossa: When the Unilateral Sensorineural Hearing Loss Guide to the Correct Diagnosis

    OpenAIRE

    De Stefano, Alessandro; Dispenza, Francesco; Kulamarva, Gautham

    2011-01-01

    The Facial Nerve Schwannoma is a rare tumor and it seldom involved the middle cranial fossa. Facial nerve schwannoma has various manifestations, including facial palsy but unfortunately facial nerve is very resistant to compression and often facial nerve paralysis or a facial weakness are not present. We present a case of giant facial nerve schwannoma involved the middle cranial fossa without facial nerve paralysis. In these cases the unilateral hearing loss (if present) guide to a correct di...

  5. Ortner's Syndrome: Secondary Laryngeal Paralysis Caused by a Great Thoracic Aorta Aneurysm

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    Zangirolami, Ana Claudia Alves

    2015-01-01

    Full Text Available Introduction Recurrent laryngeal nerve injury caused by cardiovascular disease is a rare condition, and often it is the only prominent sign of an imminent break of an aortic artery aneurysm. Objective To report left laryngeal paralysis caused by a great aortic arch aneurysm and to highlight the importance of an otorhinolaryngologic evaluation along with a thoracic radiologic study. Resumed Report A 42-year-old man complained of thickness of his voice and dysphagia for 3 months, but no thoracic pain or other relevant complaints. Video laryngoscopy revealed immobility of his left vocal fold in the paramedian position. Imaging was obtained for investigation, including magnetic resonance imaging of his thorax, which showed a fusiform aneurysm in the aortic arch, leading to recurrent compression of the left laryngeal nerve. The patient was successfully treated with endovascular repair of the aneurysm. At 2-month follow-up, there was still no recovery of the laryngeal mobility. Conclusion An aortic artery aneurysm can suddenly break, requiring emergency heart surgery, and the results can be fatal in many cases. We suggest routine exam of the vocal folds in all patients with a heart condition, and we review the literature and suggest the use of imaging to reduce the number of emergency procedures.

  6. Ortner's Syndrome: Secondary Laryngeal Paralysis Caused by a Great Thoracic Aorta Aneurysm.

    Science.gov (United States)

    Zangirolami, Ana Claudia Alves; Oliveira, Frederico Vieira de; Tepedino, Miguel Soares

    2015-04-01

    Introduction Recurrent laryngeal nerve injury caused by cardiovascular disease is a rare condition, and often it is the only prominent sign of an imminent break of an aortic artery aneurysm. Objective To report left laryngeal paralysis caused by a great aortic arch aneurysm and to highlight the importance of an otorhinolaryngologic evaluation along with a thoracic radiologic study. Resumed Report A 42-year-old man complained of thickness of his voice and dysphagia for 3 months, but no thoracic pain or other relevant complaints. Video laryngoscopy revealed immobility of his left vocal fold in the paramedian position. Imaging was obtained for investigation, including magnetic resonance imaging of his thorax, which showed a fusiform aneurysm in the aortic arch, leading to recurrent compression of the left laryngeal nerve. The patient was successfully treated with endovascular repair of the aneurysm. At 2-month follow-up, there was still no recovery of the laryngeal mobility. Conclusion An aortic artery aneurysm can suddenly break, requiring emergency heart surgery, and the results can be fatal in many cases. We suggest routine exam of the vocal folds in all patients with a heart condition, and we review the literature and suggest the use of imaging to reduce the number of emergency procedures.

  7. Preoperative Identification of Facial Nerve in Vestibular Schwannomas Surgery Using Diffusion Tensor Tractography

    OpenAIRE

    Choi, Kyung-Sik; Kim, Min-Su; Kwon, Hyeok-Gyu; Jang, Sung-Ho; Kim, Oh-Lyong

    2014-01-01

    Objective Facial nerve palsy is a common complication of treatment for vestibular schwannoma (VS), so preserving facial nerve function is important. The preoperative visualization of the course of facial nerve in relation to VS could help prevent injury to the nerve during the surgery. In this study, we evaluate the accuracy of diffusion tensor tractography (DTT) for preoperative identification of facial nerve. Methods We prospectively collected data from 11 patients with VS, who underwent pr...

  8. Laryngeal morbidity after tracheal intubation

    DEFF Research Database (Denmark)

    Sørensen, M K; Rasmussen, N; Kristensen, M S

    2013-01-01

    BACKGROUND: Tracheal intubation may cause vocal fold damage. The trial was designed to assess laryngeal morbidity comparing the Endoflex(®) tube with a conventional endotracheal tube with stylet. We hypothesised that laryngeal morbidity within the first 24 h after extubation would be lower...... with the Endoflex tube than with the conventional endotracheal tube with stylet because of less rigidity. METHODS: This randomised trial included 130 elective surgical patients scheduled for general anaesthesia with endotracheal intubation. Pre- and post-operative assessment of hoarseness, vocal fold pathology......% with the Endoflex tube and 55% with the endotracheal tube with stylet at 24 h after extubation (P = 0.44). Post-operative vocal fold injury was present in 23% in the Endoflex tube group and in 36% in the endotracheal tube with stylet group (P = 0.13). The increase in shimmer, the voice analysis variable reflecting...

  9. Post-traumatic Unilateral Avulsion of the Abducens Nerve with Damage to Cranial Nerves VII and VIII: Case Report.

    Science.gov (United States)

    Yamasaki, Fumiyuki; Akiyama, Yuji; Tsumura, Ryu; Kolakshyapati, Manish; Adhikari, Rupendra Bahadur; Takayasu, Takeshi; Nosaka, Ryo; Kurisu, Kaoru

    2016-07-01

    Traumatic injuries of the abducens nerve as a consequence of facial and/or head trauma occur with or without associated cervical or skull base fracture. This is the first report on unilateral avulsion of the abducens nerve in a 29-year-old man with severe right facial trauma. In addition, he exhibited mild left facial palsy, and moderate left hearing disturbance. Magnetic resonance imaging (MRI) using fast imaging employing steady-state acquisition (FIESTA) revealed avulsion of left sixth cranial nerve. We recommend thin-slice MR examination in patients with abducens palsy after severe facial and/or head trauma.

  10. Allergic laryngitis: unraveling the myths.

    Science.gov (United States)

    Stachler, Robert J; Dworkin-Valenti, James P

    2017-06-01

    This article provides a thorough review of the literature highlighting the articles that have advanced our knowledge about the sensitivity of the larynx to allergens in the air or ones consumed. This area of inquiry requires continued interest and investigation. As the field of clinical laryngology changes, and more information is discovered about the possible causal association between allergy and vocal pathologies, practicing otolaryngologists, allergists, and other medical professionals may discover more comprehensive methods to evaluate and treat their allergic patients, particularly those who present with complaints of dysphonia, dysphagia, laryngopharyngeal reflux (LPR), and/or dyspnea. There continues to be epidemiological studies designed to describe the relationship of allergy to vocal symptoms and signs. Both population and smaller studies have recently attempted to link these two conditions. Unfortunately, the patient with chronic laryngeal complaints is often tagged by default with the diagnosis of LPR and treated with proton pump inhibitors, which are not always beneficial. The endoscopic assessment may not be as reliable to make the diagnosis of LPR as the examination is subjective and the inter-rater reliability is low. It has been demonstrated by direct laryngeal provocation studies that sticky-viscous endo-laryngeal mucous is the only reliable finding consistently associated with allergy potential allergic tissue reactivity. The interrelationship of allergic sensitivity and chronic laryngitis in certain individuals is becoming clearer because our knowledge of inquiry has increased and the available routine technology to diagnose these conditions has remarkably improved. Notwithstanding these advancements, much more research is needed on this subject to reduce the frequency of mis-diagnoses and mis-management of allergic patients.

  11. Paediatric laryngeal granular cell tumour

    Directory of Open Access Journals (Sweden)

    Dauda Ayuba

    2009-01-01

    Full Text Available Granular cell tumour (GCT affecting the larynx is not common, especially in children. Most cases are apt to be confused with respiratory papilloma and may even be mistaken for a malignant neoplasia. We present a case of laryngeal GCT in a 12-year-old child to emphasize that the tumour should be regarded in the differential of growths affecting the larynx in children.

  12. Multiple cranial nerve dysfunction caused by neurosarcoidosis

    NARCIS (Netherlands)

    Loor, Rivkah G. J.; van Tongeren, Joost; Derks, Wynia

    2012-01-01

    Neurosarcoidosis is a rare identity and occurs in only 5% to 15% of patients with sarcoidosis. It can manifest in many different ways, and therefore, diagnosis may be complicated. We report a case presented in a very unusual manner with involvement of 3 cranial nerves; anosmia (NI), facial palsy

  13. Multidisciplinary Management of Laryngeal Carcinoma

    International Nuclear Information System (INIS)

    Mendenhall, William M.; Mancuso, Anthony A.; Hinerman, Russell W.; Malyapa, Robert S.; Werning, John W.; Amdur, Robert J.; Villaret, Douglas B.

    2007-01-01

    The management of head and neck cancer has evolved into a multidisciplinary approach in which patients are evaluated before treatment and decisions depend on prospective multi-institutional trials, as well as retrospective outcome studies. The choice of one or more modalities to use in a given case varies with the tumor site and extent, as exemplified in the treatment of laryngeal squamous cell carcinomas. The goals of treatment include cure, laryngeal voice preservation, voice quality, optimal swallowing, and minimal xerostomia. Treatment options include transoral laser excision, radiotherapy (both definitive and postoperative), open partial laryngectomy, total laryngectomy, and neck dissection. The likelihood of local control and preservation of laryngeal function is related to tumor volume. Patients who have a relatively high risk of local recurrence undergo follow-up computed tomography scans every 3-4 months for the first 2 years after radiotherapy. Patients with suspicious findings on computed tomography might benefit from fluorodeoxyglucose positron emission tomography to differentiate post-radiotherapy changes from tumor

  14. Intraoperative Hypoglossal Nerve Mapping During Carotid Endarterectomy: Technical Note.

    Science.gov (United States)

    Kojima, Atsuhiro; Saga, Isako; Ishikawa, Mami

    2018-05-01

    Hypoglossal nerve deficit is a possible complication caused by carotid endarterectomy (CEA). The accidental injury of the hypoglossal nerve during surgery is one of the major reasons for permanent hypoglossal nerve palsy. In this study, we investigated the usefulness of intraoperative mapping of the hypoglossal nerve to identify this nerve during CEA. Five consecutive patients who underwent CEA for the treatment of symptomatic or asymptomatic carotid artery stenosis were studied. A hand-held probe was used to detect the hypoglossal nerve in the operative field, and the tongue motor evoked potentials (MEPs) were recorded. The tongue MEPs were obtained in all the patients. The invisible hypoglossal nerve was successfully identified without any difficulty when the internal carotid artery was exposed. Intraoperative mapping was particularly useful for identifying the hypoglossal nerve when the hypoglossal nerve passed beneath the posterior belly of the digastric muscle. In 1 of 2 cases, MEP was also elicited when the ansa cervicalis was stimulated, although the resulting amplitude was much smaller than that obtained by direct stimulation of the hypoglossal nerve. Postoperatively, none of the patients presented with hypoglossal nerve palsy. Intraoperative hypoglossal nerve mapping enabled us to locate the invisible hypoglossal nerve during the exposure of the internal carotid artery accurately without retracting the posterior belly of the digastric muscle and other tissues in the vicinity of the internal carotid artery. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Pinched Nerve

    Science.gov (United States)

    ... You are here Home » Disorders » All Disorders Pinched Nerve Information Page Pinched Nerve Information Page What research is being done? Within the NINDS research programs, pinched nerves are addressed primarily through studies associated with pain ...

