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PubMed1979

Idiopathic facial paralysis in the dog.

Facial nerve paralysis of acute onset is reported in seven mature dogs, five of which were cocker spaniels. The clinical signs were characterised by ear drooping, lip commissural paralysis, sialosis, and collection of food on the paralysed side of the mouth. All dogs showed absent menace responses and trigeminofacial/acousticofacial reflexes. Horner's syndrome was not present in any dog. In four dogs, bilateral facial paralysis developed. The facial paralysis was unrelated to otitis media. Electrodiagnostic studies revealed denervation potentials and absent evoked muscle potentials. Facial nerve biopsies from two cases showed nerve fibre degeneration and apparent loss of larger diameter myelinated fibres. The condition has been termed idiopathic facial paralysis since the aetiopathogenesis is presently unknown.

Animals↗
PubMed1977

Surgical and nonsurgical management of facial paralysis following closed head injury.

The outcomes of facial nerve decompression, surgical exploration, and nonsurgical treatment for facial paralysis following closed head injury were analyzed in 30 patients with an intact facial nerve, and complete evaluation. Objective evaluation of outcome was achieved by calculation of a Facial Paralysis Recovery Profile and Recovery Index (Profile minus complications). Twelve of 15 patients with incomplete facial paralysis were treated medically. All followed patients with incomplete paralysis and bilaterally equal facial nerve excitability had a Recovery Index of + 10 (complete recovery of function, no complications). Three with partial denervation had a Recovery Profile of + 10 with mild contracture and synkinesis. The average Recovery Profiles for all patients treated by decompression, exploration, or nonsurgically were respectively 4.0, 5.7, and 5.7. The Recovery Indices were +1.8, +3, and +2.7, respectively. Where nerve excitability had become abnormal, facial nerve decompression was of no benefit in traumatic facial paralysis due to closed head injury. Nerve excitability tests of peripheral branches are of great value for prognosis and selection of patients who do not need surgical intervention. Substitution of facial nerve exploration for facial nerve decompression seems reasonable. Polytomography of the facial canal is invaluable in selection of patients for operation.

Adolescent↗
PubMed1976

[Prognostic assessment in peripheral facial nerve paralysis with particular reference to electroneurography (author's transl)].

Electrophysiological investigations were carried out on 20 healthy controls and 130 patients with peripheral facial nerve paralysis. The aetiology was as follows: idiopathic (Bell's palsy) in 60 cases, viral in 29, traumatic in 18, postoperative in 4, in connexion with chronic otitis media in 6, diabetes mellitus in 4, positive rheumatological tests in 3, disturbed lipid metabolism in 2, the Melkersson-Rosenthal syndrome in 1, as a complication of pregnancy in 2, and in association with a tumour in 1 case. The compound action potential (CAP) of the orbicularis oris muscle was determinedi n 370 occasions in a right/left comparision, the record of the muscle response was intergrated over the time of action (IAR) on 32 occasions and trison of 255 occasions. The normal values are given in the first place and their dependence of the age of the subject. Then, the prognostic sifnficance of the above-mentioned parameters is investigated in cases of peripheral facial nerve paralysis. It is apparent that the determination of the CAP in a right/left comparison is a valuable prognostic guide as early as the 4th day, insofar as a decrease in this parameter of under 50% can be interpreted as a favourable sign and satisfactory reversal of the paralysis can be expected within 6-8 weeks. By contrast, a decrease of over 70% in the CAP is a bad prognostic sign, indicative of presumably only a poor trend to reversal of the paralysis. An intermediate depression of the CAP in the range of 50-70% signifies an expected moderate recovery within 6-8 weeks ahe case of CAP determination at the time of maximum amplitude depression (as opposed to the 4th day), then a decrease of less than 70% is taken to be indicative of satisfactory functional recovery within 6-8 weeks; a decrease of 95-100% signifies a bad prognosis, whilst a decrease amounting to between 70 and 95% carries an uncertain prognosis. The maximum decrease in amplitude was registered on the 8th day on average; the range lay between the 4th and the 14th day. An exception to these figures was the delayed response of the CAP in the case of 6 patients, 5 of whom showed a maximum decrease during the 3rd week and the last patient as late as the 4th week following the onset of facial nerve paresis. Similar reliance can be placed on the prognostic value of the IAR. however, the decrease in the IAR is smaller than that of the CAP measured on the same potential in a right/left comparison, so that a decrease in the IAR of over 60% can already herald a poor recovery. Repeated determination of the latency in cases of facial nerve paralysis showed that the mean latency value for the entire group of patients was slightly prolonged at the end of the 1st week, but the latency values obtained in any one particular patient are of no prognostic significance. A comparison between CAP and latency values obtained with the opposite (i.e...

