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PubMed1989

[Magnetic resonance imaging in paralysis of the upper limb of traumatic origin].

We have used magnetic resonance imaging in addition to the other imaging techniques for the examination of 31 patients with traumatic upper limb paralysis. The therapeutic indications of traumatic brachial plexus paralysis depend on the early and precise assessment of the lesions. Computed tomography with a contrast injection at a lumbar level opacifying the subarachnoid spaces provides a morphological study of the canal, spine and nerve roots and of container-contents relationships. In our experience, the diagnostic reliability for the detection of intraspinal radicular lesions is 86%. A study in all 3 spatial planes is possible with MRI with T1- and T2-weighted or gradient echo sequences. The reliability of the technique for the diagnosis of meningoceles in the detection of nerve root avulsion is similar to that of CT (85%). The excellent spatial resolution and natural high contrast allow following the nerve roots in their extraspinal course and determining the site of nerve trunk rupture (50%). The use of oblique and double-obliquity sections should yet improve these results. These first results lead us to proposing magnetic resonance imaging for the exploration of traumatic lesions of the brachial plexus. This nonagressive, more precise and more complete assessment of the lesions certainly has a significant influence on therapeutic choice.

Adolescent↗
PubMedDate not supplied

[Submandibular secretion in the clinical evaluation of peripheral paralysis of the facial nerve].

In 157 patients with different forms of peripheral lesions of the facial nerve the volume of submandibular secretion has been continually estimated a year following their onset and it has been analysed in the direct correlation with the degree of motor insufficiency. It has been found that a satisfactory recovery of the motor nerve function can be expected if the volume of secretion has been over 40% at the onset of paralysis. The patients with lower values, especially below 20% most frequently have had a prolonged and incomplete recovery of the motor function followed by stoppage in restitution of secretion. A significant number of patients with values of the secretion over 50% have been recovered within 6 months and for the final recovery of paralysis with lower values of secretion a year and more has been necessary. The results and their clinical aspect have been analysed from the standpoints of the definite anatomic, physiologic and etiopathogenetic characteristics of dual innervation of the facial nerve.

Adult↗
PubMed1989

[Follow-up study of auditory evoked brain stem potentials--a contribution to the differential diagnosis of facial paralysis].

The case report of a 5-year-old girl suffering from an acute peripheral facial paralysis is used to discuss the clinical picture of Bell's paralysis. In the present case the sign was due to a brain-stem encephalitis, the diagnosis being based on brain-stem acoustically evoked potentials. Although not significantly influencing further practical procedure the authors consider it worth mentioning that apparently banal "peripheral" facial paralyses can actually be part of complex CNS lesions.

Brain Stem↗
PubMed1989

Neonatal vocal cord paralysis following extracorporeal membrane oxygenation.

Five cases of unilateral vocal cord paralysis/paresis were diagnosed following extracorporeal membrane oxygenation for newborn respiratory failure. All were right sided and transient in nature. None of the five patients had other findings commonly associated with vocal cord palsy. The extracorporeal membrane oxygenation procedure requires surgical dissection in the carotid sheath on the right side of the neck, an area immediately adjacent to both the vagus and recurrent laryngeal nerve. It is speculated that vocal cord paralysis in these infants was acquired as a result of the extracorporeal membrane oxygenation cannulation. Although the vocal cord paralysis resolved in all cases, two patients had difficult courses after extracorporeal membrane oxygenation. Therefore, laryngoscopic examination should be considered for patients after extracorporeal membrane oxygenation.

Extracorporeal Membrane Oxygenation↗
PubMed1987

Role of the heavy and light chains of botulinum neurotoxin in neuromuscular paralysis.

Botulinum neurotoxin (NT) is synthesized by Clostridium botulinum in any of seven antigenically distinct forms called types A-G. NT, when fully active, is a dichain protein, composed of two polypeptides, a heavy (H) and a light (L) chain (approximately 100,000 and approximately 50,000 Da, respectively) that are held together by noncovalent bonds and at least one disulfide bond. Two types of dichain NT, A and B, and their respective H and L chains were applied to nerve-muscle (NM) preparations (phrenic nerve-hemidiaphragm of the mouse), in order to develop a broader, comparative understanding of the neuroparalytic actions of NT types. It was found that the paralysis induced by dichain NT was delayed or antagonized if NM preparations were incubated with isolated and purified H chain prior to, or during, incubation with the parent, dichain NT. NM preparations preincubated with H chain and then washed free of unbound H chain became paralyzed after subsequent incubation with L chain. Paralysis did not occur if NM preparations were incubated first with L chain, washed, and then incubated with H chain. These observations suggest that the H chain binds with specific sites on the nerve terminal. This binding appears to permit the L chain, or some combination of the L and H chain, to bring about neuroparalysis through a mechanism very similar to that of the parent, dichain NT.

Animals↗
PubMed1988

Surgical management of bilateral diaphragmatic paralysis in a dog.