  16. Clinical study of T1 and T2 laryngeal cancers. Key points for laryngeal preservation

    International Nuclear Information System (INIS)

    Nasu, Takashi; Koike, Shuji; Inamura, Hiroo; Aoyagi, Masaru; Namura, Tadashi

    2004-01-01

    Between 1989 and 2003, we treated 129 patients with T1 and T2 laryngeal cancers. The purpose of this study was to estimate the management of T1 and T2 laryngeal cancers, referring to the relationship with the T classification, subtype, treatment, prognosis and laryngeal preservation. The treatment plan for T1 and T2 laryngeal cancers is fundamentally radiotherapy. To raise the laryngeal preservation rate, concurrent chemoradiotherapy by FAR therapy, carboplatin (CBDCA), docetaxel (DOC) and laser treatment was performed for the T2 cases. The 5-year survival rates of the T1 and T2 cases were 94.7% and 94.8%, respectively. The 5-year laryngeal preservation rates of the T1 and T2 cases were 97.1% and 72.3%, respectively. The 5-year survival rates of the glottic cancer and supraglottic cancer cases were 96.7% and 87.0% and the 5-year laryngeal preservation rates of these cases were 97.1% and 57.2%, respectively. Particularly in T2 supraglottic laryngeal cancer, the laryngeal preservation rate is not improved even with concurrent chemoradiotherapy by CBDCA and FAR therapy. To improve the laryngeal preservation rate in T2 supraglottic laryngeal cancer, it is necessary to consider concurrent chemoradiotherapy by DOC or hyperfractionation. (author)

  17. Disfunção temporária do nervo lingual após uso de máscara laríngea: relato de caso Disfunción temporal del nervio lingual trás del uso de máscara laríngea: relato de caso Temporary lingual nerve dysfunction following the use of the laryngeal mask airway: report

    Directory of Open Access Journals (Sweden)

    Hugo Eckener Dantas de Pereira Cardoso

    2007-08-01

    ño tres. El volumen aplicado para insuflación del globo fue de 30 mL de aire. Después de la primera hora del postoperatorio, se inició el cuadro de adormecimiento y dolor en la garganta y en los dos tercios posteriores de la lengua que evolucionó en 24 horas con pérdida de la percepción del sabor de los alimentos. La sospecha diagnóstica fue de neuropraxia del nervio lingual por el uso de máscara laríngea. Este cuadro se mantuvo por tres semanas, período en que se obtuvo una resolución de los síntomas. CONCLUSIÓN: Complicaciones después del uso de máscara laríngea, a pesar de no frecuentes, pueden ocurrir. La neuropraxia del nervio lingual es una de ellas. Su diagnóstico es clínico y su evolución es favorable con resolución de los síntomas en semanas o meses.BACKGROUND AND OBJECTIVES: The laryngeal mask has been frequently used in Anesthesiology. Although the rate of complications with this technique is smaller than that of the endotracheal tube, it is not devoid of risks, especially in cases of difficult airways. The objective of this study was to report a case of unilateral lingual nerve damage after the use of the laryngeal mask airway. CASE REPORT: A female patient underwent a surgical procedure for removal of bilateral breast prosthesis under general, balanced anesthesia, with a size three laryngeal mask. The balloon was inflated with 30 mL of air. After the first postoperative hour, she developed decreased sensation and pain in the oropharynx and posterior two thirds of the tongue, which evolved for loss of taste in the next 24 hours. A tentative diagnosis of lingual nerve neuropraxis secondary to the use of the laryngeal mask was made. After three weeks, her symptoms subsided. CONCLUSION: Although complications after the use of the laryngeal mask airway are rare, they do occur, and neuropraxis of the lingual nerve is one of them. The diagnosis is clinical and it has a good outcome, with resolution of the symptoms within a few weeks or months.

  18. Imaging the Facial Nerve: A Contemporary Review

    International Nuclear Information System (INIS)

    Gupta, S.; Roehm, P.C.; Mends, F.; Hagiwara, M.; Fatterpekar, G.

    2013-01-01

    Imaging plays a critical role in the evaluation of a number of facial nerve disorders. The facial nerve has a complex anatomical course; thus, a thorough understanding of the course of the facial nerve is essential to localize the sites of pathology. Facial nerve dysfunction can occur from a variety of causes, which can often be identified on imaging. Computed tomography and magnetic resonance imaging are helpful for identifying bony facial canal and soft tissue abnormalities, respectively. Ultrasound of the facial nerve has been used to predict functional outcomes in patients with Bell’s palsy. More recently, diffusion tensor tractography has appeared as a new modality which allows three-dimensional display of facial nerve fibers

  19. Vagus nerve stimulation for epilepsy activates the vocal folds maximally at therapeutic levels.

    NARCIS (Netherlands)

    Ardesch, J.J.; Sikken, J.R.; Veltink, Petrus H.; van der Aa, H.E.; Hageman, G.; Buschman, H.P.J.

    Purpose Vagus nerve stimulation (VNS) for medically refractory epilepsy can give hoarseness due to stimulation of the recurrent laryngeal nerve. For a group of VNS-therapy users this side-effect interferes severely with their daily activities. Our goal was to investigate the severity of

  20. Case study: lessons from a laryngeal abscess

    African Journals Online (AJOL)

    pathology is explored, as well as the diagnostic error that could have resulted in serious complications. Keywords: asthma, error, laryngeal abscess, squamous carcinoma. Introduction .... tified or cultured and syphilis serology was normal. The laryngeal biopsies confirmed a well-differentiated keratinising squamous.

  1. Clinical manifestation of Laryngeal Tuberculosis | Abdalla | Sudan ...

    African Journals Online (AJOL)

    All tuberculous patients with laryngeal symptoms and those diagnosed histologically to have laryngeal tuberculosis were included. Results: Eight patients were studied; they were five males and three females, with age range between 12-70 years (mean 41years). Strider, dysphonia and dysphagia were the main complaints.

  2. Contemporary management of advanced laryngeal cancer.

    Science.gov (United States)

    Britt, Christopher J; Gourin, Christine G

    2017-10-01

    The treatment of advanced laryngeal cancer has undergone a paradigm shift in recent years, with an increase in chemoradiation for organ preservation and a decrease in primary surgery. This review will summarize the contemporary management of advanced laryngeal cancer and discuss treatment-related toxicity and strategies to improve outcomes. NA.

  3. Treatment of peroneal nerve injuries with simultaneous tendon transfer and nerve exploration.

    Science.gov (United States)

    Ho, Bryant; Khan, Zubair; Switaj, Paul J; Ochenjele, George; Fuchs, Daniel; Dahl, William; Cederna, Paul; Kung, Theodore A; Kadakia, Anish R

    2014-08-06

    Common peroneal nerve palsy leading to foot drop is difficult to manage and has historically been treated with extended bracing with expectant waiting for return of nerve function. Peroneal nerve exploration has traditionally been avoided except in cases of known traumatic or iatrogenic injury, with tendon transfers being performed in a delayed fashion after exhausting conservative treatment. We present a new strategy for management of foot drop with nerve exploration and concomitant tendon transfer. We retrospectively reviewed a series of 12 patients with peroneal nerve palsies that were treated with tendon transfer from 2005 to 2011. Of these patients, seven were treated with simultaneous peroneal nerve exploration and repair at the time of tendon transfer. Patients with both nerve repair and tendon transfer had superior functional results with active dorsiflexion in all patients, compared to dorsiflexion in 40% of patients treated with tendon transfers alone. Additionally, 57% of patients treated with nerve repair and tendon transfer were able to achieve enough function to return to running, compared to 20% in patients with tendon transfer alone. No patient had full return of native motor function resulting in excessive dorsiflexion strength. The results of our limited case series for this rare condition indicate that simultaneous nerve repair and tendon transfer showed no detrimental results and may provide improved function over tendon transfer alone.

  4. Effect of laryngeal anesthesia on pulmonary function testing in normal subjects.

    Science.gov (United States)

    Kuna, S T; Woodson, G E; Sant'Ambrogio, G

    1988-03-01

    Pulmonary function tests (PFT) were performed on 11 normal subjects before and after topical anesthesia of the larynx. The PFT consisted of flow volume loops and body box determinations of functional residual capacity and airway resistance, each performed in triplicate. After the first set of tests, cotton pledgets soaked in 4% lidocaine were held in the pyriform sinuses for 2 min to block the superior laryngeal nerves. In addition, 1.5 ml of 10% cocaine was dropped on the vocal cords via indirect laryngoscopy. PFT were repeated 5 min after anesthesia. Besides routine analysis of the flow volume loops, areas under the inspiratory (Area I) and expiratory (Area E) portions of the loops were calculated by planimetry. Area I, peak inspiratory flow (PIF), as well as forced inspiratory flow at 25, 50, and 75% forced vital capacity (FVC), decreased after anesthesia. Peak expiratory flow decreased after anesthesia, but Area E and forced expiratory flow at 25, 50, and 75% FVC were unchanged. This protocol also was performed in 12 normal subjects with isotonic saline being substituted for the lidocaine and cocaine. In this group, no significant differences were observed when flow volume loop parameters were compared before and after topical application of saline. In 5 spontaneously breathing anesthetized dogs, posterior cricoarytenoid muscle and afferent superior laryngeal nerve activity were recorded before and after laryngeal anesthesia performed with the same procedure used in the human subjects. Laryngeal anesthesia resulted in a substantial decrease or a complete disappearance of afferent SLN activity recorded during unobstructed and obstructed respiration. The data suggest that laryngeal receptors help modulate upper airway patency in man.

  5. Branchial cleft cyst encircling the hypoglossal nerve

    Science.gov (United States)

    Long, Kristin L.; Spears, Carol; Kenady, Daniel E.

    2013-01-01

    Branchial cleft anomalies are a common cause of lateral neck masses and may present with infection, cyst enlargement or fistulas. They may affect any of the nearby neck structures, causing compressive symptoms or vessel thrombosis. We present a case of a branchial cleft cyst in a 10-year-old boy who had been present for 1year. At the time of operation, the cyst was found to completely envelop the hypoglossal nerve. While reports of hypoglossal nerve palsies due to external compression from cysts are known, we believe this to be the first report of direct nerve involvement by a branchial cleft cyst. PMID:24963902

  6. Nanomedicine in cerebral palsy

    Science.gov (United States)

    Balakrishnan, Bindu; Nance, Elizabeth; Johnston, Michael V; Kannan, Rangaramanujam; Kannan, Sujatha

    2013-01-01

    Cerebral palsy is a chronic childhood disorder that can have diverse etiologies. Injury to the developing brain that occurs either in utero or soon after birth can result in the motor, sensory, and cognitive deficits seen in cerebral palsy. Although the etiologies for cerebral palsy are variable, neuroinflammation plays a key role in the pathophysiology of the brain injury irrespective of the etiology. Currently, there is no effective cure for cerebral palsy. Nanomedicine offers a new frontier in the development of therapies for prevention and treatment of brain injury resulting in cerebral palsy. Nanomaterials such as dendrimers provide opportunities for the targeted delivery of multiple drugs that can mitigate several pathways involved in injury and can be delivered specifically to the cells that are responsible for neuroinflammation and injury. These materials also offer the opportunity to deliver agents that would promote repair and regeneration in the brain, resulting not only in attenuation of injury, but also enabling normal growth. In this review, the current advances in nanotechnology for treatment of brain injury are discussed with specific relevance to cerebral palsy. Future directions that would facilitate clinical translation in neonates and children are also addressed. PMID:24204146

  7. Bilateral traumatic paralysis of abducent nerves and clivus fracture: Case Report

    Directory of Open Access Journals (Sweden)

    Calderon-Miranda Willen Guillermo

    2014-12-01

    Full Text Available Clivus fractures are a rare pathology, frecuently associated tohigh power trauma. Such injuries may be associated with vascular and cranial nerves lesions. The abducens nerve is particularly vulnerable to traumatic injuries due to its long intracranial course, since their real origin until the lateral rectus muscle. The unilateral abducens nerve palsy of 1- 2-7% occurs in patients with cranial trauma, bilateral paralysis is rare. We report a patient who presented bilateral abducens nerve palsy associated with a clivus fracture

  8. Imaging of Cranial Nerves III, IV, VI in Congenital Cranial Dysinnervation Disorders.

    Science.gov (United States)

    Kim, Jae Hyoung; Hwang, Jeong Min

    2017-06-01

    Congenital cranial dysinnervation disorders are a group of diseases caused by abnormal development of cranial nerve nuclei or their axonal connections, resulting in aberrant innervation of the ocular and facial musculature. Its diagnosis could be facilitated by the development of high resolution thin-section magnetic resonance imaging. The purpose of this review is to describe the method to visualize cranial nerves III, IV, and VI and to present the imaging findings of congenital cranial dysinnervation disorders including congenital oculomotor nerve palsy, congenital trochlear nerve palsy, Duane retraction syndrome, Möbius syndrome, congenital fibrosis of the extraocular muscles, synergistic divergence, and synergistic convergence. © 2017 The Korean Ophthalmological Society.

  9. Bell’s palsy: data from a study of 70 cases

    Science.gov (United States)

    Cirpaciu, D; Goanta, CM

    2014-01-01

    Bell’s palsy is a condition that affects the facial nerve, which is one of the twelve cranial nerves. Its main function is to control all the muscles of the facial expression. It is a unilateral, acute, partial or complete paralysis of the facial nerve. Bell's palsy remains the most common cause of facial nerve paralysis, more often encountered in females aged 17 to 30 years, recurrent in many cases and with poor associations with other pathologic conditions. In modern literature, the suspected etiology could be due to the reactivation of the latent herpes viral infections in the geniculate ganglia, and their subsequent migration to the facial nerve but, favorable outcome by using vasodilators, neurotrophic and corticosteroid therapy was recorded. PMID:25870668

  10. The association of Varicella zoster virus reactivation with Bell's palsy in children.

    Science.gov (United States)

    Abdel-Aziz, Mosaad; Azab, Noha A; Khalifa, Badwy; Rashed, Mohammed; Naguib, Nader

    2015-03-01

    Bell's palsy is considered the most common cause of facial nerve paralysis in children. Although different theories have been postulated for its diagnosis, reactivation of the Varicella zoster virus (VZV) has been implicated as one of the causes of Bell's palsy. The aim of the study was to evaluate the association of Varicella-zoster virus infection with Bell's palsy and its outcome in children. A total of 30 children with Bell's palsy were recruited and were assayed for evidence of VZV infection. The severity of facial nerve dysfunction and the recovery rate were evaluated according to House-Brackmann Facial Nerve Grading Scale (HB FGS). Paired whole blood samples from all patients were obtained at their initial visit and 3 weeks later, and serum samples were analyzed for VZV IgG and IgM antibodies using ELISA. A significantly higher percentage of Bell's palsy patients were seropositive for VZV IgM antibodies than controls (36.6% of patients vs 10% of controls) while for VZV IgG antibodies the difference was statistically nonsignificant. HB FGS in Bell's palsy patients with serologic evidence of VZV recent infection or reactivation showed a statistiacally significant less cure rate than other patients. VZV reactivation may be an important cause of acute peripheral facial paralysis in children. The appropriate diagnosis of VZV reactivation should be done to improve the outcome and the cure rate by the early use of antiviral treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  11. Value of Laryngeal Electromyography in Spasmodic Dysphonia Diagnosis and Therapy.

    Science.gov (United States)

    Yang, Qingwen; Xu, Wen; Li, Yun; Cheng, Liyu

    2015-07-01

    To investigate the role of laryngeal electromyography (LEMG) in the diagnosis and treatment of spasmodic dysphonia (SD). The clinical manifestations, characteristics of motor unit potentials (MUPs), recruitment potentials, and laryngeal nerve evoked potentials (EPs) in LEMG, as well as the changes after botulinum toxin (BTX) treatment, were analyzed in 39 patients with adductor SD. The main clinical manifestations were a strained voice and phonation interruptions; in addition, the patients displayed hyper-adducted vocal folds during phonation. LEMG revealed significantly increased amplitudes of the thyroarytenoid muscle MUPs. The recruitment potentials were in a dense bunch, discharging full interference patterns with significantly increased amplitudes; the mean and maximum amplitude of recruitment potentials were 3090 μV and 5000 μV, respectively. The amplitude of EPs of thyroarytenoid muscle increased significantly; the mean and maximum amplitudes were 10.3 mV and 26.3 mV, respectively. After BTX was injected, the LEMG revealed denervation changes, and the EPs weakened or disappeared in the injected muscle. SD could be diagnosed, and the therapeutic efficacy of SD treatments could be evaluated based on clinical characteristics combined with LEMG characteristics. The increased amplitudes of the recruitment potentials and EPs of the thyroarytenoid muscle were the characteristic indexes. After BTX was injected, denervated potential characteristics appeared in the muscles. © The Author(s) 2015.

  12. Unilateral Laryngeal Pacing System and Its Functional Evaluation

    Directory of Open Access Journals (Sweden)

    Taiping Zeng

    2017-01-01

    Full Text Available Goal. To establish a reliable instrumental system for synchronized reactivation of a unilaterally paralyzed vocal fold and evaluate its functional feasibility. Methods. Unilateral vocal fold paralysis model was induced by destruction of the left recurrent laryngeal nerve (RLN in anesthetized dogs. With a micro controller-based electronic system, electromyography (EMG signals from cricothyroid (CT muscle on the ipsilateral side were recorded and used to trigger pacing of paralyzed vocalis muscles. The dynamic movement of vocal folds was continuously monitored using an endoscope, and the opening and closing of the glottis were quantified with customized imaging processing software. Results. The recorded video images showed that left side vocal fold was obviously paralyzed after destructing the RLN. Using the pacing system with feedback triggering EMG signals from the ipsilateral CT muscle, the paralyzed vocal fold was successfully reactivated, and its movement was shown to be synchronized with the healthy side. Significance. The developed unilateral laryngeal pacing system triggered by EMG from the ipsilateral side CT muscle could be successfully used in unilateral vocal fold paralysis with the advantage of avoiding disturbance to the healthy side muscles.

  13. MR of acoustic neuromas; Relationship to cranial nerves

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Masayuki; Takashima, Tsutomu; Kadoya, Masumi; Takahashi, Shiroh; Miyayama, Shiroh; Taira, Sakae; Kashihara, Kengo; Yamashima, Tetsumori; Itoh, Haruhide [Kanazawa Univ. (Japan). School of Medicine

    1989-08-01

    In this report, the relationship of acoustic neuromas to the adjacent cranial nerves is discussed. On T{sub 1}-weighted images, the trigeminal nerve was detected in all 13 cases. Mild to marked compression of these nerves by the tumors was observed in eight cases. The extent of compression did not always correspond to the clinical symptoms. In four cases with a maximum tumor diameter of 2 cm or less, the 7th and 8th cranial nerves were identified. There was no facial palsy in these patients. Two patients with a tumor diameter of more than 2 cm also had no facial palsy. All patients, including those with small tumors, complained of hearing loss and/or tinnitus. While MR imaging has some limitations, it is an effective imaging modality for showing the relationship between tumors and nerves. (author).