Bilateral diaphragmatic paralysis of uncertain cause developed in a 3-month-old Golden Retriever. A surgical procedure for tightening the diaphragmatic muscle was used to help alleviate the dog's respiratory distress. During thoracotomy, the central tendon of the diaphragm was plicated, using an interlocking suture pattern. The dog improved after surgery, and although complete recovery from paralysis was achieved only on one side, the dog has remained clinically normal 1 year after surgery.

Animals↗
PubMed1988

[On the contribution of magnets in sequelae of facial paralysis. Preliminary clinical study].

This trial was designed to evaluate the efficacy of EPOREC 1 500 magnets as an adjuvant to rehabilitation following peripheral facial paralysis. Magnetotherapy is used in many other specialties, and in particular in rheumatology. The properties of repulsion between identical poles were used to decrease the effect of sequelae in the form of contractures on the facial muscles. There were two groups of 20 patients: one group with physiotherapy only and the other with standard rehabilitation together with the use of magnets. These 40 patients had facial paralysis of various origins (trauma, excision of acoustic neuroma, Bell's palsy etc). Obviously all patients had an intact nerve. It was at the time of the development of contractures that magnets could be used in terms of evaluation of their efficacy of action on syncinesiae, contractures and spasticity. Magnets were worn at night for a mean period of six months and results were assessed in terms of disappearance of eye-mouth syncinesiae, and in terms of normality of facial tone. Improvement and total recovery without sequelae were obtained far more frequently in the group which wore magnets, encouraging us to continue along these lines.

Facial Paralysis↗
PubMed1988

Bilateral diaphragmatic paralysis: clinical spectrum, prognosis, and diagnostic approach.

In a retrospective review of the clinical course of five patients with nontrauma-related bilateral diaphragmatic paralysis, we found that the diagnosis is generally delayed (median delay: two years) in the presence of moderate to severe respiratory insufficiencies. Orthopnea out of proportion to the underlying cardiopulmonary status and thoracoabdominal paradoxus in the supine position are the clues to the diagnosis. Pulmonary function tests showed a typical restrictive ventilatory defect, and arterial blood gas showed chronic respiratory acidosis. Failure to recognize the diaphragmatic impairment led to cardiopulmonary decompensations such as cor pulmonale and acute respiratory failure. However, with the institution of appropriate therapy, adverse effects resolved and all five patients are alive and continue to lead independent lives. We conclude that nontrauma-related bilateral diaphragmatic paralysis is an underrecognized and underdiagnosed condition. The results also indicate that early diagnosis and treatment can minimize morbidity and mortality, and that excellent long-term, good-quality survival can be expected.

Aged↗
PubMed1988

[Neurinoma of the vagus nerve, contralateral peripheral facial paralysis].

A right facial paralysis led to the discovery of a tumor on the left side of the medulla oblongata. A neurinoma was suspected on MRI and confirmed by surgery and pathological examination. Ultrasonic aspiration was on interest in this case. The mechanism of the facial paralysis is uncertain: ischemia, compression and pure coincidence may be considered.

Adult↗
PubMed1988

Sleep paralysis: a study in family practice.

Over a period of two years, five patients with sleep paralysis referred themselves to four family practices in Israel serving a population of 6800. None of the patients suffered from daytime sleep attacks or cataplexy and all were from the oriental (sephardi) community. The two who were tissue typed had HLA haplotypes different from those which are exclusively associated with narcolepsy and one of them who also underwent polysomnography had a normal tracing. There was considerable delay in consulting a physician despite the physical and mental anguish caused by the disorder and some improvement was noted once the diagnosis was explained. The serious nature of the components of the differential diagnosis - myocardial infarction, seizure disorder, cardiac arrest, anaesthetic accident - makes it important that sleep paralysis be more widely recognized.

Adult↗
PubMed1988

Functional electric stimulation in the reversal of conversion disorder paralysis.

Numerous reports have documented the usefulness of functional electric stimulation (FES) in restoring and/or improving the function of organically diseased or paralyzed muscles. There are few reports related to the use of FES in the treatment of conversion disorder paralysis of the hysterical type. This paper presents a case of hysterically paralyzed muscles where the patient received daily treatment with FES for two weeks. Electric current was applied to a weak quadriceps and to paralyzed tibialis anterior muscles. This electrotherapeutic modality was effective in improving the function of the quadriceps and in reversing the paralysis of the tibialis anterior muscles. The improvement in the muscles' functional abilities was documented through the use of quantitative measures of muscle strength as well as computerized analysis of EMG signals. The results showed that the administration of FES resulted in a dramatic increase in motor units recruitment, increased muscle strength, and improved voluntary muscle control.

Adult↗
PubMed1988

Fractures of the humerus associated with paralysis of the radial nerve.