  14. Is peroneal nerve injury associated with worse function after knee dislocation?

    Science.gov (United States)

    Krych, Aaron J; Giuseffi, Steven A; Kuzma, Scott A; Stuart, Michael J; Levy, Bruce A

    2014-09-01

    Peroneal nerve palsy is a frequent and potentially disabling complication of multiligament knee dislocation, but little information exists on the degree to which patients recover motor or sensory function after this injury, and whether having this nerve injury--with or without complete recovery--is a predictor of inferior patient-reported outcome scores. The purposes of this study were to (1) report on motor and sensory recovery as well as patient-reported outcomes scores of patients with peroneal nerve injury from multiligament knee dislocation; (2) compare those endpoints between patients who had partial versus complete nerve injuries; and (3) compare patient-reported outcomes among patients who sustained peroneal nerve injuries after knee dislocation with a matched cohort of multiligament knee injuries without nerve injury. Thirty-two patients were identified, but five did not have 2-year followup and are excluded (16% lost to followup). Twenty-seven patients (24 male, three female) with peroneal nerve injury underwent multiligament knee reconstruction and were followed for 6.3 years (range, 2-18 years). Motor grades were assessed by examination and outcomes by International Knee Documentation Committee (IKDC) and Lysholm scores. Retrospectively, patients were divided into complete (n = 9) and partial nerve palsy (n = 18). Treatment for complete nerve palsy included an ankle-foot orthosis for all patients, nonoperative (one), neurolysis (two), tendon transfer (three), nerve transfer (one), and combined nerve/tendon transfer (one). Treatment for partial nerve palsy included nonoperative (12), neurolysis (four), nerve transfer (one), and combined nerve/tendon transfer (one). Furthermore, patients without nerve injury were matched by Schenck classification, age, and sex. Data were analyzed using univariate and multivariate models. Overall, 18 patients (69%) regained antigravity ankle dorsiflexion after treatment (three complete nerve palsy [38%] versus 15 partial

  15. Laryngeal Sensation Before and After Clearing Behaviors

    Science.gov (United States)

    Bonilha, Heather Shaw; Gerlach, Terri Treman; Sutton, Lori Ellen; Dawson, Amy Elizabeth; Nietert, Paul J

    2013-01-01

    Purpose People frequently present to voice clinics with complaints of irritating laryngeal sensations. Clinicians attempt to reduce the irritating sensations and their common sequela, coughing and throat clearing, by advocating for techniques that remove the irritation with less harm to the vocal fold tissue. Despite the prevalence of patients with these complaints, it is not known if the less harmful techniques recommended by clinicians are effective at clearing irritating laryngeal sensations or that irritating laryngeal sensations are, in fact, more frequent in people with voice disorders than people without voice disorders. Method Assessments of participant reported laryngeal sensation, pre- and post- clearing task, were obtained from 22 people with and 24 people without a voice disorder. Six clearing tasks were used to preliminarily evaluate the differing effects of tasks believed to be deleterious and ameliorative. Results People with and without voice disorders reported pre-clear laryngeal sensation at a similar rate. Post-clear sensation was less likely to be completely or partially removed in people with voice disorders than in the non-voice disordered group. Hard throat clear and swallow with water were the most effective techniques at removing laryngeal sensation. Conclusions The findings provide initial evidence for some of the clinical practices common to treating patients with voice disorders and chronic clearing such as advocating for swallowing a sip of water as a replacement behavior instead of coughing or throat clearing. However, the findings raise questions about other practices such as associating irritating laryngeal sensation with a voice disorder. PMID:22717491

  16. Unilateral hypoglossal nerve atrophy as a late complication of radiation therapy of head and neck carcinoma: a report of four cases and a review of the literature on peripheral and cranial nerve damages after radiation therapy

    International Nuclear Information System (INIS)

    Cheng, V.S.T.; Schulz, M.D.

    1975-01-01

    The case histories of four patients who developed hemiatrophy of the tongue from 3 to 9 years after a course of curative radiation therapy for carcinomas of the head and neck are presented. These patients were subsequently followed from 1 1 / 2 to 6 years without local recurrence of the tumor, distant metastasis, or involvement of other cranial nerves, indicative of only a unilateral hypoglossal nerve atrophy. A review of the literature showed that peripheral and cranial nerve damages after radiation therapy have been reported for the optic nerve, hypoglossal nerve, oculomotor nerve, abducens nerve, recurrent laryngeal nerve, brachial plexus nerves, and peripheral nerves of the extremities. Review of clinical and experimental data indicated that in most cases, the damages were probably caused by extensive connective tissue fibrosis around and infiltrating the nerve trunks. Three possible types of peripheral and cranial nerve damages after radiation therapy are identified. (U.S.)

  17. Respiratory and laryngeal symptoms secondary to gastro-oesophageal reflux

    Science.gov (United States)

    Rafferty, G; Mainie, I; McGarvey, L P A

    2011-01-01

    Gastro-oesophageal reflux may cause a range of laryngeal and respiratory symptoms. Mechanisms responsible include the proximal migration of gastric refluxate beyond the upper oesophageal sphincter causing direct irritation of the larynx and lower airway. Alternatively, refluxate entering the distal oesophagus alone may stimulate oesophageal sensory nerves and indirectly activate airway reflexes such as cough and bronchospasm. Recognising reflux as a cause for these extraoesophageal symptoms can be difficult as many patients do not have typical oesophageal symptoms (eg, heartburn) and clinical findings on laryngoscopy are not very specific. Acid suppression remains an effective treatment in the majority of patients but there is growing appreciation of the need to consider and treat non-acid and volume reflux. New opinions about the role of existing medical and surgical (laparoscopic techniques) treatment are emerging and a number of novel anti-reflux treatments are under development. PMID:28839612

  18. Evaluation of Semon's Law in Laryngeal Paralysis

    Directory of Open Access Journals (Sweden)

    J. Hedayaty

    1957-01-01

    Full Text Available We have discussed hi t . ] . IS orica and clinical aspects of Semon's L concernIng the hevaviOur of the vocal cords' aw net ve paralysis and the exist' diff In the recurrent laryngeal Althou h ' mg I erent theories for its explanation. g One may fwd certain truth in neverthless, it seemsfl' SOmeof the old theories, ar more ogical and satisfactor the explanation of th S 'L y to us to search e ernon s aw throu h the anatomy of the SU . I g Our new knowledge of penor aryngeal nerve in man d i which innervate the .t' an ItS motor fibers In erarytenOld muscle.

  19. Case report: partial relapse of Bell's palsy following superficial radiotherapy to a basal cell carcinoma in the temple

    Energy Technology Data Exchange (ETDEWEB)

    Brincat, S.; Mantell, B.S.

    1986-07-01

    A patient who developed a partial relapse of Bell's palsy following superficial radiotherapy to a basal cell carcinoma in the temple is reported. Nerves injured by Bell's palsy may be more susceptible to radiation induced damage.

  20. Nanomedicine in cerebral palsy

    Directory of Open Access Journals (Sweden)

    Balakrishnan B

    2013-11-01

    Full Text Available Bindu Balakrishnan,1 Elizabeth Nance,1 Michael V Johnston,2 Rangaramanujam Kannan,3 Sujatha Kannan1 1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University; Baltimore, MD, USA; 2Department of Neurology and Pediatrics, Kennedy Krieger Institute, Baltimore, MD, USA; 3Department of Ophthalmology, Center for Nanomedicine, Johns Hopkins University, Baltimore, MD, USA Abstract: Cerebral palsy is a chronic childhood disorder that can have diverse etiologies. Injury to the developing brain that occurs either in utero or soon after birth can result in the motor, sensory, and cognitive deficits seen in cerebral palsy. Although the etiologies for cerebral palsy are variable, neuroinflammation plays a key role in the pathophysiology of the brain injury irrespective of the etiology. Currently, there is no effective cure for cerebral palsy. Nanomedicine offers a new frontier in the development of therapies for prevention and treatment of brain injury resulting in cerebral palsy. Nanomaterials such as dendrimers provide opportunities for the targeted delivery of multiple drugs that can mitigate several pathways involved in injury and can be delivered specifically to the cells that are responsible for neuroinflammation and injury. These materials also offer the opportunity to deliver agents that would promote repair and regeneration in the brain, resulting not only in attenuation of injury, but also enabling normal growth. In this review, the current advances in nanotechnology for treatment of brain injury are discussed with specific relevance to cerebral palsy. Future directions that would facilitate clinical translation in neonates and children are also addressed. Keywords: dendrimer, cerebral palsy, neuroinflammation, nanoparticle, neonatal brain injury, G4OH-PAMAM

  1. Laryngeal Neuropathy in Adult Goats With Copper Deficiency.

    Science.gov (United States)

    Sousa, R F A; Almeida, V M; Neto, J E; Nascimento, C W A; Medeiros, G X; Medeiros, R M T; Riet-Correa, F; Mendonça, F S

    2017-07-01

    The aim of this study was to elucidate the cause of a neurological syndrome characterized by stridor in adult goats with clinical signs of copper deficiency. The main clinical signs consisted of apathy, emaciation, pale mucous membranes, mucous nasal discharge, dyspnea, severe achromotrichia, diffuse alopecia, torpor, ataxia, and stridor. When the goats were forced to move, the stridor increased. In a herd of 194 Toggenburg goats, 10 adult goats with clinical signs of copper deficiency were removed from the herd and divided into 2 groups: group 1, which consisted of 4 nannies and 1 buck with stridor, and group 2, which consisted of 4 nannies and 1 buck without stridor. Group 3, used as a control, consisted of 5 adult goats from another flock without any clinical signs of disease. The mean serum copper concentrations were 1.3 ± 0.3 μmol/L in group 1, 8.1 ± 1.1 μmol/L in group 2, and 11.3 ± 2.2 μmol/L in group 3. The mean serum iron concentrations were 42.3 ± 14.2 μmol/L in group 1, 39.1 ± 8.2 μmol/L in group 2, and 20.6 ± 6.1 μmol/L in group 3. The main histological lesions in goats from group 1 were axonal degeneration of the recurrent laryngeal nerves and atrophy of the muscles of vocal folds and of the dorsal cricoarytenoid and right and left cricothyroid muscles. Goats with ataxia had neuronal degeneration and necrosis of cerebellar Purkinje cells and of the cranial cervical ganglion. We concluded that the stridor was caused by axonal degeneration of the recurrent laryngeal nerves due to the severe copper deficiency.

  2. Intraoperative nerve monitoring in laryngotracheal surgery.

    Science.gov (United States)

    Bolufer, Sergio; Coves, María Dolores; Gálvez, Carlos; Villalona, Gustavo Adolfo

    Laryngotracheal surgery has an inherent risk of injury to the recurrent laryngeal nerves (RLN). These complications go from minor dysphonia to even bilateral vocal cord paralysis. The intraoperative neuromonitoring of the RLN was developed in the field of thyroid surgery, in order to preserve nerve and vocal cord function. However, tracheal surgery requires in-field intubation of the distal trachea, which limits the use of nerve monitoring using conventional endotracheal tube with surface electrodes. Given these challenges, we present an alternative method for nerve monitoring during laryngotracheal surgery through the insertion of electrodes within the endolaryngeal musculature by bilateral puncture. Copyright © 2016 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  3. A case misdiagnosed as bilateral abducens palsy

    International Nuclear Information System (INIS)

    Takeda, Naoya; Kuwamura, Keiichi; Shirataki, Kunio; Tamaki, Norihiko; Matsumoto, Satoshi

    1984-01-01

    A 66-year-old male was admitted to our neurosurgical floor because of double vision and gait disturbance. Neurological examinations revealed bilateral 6th nerve palsy with both eyes pointing toward the midline. Initially, using a tentative diagnosis of intracranial mass lesions, especially localized at the base of the skull, computerized tomography of the head, cerebral angiography, orbital venography, and metrizamide CT cisternography were performed; the findings were normal. An orbital CT scan showed an enlargement of the bilateral medial rectus muscles, and the thyroid functions of T 3 and T 4 and the T 3 uptake were all elevated, which was compatible with the diagnosis of Graves' disease. The limitations of both eyeballs were considered to be due not to the 6th nerve palsy, but to the hypertrophy of the bilateral medial rectus muscles. We neurosurgeons should recall Graves' disease as well as intracranial lesions, cerebrovascular disease, and post-traumatic sequelae when examining a patient who presents limitations of external ocular movement. (author)

  4. Reinnervation of Paralyzed Muscle by Nerve-Muscle-Endplate Band Grafting

    Science.gov (United States)

    2015-10-01

    Antoniadis G, Braun V, Rath SA, Richter HP. Evaluation of iatrogenic lesions in 722 surgically treated cases of peripheral nerve trauma. J Neurosurg...achieved by end-to-end approximation: review of 2,181 nerve lesions . Microsurgery. 1993;14(4):244- 246. 18 25. McAllister RM, Gilbert SE, Calder JS...innervation through irreparable damage to its nerve . DNI has been used for selective reinnervation of paralyzed laryngeal and facial muscles [15,16] as well

  5. Cranial nerves III, IV and VI

    International Nuclear Information System (INIS)

    Laine, I.J.; Smoker, W.R.; Kuta, A.J.; Felton, W.L.

    1991-01-01

    Because of advances in CT and MR imaging, accurate identification and evaluation of cranial nerve lesions is now possible. Cranial nerves III, IV, and VI, providing motor and sensory control of the eye, can be evaluated as a unit. In this paper, the authors present an overview of the anatomy and pathology of these cranial nerves. We first illustrate their normal anatomic pathways from the brain stem to the orbit. This is followed by clinical examples of patients with a variety of isolated and complex palsies of these three cranial nerves. This is accomplished by inclusion of ocular photographs, correlative imaging studies, and the use of diagrams. Knowledge of the gross and imaging anatomy and the ophthalmologic manifestations of pathology affecting these three cranial nerves permits a tailored approach to their evaluation

  6. Optic nerve hypoplasia

    Directory of Open Access Journals (Sweden)

    Savleen Kaur

    2013-01-01

    Full Text Available Optic nerve hypoplasia (ONH is a congenital anomaly of the optic disc that might result in moderate to severe vision loss in children. With a vast number of cases now being reported, the rarity of ONH is obviously now refuted. The major aspects of ophthalmic evaluation of an infant with possible ONH are visual assessment, fundus examination, and visual electrophysiology. Characteristically, the disc is small, there is a peripapillary double-ring sign, vascular tortuosity, and thinning of the nerve fiber layer. A patient with ONH should be assessed for presence of neurologic, radiologic, and endocrine associations. There may be maternal associations like premature births, fetal alcohol syndrome, maternal diabetes. Systemic associations in the child include endocrine abnormalities, developmental delay, cerebral palsy, and seizures. Besides the hypoplastic optic nerve and chiasm, neuroimaging shows abnormalities in ventricles or white- or gray-matter development, septo-optic dysplasia, hydrocephalus, and corpus callosum abnormalities. There is a greater incidence of clinical neurologic abnormalities in patients with bilateral ONH (65% than patients with unilateral ONH. We present a review on the available literature on the same to urge caution in our clinical practice when dealing with patients with ONH. Fundus photography, ocular coherence tomography, visual field testing, color vision evaluation, neuroimaging, endocrinology consultation with or without genetic testing are helpful in the diagnosis and management of ONH. (Method of search: MEDLINE, PUBMED.

  7. Facial palsy in children: emergency department management and outcome.

    Science.gov (United States)

    Wang, Cheng-Hsien; Chang, Yu-Che; Shih, Hong-Mo; Chen, Chun-Yu; Chen, Jih-Chang

    2010-02-01

    To describe the characteristics of children who present to an emergency department (ED) with facial palsy and determine the association of outcome with etiology, degree of initial paralysis, and ED management. This was a retrospective cohort study of children who presented to an ED with facial nerve paralysis (FNP). There were 85 patients with a mean age of 8.0 (SD, 6.1) years; 60% (n = 51) of the patients were male, and 65.9% (n = 56) were admitted to the hospital. Bell palsy (50.6%) was the most common etiology followed by infectious (22.4%), traumatic (16.5%), congenital (7.1%), and neoplastic etiologies (3.5%). Patients with Bell palsy had shorter recovery times (P = 0.049), and traumatic cases required a longer time for recovery (P = 0.016). Acute otitis media (AOM)-related pediatric FNP had shorter recovery times than non-AOM-related cases (P = 0.005) in infectious group. Patients given steroid therapy did not have a shorter recovery time (P = 0.237) or a better recovery (P = 0.269). There was no difference in recovery rate of pediatric patients with Bell palsy between hospitalization or not (P = 0.952). Bell palsy, infection, and trauma were most common etiologies of pediatric FNP. Recovery times were shorter in pediatric patients with Bell palsy and AOM-related FNP, whereas recovery took longer in traumatic cases. Steroid therapy did not seem beneficial for pediatric FNP. Hospitalization is not indicated for pediatric patients with Bell palsy.

  8. Bells against palsy.

    Science.gov (United States)

    Williams, J D; Lehman, R

    1988-01-01

    A technique is described in which "jingle bells" are sutured in three positions on the face at the points of maximum excursion of the facial musculature when stimulated by a Hilger nerve stimulator set at 2 mA. The procedure is used to monitor movement of the facial nerve while the surgeon dissects the nerve in the cerebellopontine angle and internal auditory canal.

  9. Recurrent Respiratory Papillomatosis or Laryngeal Papillomatosis

    Science.gov (United States)

    ... Home » Health Info » Voice, Speech, and Language Recurrent Respiratory Papillomatosis or Laryngeal Papillomatosis On this page: What ... find additional information about RRP? What is recurrent respiratory papillomatosis? Recurrent respiratory papillomatosis (RRP) is a disease ...

  10. An Unusual Laryngeal Foreign Body in Adult

    Directory of Open Access Journals (Sweden)

    Cire Ndiaye

    2016-01-01

    Full Text Available The accidental aspiration of a foreign body is a frequent domestic accident among children but a rare occurrence in adults. The laryngeal impaction of a coin is an unusual accident; only a few cases have been reported in the literature. Diagnosis is mostly achieved by clinicoradiological examinations. The authors report an uncommon case of laryngeal impaction of a coin in a 21-year-old patient, presenting with dysphonia without dyspnea or stridor. The extraction was performed by endoscopy.

  11. An Unusual Laryngeal Foreign Body in Adult.

    Science.gov (United States)

    Ndiaye, Cire; Regonne, Eric Joel; Ahmed, Houra; Diom, Evelyne Siga; Deguenonvo, Richard Edouard Alain; Mbaye, Aminata; Zemene, Yilkal; Ndiaye, Issa Cheikh

    2016-01-01

    The accidental aspiration of a foreign body is a frequent domestic accident among children but a rare occurrence in adults. The laryngeal impaction of a coin is an unusual accident; only a few cases have been reported in the literature. Diagnosis is mostly achieved by clinicoradiological examinations. The authors report an uncommon case of laryngeal impaction of a coin in a 21-year-old patient, presenting with dysphonia without dyspnea or stridor. The extraction was performed by endoscopy.

  12. An Unusual Laryngeal Foreign Body in Adult

    OpenAIRE

    Ndiaye, Cire; Regonne, Eric Joel; Ahmed, Houra; Diom, Evelyne Siga; Deguenonvo, Richard Edouard Alain; Mbaye, Aminata; Zemene, Yilkal; Ndiaye, Issa Cheikh

    2016-01-01

    The accidental aspiration of a foreign body is a frequent domestic accident among children but a rare occurrence in adults. The laryngeal impaction of a coin is an unusual accident; only a few cases have been reported in the literature. Diagnosis is mostly achieved by clinicoradiological examinations. The authors report an uncommon case of laryngeal impaction of a coin in a 21-year-old patient, presenting with dysphonia without dyspnea or stridor. The extraction was performed by endoscopy.

  13. CLINICO-AETIOLOGICAL STUDY OF LOWER MOTOR NEURON FACIAL PALSY

    Directory of Open Access Journals (Sweden)

    Souvagini Acharya

    2017-05-01

    Full Text Available BACKGROUND The facial nerve paralysis is a broad term having so many differential diagnoses starting from congenital causes to malignant tumour. Accurate diagnosis with localisation of the site of injury or compression and timely intervention has become a challenge to an otorhinolaryngologist. Objective- To outline the incidence of the different aetiologies and the profile of peripheral facial nerve paralysis patients in the Otolaryngology Dept. of ENT in VIMSAR, Burla. MATERIALS AND METHODS The records of 53 patients with facial nerve paralysis seen during the years of 2016 & 2017 were analysed. RESULTS From the 53 patients analysed, 60.4% were male, maximum cases 35.85% were in 3 rd decade of age and had the right side of the face involved in 62.26%. Bell´s palsy was the most frequent aetiology (66.04%, others are traumatic (11.32%, Ramsay Hunt syndrome (1.89%, CSOM (16.98%, malignant otitis externa (1.89%. One case of Bell´s palsy during pregnancy was also seen in this series. CONCLUSION The data found are similar to the most of the literature showing that Bell´s palsy is still the most frequent. Males are more commonly affected with a preponderance to involve right side of face.

  14. Ramus marginalis mandibulae nervus facialis palsy in hemifacial microsomia.

    Science.gov (United States)

    Silvestri, A; Mariani, G; Vernucci, R A

    2008-12-01

    The paralysis of the ramus marginalis mandibulae nervus facialis may occur in Hemifacial Microsomia (HM); the combination of both HM and palsy contributes to an elongation of the mandibular body. This study explores a possible correlation between neurological deficit, muscular atony, and structural deficiency. Of 58 patients with HM who had come to the University of Rome (Sapienza) Pre-surgical Orthodontics Unit, 4 patients were afflicted with Hemifacial Microsomia and ramus marginalis mandibulae nervus palsy; these patients underwent physical, neurological, opthamologic and systemic examinations. The results were then analysed in order to determine a possible correlation between neuro-muscular and structural deficit. Electroneurographic and electromyographic examinations were performed to estimate facial nerve and muscles involvement. Neuroelectrographic exam showed a damage of the nervous motor fibres of the facial nerve ipsilateral to HM, with an associated damage of the muscular function, while neuro-muscular functions on the healthy side were normal. The peripheral nervous and muscular deficits affect the function of facial soft tissues and the growth of mandibular body with an asymmetry characterised by a hypodevelopment of the ramus (due to the HM) and by an elongation of the mandibular body (due to ramus marginalis mandibulae nerve palsy), so that the chin deviation is contralateral to HM. In these forms, a neurological examination is necessary to assess the neurological damage on the HM side. Neuromuscular deficiency can also contribute to a relapse tendency after a surgical-orthodontic treatment.