Forty-two cases of fracture of the humerus associated with paralysis of the radial nerve and treated over a period of 30 years were analysed. There was predilection for the mid-distal third, followed by the mid third and the supracondylar segment. Paralysis was complete in 39 cases and partial in 3. Treatment was conservative in 14 cases, early surgical in 18 (within 30 days), and late surgical in 10 (mean 4.7 months). The latter group involved cases where conservative treatment had not achieved recovery of neural function. Of the fractures treated conservatively, the diaphyseal fractures were slightly or moderately displaced, while supracondylar fractures were very displaced. Most of the fractures treated surgically were moderately or considerably displaced. Neurological recovery was satisfactory in 86% of the cases treated conservatively, in all those operated early, and in 50% of those operated late. The choice of treatment as between conservative or surgical must be on an individual basis, depending on the site and degree of displacement of the fracture, the extent of any exposure, and the degree of neurological deficit.

Adult↗
PubMed1988

[Facial paralysis in newborn infants and children. Clinical and therapeutic aspects].

Paralysis of the facial nerve in newborns and infants is described with a list of the various types including Bell's idiopathic paralysis, forms caused by congenital malformations and labour traumas, fractures of the temporal bone, tumours, infections and high blood pressure. Current approaches to treatment including physiotherapy, pharmacological and surgical treatment are then described.

Adolescent↗
PubMedDate not supplied

Diaphragmatic paralysis due to partial diaphragmatic hypoplasia mimicking a localized muscular dystrophy: a case report.

A case of congenital diaphragmatic paralysis is reported in an infant who died because of respiratory failure at the age of 5 weeks. The histologic findings show a dystrophy-like muscle pathology restricted to the diaphragm with a normal somatic peripheral musculature and normal phrenic nervous structures. The previous death of a male sibling because of diaphragmatic eventration suggests that this case of diaphragmatic paralysis could have been a consequence of a partial and random hypoplasia of muscle fibers, mimicking an isolated muscle dystrophy of the diaphragm.

Brain↗
PubMed1988

An undescribed Rhipicephalus species associated with field paralysis of Angora goats.

Paralysis of Angora goat kids caused by adult ticks, which most probably belong to an undescribed species of the Rhipicephalus pravus group, is described. Confirmed cases of paralysis occurred in the south-western Orange Free State between the second half of September and the first half of November as well as during the first half of February. The mean female tick burdens (mean = 21.4) of paralysed Angora kids were significantly higher than those of healthy kids (mean = 4.4). The predilection attachment site of the adult ticks was the ears of the goats. The elephant shrew Elephantulus myurus is a preferred host of the immature stages whereas the scrub hare Lepus saxatilis serves as an important host for the adult ticks.

Animals↗
PubMed1988

[Electrophysiological study of congenital facial paralysis].

The common cause of neonatal facial asymmetry is facial nerve paralysis or "asymmetric crying facies syndrome". In the not uncommon later the lower lip, symmetrical at rest, becomes tilted to the so-called normal side when the patient is smiling or crying, as the congenital hypogenesis of sublabial muscles fail to pull down the lower lip in the opposite side. The electrophysiological differentiation between the two diseases has been performed by orbicularis oculi and oris reflexes with mechanically glabellar and supralabial tapping stimulation, respectively, in addition to needle and/or surface EMG recording. In the facial nerve paralysis of the case 1, R1 and R2 were absent in the orbicularis oculi and oris reflexes. EMG activity was completely lacking over the M. orbicularis oculi and oris innervated by facial nerve. On the contrary, the orbicularis oculi and oris reflexes were normal in the asymmetric crying facial of the case 2. EMG activity was absent only in the sublabial muscles including M. depressor anguli oris and/or M. depressor labii inferioris. Furthermore, needle EMG disclosed no spontaneous activity at rest, which was suggestive of no denervation in the sublabial muscles. It was, however, not possible to determine exactly which muscle the needle was inserted, the M. deprossor anguli oris or the M. depressor labii inferioris. The case 3 might be a variant of asymmetric crying facies with hypogenesis of M. orbicularis oris and/or oculi as well as the sublabial muscle, since the latency was normal but the amplitude was significantly attenuated in the components of orbicularis oculi and oris reflexes.(ABSTRACT TRUNCATED AT 250 WORDS)

Diagnosis, Differential↗
PubMed1988

A survey of Karoo tick paralysis in South Africa.

Recent research interest in Karoo tick paralysis and its vector. Ixodes rubicundus, prompted this survey to determine the economic implications of this disease. The survey indicated relatively high losses caused by the condition, identified the stock involved and provided data on the incidence of paralysis and on the control methods employed. Recommendations are made to institute chemical control earlier in the season to attempt better containment of the problem.

Animals↗
PubMed1987

Recurrent nerve paralysis after thyroidectomy. Therapeutic approach.

While recurrent nerve paralysis is a less frequent complication of thyroid surgery today thanks to the surgical techniques effected with identification of the recurrent nerve, it however is not a rare one (4 to 5%). It should systematically be sought by means of laryngoscopy both before and after operation. It is worth an objective assessment, quantitatively with measurement of the phonatory quotient and maximum phonatory time as well as qualitatively with analysis of vocal frequency. The often speech pathologist treatment is completed by injection of GAX collagen into the vocal fold by endoscopic approach under microscopic control. Of 35 cases of paralysis treated during the last three years, we have had three cases after thyroid surgery, i.e. less than 10%.

Electromyography↗

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