  15. Schwannoma originating from lower cranial nerves: report of 4 cases.

    Science.gov (United States)

    Oyama, Hirofumi; Kito, Akira; Maki, Hideki; Hattori, Kenichi; Noda, Tomoyuki; Wada, Kentaro

    2012-02-01

    Four cases of schwannoma originating from the lower cranial nerves are presented. Case 1 is a schwannoma of the vagus nerve in the parapharyngeal space. The operation was performed by the transcervical approach. Although the tumor capsule was not dissected from the vagus nerve, hoarseness and dysphagia happened transiently after the operation. Case 2 is a schwannoma in the jugular foramen. The operation was performed by the infralabyrinthine approach. Although only the intracapsular tumor was enucleated, facial palsy, hoarseness, dysphagia and paresis of the deltoid muscle occurred transiently after the operation. The patient's hearing had also slightly deteriorated. Case 3 is a dumbbell-typed schwannoma originating from the hypoglossal nerve. The hypoglossal canal was markedly enlarged by the tumor. As the hypoglossal nerves were embedded in the tumor, the tumor around the hypoglossal nerves was not resected. The tumor was significantly enlarged for a while after stereotactic irradiation. Case 4 is an intracranial cystic schwannoma originating from the IXth or Xth cranial nerves. The tumor was resected through the cerebello-medullary fissure. The tumor capsule attached to the brain stem was not removed. Hoarseness and dysphagia happened transiently after the operation. Cranial nerve palsy readily occurs after the removal of the schwannoma originating from the lower cranial nerves. Mechanical injury caused by retraction, extension and compression of the nerve and heat injury during the drilling of the petrous bone should be cautiously avoided.

  16. Regeneration of peripheral nerve fibres following Haloxon-induced degeneration

    Directory of Open Access Journals (Sweden)

    Maria Veronica de Souza

    1996-12-01

    Full Text Available Delayed neurotoxicity has been associated with organophosphorus poisoning for years. In order to study such condition in sheep, 11 animals were given either one or two high doses of Haloxon. Exposed sheep were observed daily and between 16 and 25 days after administration neurological signs as incoordination and ataxia were detected in six of them. Biopsies of tibial and laryngeal nerves were performed as soon as neurotoxicity was diagnosed, and after death fragments of selected nerves were collected together with CNS tissues for light and electron microscopy and teased fiber studies. Laryngeal, tibial and sciatic nerves showed the most pronouced changes, consisting chiefly of wallerian degeneration that was seen either as a single fiber or as a complete fascicle feature. Exams performed after death clearly showed regenerating fascicles with axonal sprouts growing within a Schwann cell old basal lamina, and some thinly myelinated axonal sprouts.

  17. An analysis of facial nerve function in irradiated and unirradiated facial nerve grafts

    International Nuclear Information System (INIS)

    Brown, Paul D.; Eshleman, Jeffrey S.; Foote, Robert L.; Strome, Scott E.

    2000-01-01

    Purpose: The effect of high-dose radiation therapy on facial nerve grafts is controversial. Some authors believe radiotherapy is so detrimental to the outcome of facial nerve graft function that dynamic or static slings should be performed instead of facial nerve grafts in all patients who are to receive postoperative radiation therapy. Unfortunately, the facial function achieved with dynamic and static slings is almost always inferior to that after facial nerve grafts. In this retrospective study, we compared facial nerve function in irradiated and unirradiated nerve grafts. Methods and Materials: The medical records of 818 patients with neoplasms involving the parotid gland who received treatment between 1974 and 1997 were reviewed, of whom 66 underwent facial nerve grafting. Fourteen patients who died or had a recurrence less than a year after their facial nerve graft were excluded. The median follow-up for the remaining 52 patients was 10.6 years. Cable nerve grafts were performed in 50 patients and direct anastomoses of the facial nerve in two. Facial nerve function was scored by means of the House-Brackmann (H-B) facial grading system. Twenty-eight of the 52 patients received postoperative radiotherapy. The median time from nerve grafting to start of radiotherapy was 5.1 weeks. The median and mean doses of radiation were 6000 and 6033 cGy, respectively, for the irradiated grafts. One patient received preoperative radiotherapy to a total dose of 5000 cGy in 25 fractions and underwent surgery 1 month after the completion of radiotherapy. This patient was placed, by convention, in the irradiated facial nerve graft cohort. Results: Potential prognostic factors for facial nerve function such as age, gender, extent of surgery at the time of nerve grafting, preoperative facial nerve palsy, duration of preoperative palsy if present, or number of previous operations in the parotid bed were relatively well balanced between irradiated and unirradiated patients. However

  18. Functional reinnervation of vocal folds after selective laryngeal adductor denervation-reinnervation surgery for spasmodic dysphonia.

    Science.gov (United States)

    DeConde, Adam S; Long, Jennifer L; Armin, Bob B; Berke, Gerald S

    2012-09-01

    Selective laryngeal adductor denervation-reinnervation surgery (SLAD-R) offers a viable surgical alternative for patients with adductor spasmodic dysphonia refractory to botulinum toxin injections. SLAD-R selectively denervates the symptomatic thyroarytenoid muscle by dividing the distal adductor branch of the recurrent laryngeal nerve (RLN), and preventing reinnervation, by the proximal RLN and maintaining vocal fold bulk and tone by reinnervating the distal RLN with the ansa cervicalis. We present a patient who had previously undergone successful SLAD-R but presented 10 years postoperatively with a new regional dystonia involving his strap muscles translocated to his reinnervated larynx by his previous ansa-RLN neurorraphy. The patient's symptomatic vocal fold adduction resolved completely on division of the ansa-RLN neurorraphy confirming successful selective functional reinnervation of vocal fold adductors by the ansa cervicalis. Copyright © 2012 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

  19. Ultrasonographic findings in hereditary neuropathy with liability to pressure palsies.

    Science.gov (United States)

    Bayrak, Ayse O; Bayrak, Ilkay Koray; Battaloglu, Esra; Ozes, Burcak; Yildiz, Onur; Onar, Musa Kazim

    2015-02-01

    The aims of this study were to evaluate the sonographic findings of patients with hereditary neuropathy with liability to pressure palsies (HNPP) and to examine the correlation between sonographic and electrophysiological findings. Nine patients whose electrophysiological findings indicated HNPP and whose diagnosis was confirmed by genetic analysis were enrolled in the study. The median, ulnar, peroneal, and tibial nerves were evaluated by ultrasonography. We ultrasonographically evaluated 18 median, ulnar, peroneal, and tibial nerves. Nerve enlargement was identified in the median, ulnar, and peroneal nerves at the typical sites of compression. None of the patients had nerve enlargement at a site of noncompression. None of the tibial nerves had increased cross-sectional area (CSA) values. There were no significant differences in median, ulnar, and peroneal nerve distal motor latencies (DMLs) between the patients with an increased CSA and those with a normal CSA. In most cases, there was no correlation between electrophysiological abnormalities and clinical or sonographic findings. Although multiple nerve enlargements at typical entrapment sites on sonographic evaluation can suggest HNPP, ultrasonography cannot be used as a diagnostic tool for HNPP. Ultrasonography may contribute to the differential diagnosis of HNPP and other demyelinating polyneuropathies or compression neuropathies; however, further studies are required.

  20. Clinical Outcomes following median to radial nerve transfers

    Science.gov (United States)

    Ray, Wilson Z.; Mackinnon, Susan E.

    2010-01-01

    Purpose In this study the authors evaluate the clinical outcomes in patients with radial nerve palsy who underwent nerve transfers utilizing redundant fascicles of median nerve (innervating the flexor digitorum superficialis and flexor carpi radialis muscles) to the posterior interosseous nerve and the nerve to the extensor carpi radialis brevis. Methods A retrospective review of the clinical records of 19 patients with radial nerve injuries who underwent nerve transfer procedures using the median nerve as a donor nerve were included. All patients were evaluated using the Medical Research Council (MRC) grading system. Results The mean age of patients was 41 years (range 17 – 78 years). All patients received at least 12 months of follow-up (20.3 ± 5.8 months). Surgery was performed at a mean of 5.7 ± 1.9 months post-injury. Post-operative functional evaluation was graded according to the following scale: grades MRC 0/5 - MRC 2/5 were considered poor outcomes, while MRC of 3/5 was a fair result, MRC grade 4/5 was a good result, and grade 4+/5 was considered an excellent outcome. Seventeen patients (89%) had a complete radial nerve palsy while two patients (11%) had intact wrist extension but no finger or thumb extension. Post-operatively all patients except one had good to excellent recovery of wrist extension. Twelve patients recovered good to excellent finger and thumb extension, two patients had fair recovery, five patients had a poor recovery. Conclusions The radial nerve is a commonly injured nerve, causing significant morbidity in affected patients. The median nerve provides a reliable source of donor nerve fascicles for radial nerve reinnervation. This transfer was first performed in 1999 and evolved over the subsequent decade. The important nuances of both surgical technique and motor re-education critical for to the success of this transfer have been identified and are discussed. PMID:21168979

  1. Inducible Laryngeal Obstruction: Excessive Dynamic Airway Collapse vs. Inducible Laryngeal Obstruction

    Science.gov (United States)

    2017-10-20

    REPORT TYPE 10/20/2017 Poster 4. TITLE AND SUBTITLE Inducible Laryngeal Obstrnction: Excessive Dynamic Airway Collapse vs. Inducible Laryngeal...REPORT b.ABSTRACT c. THIS PAGE ABSTRACT OF PAGES 3. DATES COVERED (From - To) 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER

  2. Laryngeal neurinoma. Differential diagnosis of submucosal laryngeal tumors; Neurinoma laringeo. Diagnostico diferencial de tumoraciones submucosas laringeas

    Energy Technology Data Exchange (ETDEWEB)

    Higuera, A.; Palomo, V.; Munoz, R.; Sanchez, F.

    2002-07-01

    Laryngeal neurinoma is a rare benign tumor that appears as a submucosal mass, generally in the supraglottic region. We report the case of a patient with dysphonia of long evolution caused by a neurinoma. We discuss the radiological findings of the tumor and the value of computed tomography (CT) in the diagnosis of this and other submucosal laryngeal lesions. (Author) 16 refs.

  3. Innervation status in chronic vocal fold paralysis and implications for laryngeal reinnervation.

    Science.gov (United States)

    Lin, R Jun; Smith, Libby J; Munin, Michael C; Sridharan, Shaum; Rosen, Clark A

    2018-01-22

    Treatment options for symptomatic unilateral vocal fold paralysis (VFP) include vocal fold augmentation, laryngeal framework surgery, and laryngeal reinnervation. Laryngeal reinnervation (LR) has been suggested to provide "tone" to the paralyzed VF. This implies a loss of tone as a result of denervation without reinnervation. We performed laryngeal electromyography (LEMG) in patients with chronic VFP to understand the innervation status associated with a chronically paralyzed vocal fold. Retrospective review of LEMG data in adult patients with chronic VFP from January 2009 to December 2014. LEMG was performed at least 6 months after-onset of VFP. Qualitative LEMG, quantitative LEMG, and adductory synkinesis testing were performed, and the parameters were collected. Twenty-seven vocal folds were studied (23 unilateral VFP and 2 bilateral VFP). Average age was 59 ± 17 years. The median duration from recurrent laryngeal nerve injury to LEMG was 8.5 months (range 6-90 months). The majority of patients, 24 of 27 (89%), had motor unit potentials during phonation tasks on LEMG, and only 3 of 27 (11%) patients were electrically silent. Quantitative LEMG showed 287.8 mean turns per second (normal ≥ 400). Motor unit configuration was normal in 12 of 27 (44%), polyphasic in 12 of 27 (44%), and absent in the electrically silent patients. Adductory synkinesis was found in 6 of 20 (30%) patients. Chronic vocal fold paralysis is infrequently associated with absent motor-unit recruitment, indicating some degree of preserved innervation and/or reinnervation in these patients. LEMG should be part of the routine workup for chronic VFP prior to consideration of LR. 4. Laryngoscope, 2018. © 2018 The American Laryngological, Rhinological and Otological Society, Inc.

  4. MRI of peripheral nerve lesions of the lower limbs

    Energy Technology Data Exchange (ETDEWEB)

    Lacour-Petit, M.C.; Ducreux, D. [Dept. of Neuroradiology, Hopital Bicetre, Kremlin-Bicetre (France); Lozeron, P. [Dept. of Neurology, Hopital Bicetre, Kremlin-Bicetre (France)

    2003-03-01

    Our aim is to illustrate the contribution of MRI to diagnosis of lesions of the lower-limb nerve trunks. We report six patients who had clinical and electrophysiological examination for a peroneal or tibial nerve palsy. MRI of the knee showed in three cases a nonenhancing cystic lesion of the peroneal nerve suggesting an intraneural ganglion cyst, confirmed by histological study in one case. One patient with known neurofibromatosis had an enhancing nodular lesion of the peroneal nerve compatible with a neurofibroma. Two patients had diffuse hypertrophy with high signal on T2-weighted images, without contrast enhancement of the sciatic nerve or its branches. These lesions were compatible with localised hypertrophic neuropathy. In one case, biopsy of the superficial branch of the peroneal nerve showed insignificant axonal degeneration. MRI can provide information about the size and site of the abnormal segment of a nerve before treatment and can be used to distinguish different patterns of focal lesion. (orig.)

  5. Sound-induced facial synkinesis following facial nerve paralysis.

    Science.gov (United States)

    Ma, Ming-San; van der Hoeven, Johannes H; Nicolai, Jean-Philippe A; Meek, Marcel F

    2009-08-01

    Facial synkinesis (or synkinesia) (FS) occurs frequently after paresis or paralysis of the facial nerve and is in most cases due to aberrant regeneration of (branches of) the facial nerve. Patients suffer from inappropriate and involuntary synchronous facial muscle contractions. Here we describe two cases of sound-induced facial synkinesis (SFS) after facial nerve injury. As far as we know, this phenomenon has not been described in the English literature before. Patient A presented with right hemifacial palsy after lesion of the facial nerve due to skull base fracture. He reported involuntary muscle activity at the right corner of the mouth, specifically on hearing ringing keys. Patient B suffered from left hemifacial palsy following otitis media and developed involuntary muscle contraction in the facial musculature specifically on hearing clapping hands or a trumpet sound. Both patients were evaluated by means of video, audio and EMG analysis. Possible mechanisms in the pathophysiology of SFS are postulated and therapeutic options are discussed.

  6. Tunge- og stemmebåndsparese efter endotrakeal intubation for Legionella-pneumoni

    DEFF Research Database (Denmark)

    Sønnichsen, Rikke; Lauritsen, Anne Oberg

    2013-01-01

    Extracranial involvement of the hypoglossal nerve and recurrent laryngeal branch of the vagal nerve can be a complication of anaesthetic airway management (Tapia's syndrome) or focal involvement due to Legionella infection. We present a patient with bilateral hypoglossal and unilateral recurrent...... laryngeal nerves palsy after a complicated intubation and a Legionella infection. Clarithromycin therapy was started. Within months, tongue mobility and swallowing gradually improved. Two months after discharge persisting unilateral recurrent nerve palsy was observed....

  7. Facial Nerve Paralysis due to a Pleomorphic Adenoma with the Imaging Characteristics of a Facial Nerve Schwannoma.

    Science.gov (United States)

    Nader, Marc-Elie; Bell, Diana; Sturgis, Erich M; Ginsberg, Lawrence E; Gidley, Paul W

    2014-08-01

    Background Facial nerve paralysis in a patient with a salivary gland mass usually denotes malignancy. However, facial paralysis can also be caused by benign salivary gland tumors. Methods We present a case of facial nerve paralysis due to a benign salivary gland tumor that had the imaging characteristics of an intraparotid facial nerve schwannoma. Results The patient presented to our clinic 4 years after the onset of facial nerve paralysis initially diagnosed as Bell palsy. Computed tomography demonstrated filling and erosion of the stylomastoid foramen with a mass on the facial nerve. Postoperative histopathology showed the presence of a pleomorphic adenoma. Facial paralysis was thought to be caused by extrinsic nerve compression. Conclusions This case illustrates the difficulty of accurate preoperative diagnosis of a parotid gland mass and reinforces the concept that facial nerve paralysis in the context of salivary gland tumors may not always indicate malignancy.

  8. Terminal nerve: cranial nerve zero

    Directory of Open Access Journals (Sweden)

    Jorge Eduardo Duque Parra

    2006-12-01

    Full Text Available It has been stated, in different types of texts, that there are only twelve pairs of cranial nerves. Such texts exclude the existence of another cranial pair, the terminal nerve or even cranial zero. This paper considers the mentioned nerve like a cranial pair, specifying both its connections and its functional role in the migration of liberating neurons of the gonadotropic hormone (Gn RH. In this paper is also stated the hypothesis of the phylogenetic existence of a cerebral sector and a common nerve that integrates the terminal nerve with the olfactory nerves and the vomeronasals nerves which seem to carry out the odors detection function as well as in the food search, pheromone detection and nasal vascular regulation.

  9. Bilateral Facial Nerve Paralysis as First Presentation of Lung Cancer

    Directory of Open Access Journals (Sweden)

    Shadi Hamouri

    2016-11-01

    Full Text Available Leptomeningeal carcinomatosis is rare, and its precise incidence is unknown. It is associated with a wide spectrum of solid and hematological malignancies. To complicate its diagnosis, the clinical presentation of leptomeningeal carcinomatosis can be variable. We report a case of a 38-year-old male with bilateral facial nerve paralysis as first presentation of lung adenocarcinoma. To our knowledge, this is the only case describing bilateral facial nerve palsy as the first and only manifestation of lung adenocarcinoma.

  10. Effects of electroacupuncture therapy for Bell's palsy from acute stage: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Liu, Zhi-dan; He, Jiang-bo; Guo, Si-si; Yang, Zhi-xin; Shen, Jun; Li, Xiao-yan; Liang, Wei; Shen, Wei-dong

    2015-08-25

    Although many patients with facial paralysis have obtained benefits or completely recovered after acupuncture or electroacupuncture therapy, it is still difficult to list intuitive evidence besides evaluation using neurological function scales and a few electrophysiologic data. Hence, the aim of this study is to use more intuitive and reliable detection techniques such as facial nerve magnetic resonance imaging (MRI), nerve electromyography, and F waves to observe changes in the anatomic morphology of facial nerves and nerve conduction before and after applying acupuncture or electroacupuncture, and to verify their effectiveness by combining neurological function scales. A total of 132 patients with Bell's palsy (grades III and IV in the House-Brackmann [HB] Facial Nerve Grading System) will be randomly divided into electroacupuncture, manual acupuncture, non-acupuncture, and medicine control groups. All the patients will be given electroacupuncture treatment after the acute period, except for patients in the medicine control group. The acupuncture or electroacupuncture treatments will be performed every 2 days until the patients recover or withdraw from the study. The primary outcome is analysis based on facial nerve functional scales (HB scale and Sunnybrook facial grading system), and the secondary outcome is analysis based on MRI, nerve electromyography and F-wave detection. All the patients will undergo MRI within 3 days after Bell's palsy onset for observation of the signal intensity and facial nerve swelling of the unaffected and affected sides. They will also undergo facial nerve electromyography and F-wave detection within 1 week after onset of Bell's palsy. Nerve function will be evaluated using the HB scale and Sunnybrook facial grading system at each hospital visit for treatment until the end of the study. The MRI, nerve electromyography, and F-wave detection will be performed again at 1 month after the onset of Bell's palsy. Chinese Clinical Trials

  11. Transfer of obturator nerve for femoral nerve injury: an experiment study in rats.

    Science.gov (United States)

    Meng, Depeng; Zhou, Jun; Lin, Yaofa; Xie, Zheng; Chen, Huihao; Yu, Ronghua; Lin, Haodong; Hou, Chunlin

    2018-07-01

    Quadriceps palsy is mainly caused by proximal lesions in the femoral nerve. The obturator nerve has been previously used to repair the femoral nerve, although only a few reports have described the procedure, and the outcomes have varied. In the present study, we aimed to confirm the feasibility and effectiveness of this treatment in a rodent model using the randomized control method. Sixty Sprague-Dawley rats were randomized into two groups: the experimental group, wherein rats underwent femoral neurectomy and obturator nerve transfer to the femoral nerve motor branch; and the control group, wherein rats underwent femoral neurectomy without nerve transfer. Functional outcomes were measured using the BBB score, muscle mass, and histological assessment. At 12 and 16 weeks postoperatively, the rats in the experimental group exhibited recovery to a stronger stretch force of the knee and higher BBB score, as compared to the control group (p nerve with myelinated and unmyelinated fibers was observed in the experimental group. No significant differences were observed between groups at 8 weeks postoperatively (p > 0.05). Obturator nerve transfer for repairing femoral nerve injury was feasible and effective in a rat model, and can hence be considered as an option for the treatment of femoral nerve injury.

  12. Laryngeal granuloma: a complication of prolonged endotracheal intubation.

    OpenAIRE

    Keiser, G. J.; Bozentka, N. E.; Gold, B. D.

    1991-01-01

    Laryngeal granuloma is an uncommon complication arising from irritation of the laryngeal structures. We present a case where bilateral laryngeal granulomas became clinically evident 3 mo after orthognathic surgery. The patient, a 19-yr-old female, developed acute dyspnea after experiencing gradual voice loss. Excision of the lesions under endotracheal general anesthesia led to an uneventful outcome. The causes, predisposing factors, diagnostic features, and treatment of laryngeal granuloma ar...

  13. Reflex vocal fold adduction in the porcine model: the effects of stimuli delivered to various sensory nerves.

    Science.gov (United States)

    Woo, Jeong-Soo; Hundal, Jagdeep S; Sasaki, Clarence T; Abdelmessih, Mikhail W; Kelleher, Stephen P

    2008-10-01

    The aim of this study was to identify a panel of sensory nerves capable of eliciting an evoked glottic closure reflex (GCR) and to quantify the glottic closing force (GCF) of these responses in a porcine model. In 5 pigs, the internal branch of the superior laryngeal nerve (iSLN) and the trigeminal, pharyngeal plexus, glossopharyngeal, radial, and intercostal nerves were surgically isolated and electrically stimulated. During stimulation of each nerve, the GCR was detected by laryngeal electromyography and the GCF was measured with a pressure transducer. The only nerve that elicited the GCR in the 5 pigs was the iSLN. The average GCF was 288.9 mm Hg. This study demonstrates that the only afferent nerve that elicits the GCR in pigs is the iSLN, and that it should remain the focus of research for the rehabilitation of patients with absent or defective reflex vocal fold adduction.

  14. [Early diagnosis and prognosis evaluation of Bell palsy with blink reflex ].

    Science.gov (United States)

    Xie, Dan-dan; Li, Xiao-song; Liu, Yuan-yuan

    2014-11-01

    To determine the value of blink reflex in early diagnosis and prognosis evaluation of Bell palsy. Blink reflex and facial nerve conduction were examined in 58 patients with Bell palsy within one week after symptom onset. The patients without response of R1 , R2 and R2 ' waves were classified as complete efferent retardarce (Group A, 30 cases), and those with response of R1 , R2 and R2 ' waves were classified as incomplete efferent anomalies (Group B, 28 cases). The clinical outcomes after three months of systemic therapy were evaluated using the House-Blackmann (H-B) scale. Efferent anomalies of blink reflex occurred in ail of the 58 patients. Abnormal results of facial nerve conduction appeared in 23 (39. 7%) patients. The three months therapy was effective in 93% patients in Group B and 70% patients in Group A (PBell palsy.

  15. Epigenetic Dysregulation in Laryngeal Squamous Cell Carcinoma

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    Thian-Sze Wong

    2012-01-01

    Full Text Available Laryngeal carcinoma is a common head and neck cancer with poor prognosis. Patients with laryngeal carcinoma usually present late leading to the reduced treatment efficacy and high rate of recurrence. Despite the advance in the use of molecular markers for monitoring human cancers in the past decades, there are still no reliable markers for use to screen laryngeal carcinoma and follow the patients after treatment. Epigenetics emerged as an important field in understanding the biology of the human malignancies. Epigenetic alterations refer to the dysregulation of gene, which do not involve the alterations of the DNA sequence. Major epigenetic changes including methylation imbalance, histone modification, and small RNA dysregulation could play a role in the development of human malignancies. Global epigenetic change is now regarded as a molecular signature of cancer. The characteristics and behavior of a cancer could be predicted based on the specific epigenetic pattern. We here provide a review on the understanding of epigenetic dysregulation in laryngeal carcinoma. Further knowledge on the initiation and progression of laryngeal carcinoma at epigenetic level could promote the translation of the knowledge to clinical use.

  16. Post-traumatic Unilateral Avulsion of the Abducens Nerve with Damage to Cranial Nerves VII and VIII: Case Report

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    Yamasaki, Fumiyuki; Akiyama, Yuji; Tsumura, Ryu; Kolakshyapati, Manish; Adhikari, Rupendra Bahadur; Takayasu, Takeshi; Nosaka, Ryo; Kurisu, Kaoru

    2016-01-01

    Traumatic injuries of the abducens nerve as a consequence of facial and/or head trauma occur with or without associated cervical or skull base fracture. This is the first report on unilateral avulsion of the abducens nerve in a 29-year-old man with severe right facial trauma. In addition, he exhibited mild left facial palsy, and moderate left hearing disturbance. Magnetic resonance imaging (MRI) using fast imaging employing steady-state acquisition (FIESTA) revealed avulsion of left sixth cra...

  17. MR imaging in Bell's palsy and herpes zoster opticus: correlation with clinical findings

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    Kwon, Jung Ho; Mo, Jong Hyun; Moon, Sung Hee; Lee, Sang Sun; Park, Yang Hee; Lee, Kyung Hee [National Police Hospital, Seoul (Korea, Republic of); Choi, Ik Joon [Sejong General Hospital, Seoul (Korea, Republic of)

    1998-09-01

    To evaluate the MRI findings of acute facial nerve paralysis in Bell's palsy and herpes zoster opticus, and to correlate these with the clinical findings. We retrowspectively reviewed the MRI findings in six cases of BEll's palsy(BP) and two of herpes zoster oticus(HZO), and compared them with the findings for 30 normal facial nerves. This nerve was considered abnormal when its signal intensity was greater than that of brain parenchyma or the contralateral normal side on Gd-enhanced T1-weighted axial and coronal MR images. We analysed the location and degree of contrast enhancement, interval change, and clinical progression in correlation with House-Brackmann(HB) grade and electroneuronography (ENoG) findings. Fifteen of 30 normal facial nerves(50%) seen on Gd-enhanced MRI were mildly enhanced in the geniculate ganglion, the proximal tympanic, and the proximal mastoid segment of the facial nerve. No enhancement of the internal auditory canal(IAC) or labyrinthine segment of the facial nerve was noted, however. In BP and HZO, Gd-enhanced MR images revealed fair to marked enhancement for more than two segments from the internal auditory canal to the mastoid segment of the facial nerve. During follow-up MRI, enhancement of the facial nerve varied in location and signal intensity, though gradually decreased in intensity approximately eight weeks after the onset of facial nerve palsy. No correlation between clinical HB grade, ENoG, and follow up MRI findings was noted. Except in the internal auditory canal and labyrinthine segment, normal facial nevemay show mild and relatively symmetrical enhancement. In BP and HZO, the facial nerve showed diffuse enhancement from the IAC to the mastoid segment.=20.

  18. MR imaging in Bell's palsy and herpes zoster opticus: correlation with clinical findings

    International Nuclear Information System (INIS)

    Kwon, Jung Ho; Mo, Jong Hyun; Moon, Sung Hee; Lee, Sang Sun; Park, Yang Hee; Lee, Kyung Hee; Choi, Ik Joon

    1998-01-01

    To evaluate the MRI findings of acute facial nerve paralysis in Bell's palsy and herpes zoster opticus, and to correlate these with the clinical findings. We retrowspectively reviewed the MRI findings in six cases of BEll's palsy(BP) and two of herpes zoster oticus(HZO), and compared them with the findings for 30 normal facial nerves. This nerve was considered abnormal when its signal intensity was greater than that of brain parenchyma or the contralateral normal side on Gd-enhanced T1-weighted axial and coronal MR images. We analysed the location and degree of contrast enhancement, interval change, and clinical progression in correlation with House-Brackmann(HB) grade and electroneuronography (ENoG) findings. Fifteen of 30 normal facial nerves(50%) seen on Gd-enhanced MRI were mildly enhanced in the geniculate ganglion, the proximal tympanic, and the proximal mastoid segment of the facial nerve. No enhancement of the internal auditory canal(IAC) or labyrinthine segment of the facial nerve was noted, however. In BP and HZO, Gd-enhanced MR images revealed fair to marked enhancement for more than two segments from the internal auditory canal to the mastoid segment of the facial nerve. During follow-up MRI, enhancement of the facial nerve varied in location and signal intensity, though gradually decreased in intensity approximately eight weeks after the onset of facial nerve palsy. No correlation between clinical HB grade, ENoG, and follow up MRI findings was noted. Except in the internal auditory canal and labyrinthine segment, normal facial nevemay show mild and relatively symmetrical enhancement. In BP and HZO, the facial nerve showed diffuse enhancement from the IAC to the mastoid segment.=20

  19. HERPES SIMPLEX VIRUS IN SALIVA OF PATIENTS WITH BELL'S PALSY

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    M.H. Harirchian

    2008-04-01

    Full Text Available Acute idiopathic peripheral facial paralysis (Bell's palsy is the most common disorder of the facial nerve. Most patients recover completely, although some have permanent disfiguring facial weakness. Many studies have attempted to identify an infectious etiology for this disease. Although the cause of Bell's palsy remains unknown, recent studies suggest a possible association with Herpes Simplex Virus-1(HSV-1 infection. In this case-control study we investigated the presence of DNA of HSV in the saliva of 26 patients with Bells palsy in first and second weeks of disorder compared to normal population who were matched in sex, age, as well as history of diabetes mellitus, hypertension and labial herpes. In the case group 3 and 7 patients had positive polymerase chain reaction (PCR for HSV in first and second weeks of disease respectively compared to 4 in controls. It means that there was not any relationship between Bell's palsy and HSV in saliva either in first or in second week. Two and 6 of positive results from the sample of first and second weeks were from patients with severe (grade 4-6 Bell's palsy. Although the positive results were more in second week in patient group and more in severe palsies, but a significant relationship between Bell's palsy or its severity and positive PCR for HSV was not detected (P >0.05.

  20. Comparison of Medical and Voice Therapy for reflux Laryngitis Based on Acoustic and Laryngeal Characteristics

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    Abbas Dehestani Ardakani

    2011-12-01

    Full Text Available Background and Aim: Reflux laryngitis is extremely common among patients with voice disorder. Medical therapy approaches are not efficient enough. The main goal of this study is to assess the acoustic and laryngeal characteristics of patients with dysphonia before and after medical or voice therapy, and to evaluate the effectiveness of each.Methods: In this retrospective study, 16 reflux laryngitis patients were assessed. Five received complete voice therapy, tow ceased voice therapy and nine received medication. Perceptual voice evaluation was performed by a speech-language pathologist, the severity of voice problem was calculated, based on the affected acoustic and laryngeal characteristics pre- and post-treatment.Results: Post-treatment evaluation in patients who received complete voice therapy indicates 80 percent improvement in the severity of disorder and 100 percent improvement in the perceptual voice evaluation. After medical therapy, we observed that voice disorder and perceptual voice evaluation are improved 44 and 66 percent respectively. The improvement was statistically significant in both treatment approaches: complete voice therapy (P=0.039 and medical therapy (p=0.017.Conclusion: In patients with reflux laryngitis, most acoustic and laryngeal characteristics were normal and satisfying after the treatment. It can be concluded that the proficiency of voice therapy in improving the acoustic and laryngeal characteristics is comparable to medical therapy