Action Potentials↗
PubMed1979

Regulation of plasma potassium in hyperkalemic periodic paralysis.

Hyperkalemic periodic paralysis is frequently considered a disorder in which episodes of weakness and an attendant rise in plasma potassium interrupt a baseline of normal strength and potassium. We studied venous potassium throughout a 36-hour period in two patients with hyperkalemic periodic paralysis and in nine normals under rigidly controlled conditions. At no time did the patients with periodic paralysis have an attack of weakness, but their mean potassium concentrations were above the normal range for 33 to 36 hours. In hyperkalemic periodic paralysis, the postprandial change in potassium relative to insulin release exceeded normal. There appears to be a continuous alteration in potassium regulation in our patients with hyperkalemic periodic paralysis.

Female↗
PubMed1979

Pediatric vocal cord paralysis.

Pediatric vocal cord paralysis accounts for approximately 10% of all congenital laryngeal lesions. Early detection of these neurogenic disorders is based upon a high index of suspicion and is important to prevent catastrophes during periods of acute respiratory embarrassment. This paper reviews the symptoms, etiology and management of unilateral and bilateral vocal cord paralysis as it pertains to this age group. A case is presented of a neonate with vocal cord paralysis and associated hydrocephalous and meningomyelocele to illustrate many of the problems associated with pediatric laryngeal paralysis.

Abnormalities, Multiple↗
PubMed1977

Neuromuscular paralysis caused by tick envenomation.

The Australian scrub-tick Ixodes holocyclus causes a series of significant toxic effects in its victims. The most important feature of tick envenomation is neuromuscular paralysis. Children poisoned by ticks may manifest only local motoneural effects, usually facial paralysis. Progressive ascending flaccid paralysis occurs if the removal of an embedded tick is delayed. The specific neurological features of tick-bite are discussed in the light of a series of 6 children who all showed signs of tick paralysis. Tick venom is known to slow nerve conduction, and may have a botulinum-like effect at the neuromuscular junction. The literature on the neurological effects of tick-envenomation is reviewed.

Australia↗
PubMed1978

Transient paralytic attacks of obscure nature: the question of non-convulsive seizure paralysis.

Eleven patients with transient paralytic attacks of obscure nature are described. Paralysis could involve face or leg alone, face and hand, or face, arm and leg. The duration varied from two minutes to one day. Four patients had brain tumors, six probably had brain infarcts, and one a degenerative process. The differential diagnosis included TIAs, migraine accompaniments, and seizures. In the absence of good evidence for the first two, the cases are discussed from the standpoint of possibly representing nonconvulsive seizure paralysis (ictal paralysis, inhibitory seizure paralysis or somatic inhibitory seizure). Because of the difficulty in defining seizures as well as TIAs and migraine in their atypical variations, a firm conclusion concerning the mechanisms of the spells was not attained. Two cases of the hypertensive amaurosis-seizure syndrome have been added as further examples of ictal deficits.

Adult↗
PubMed1977

Preoperative facial paralysis in malignant parotid tumours.

Preoperative paralysis of the facial nerve was found in 145 of 1,029 patients with malignant parotid tumours (14%) treated at nine university clinics in Scandinavia. The incidence of facial paralysis varied between the different clinics. A parellelism between the incidence of the facial paralysis and the impairment of the prognosis of the different tumour types is shown. The presence of preoperative facial nerve paralysis in malignant parotid tumours implies a very poor prognosis but the situation is not as hopeless as has been suggested and therefore one must rely on very radical surgery.

Adenoma↗
PubMedDate not supplied

Etiology of bilateral abductor vocal cord paralysis: a review of 389 cases.

The etiology of 389 cases of partial or complete bilateral abductor vocal cord paralysis has been determined and classified. One hundred and forty-nine were infants and children 12 years of age and under; 240 were adults, age 13 and older. In the infants and children the paralyses were congenital in 82 cases, of which 43 were associated with other congenital anomalies, and 39 were without associated anomalies. Fifty-nine cases were considered acquired, most being secondary to underlying congenital anomalies, particularly the associated findings of meningomyelocele, Arnold-Chiari malformation, and hydrocephalus. Eight cases of paralysis in this age group were of undetermined etiology. Of the 240 adult cases of bilateral vocal cord paralysis. 138 followed thyroidectomy. Fifty-two cases were associated with various neurologic disorders, including poliomyelitis, Parkinson's disease, cerebrovascular accident, Guillain-Barré syndrome, multiple sclerosis, neoplasms and other miscellaneous neurologic conditions. Sixteen cases were due to malignant neoplasms of the neck and mediastinum. The remaining 34 cases constitute a miscellaneous group which includes foreign bodies, bilateral neck dissection, infection, congenital lesions, trauma, and idiopathic paralyses. The characteristic symptoms of bilateral abductor vocal cord paralysis include normal or near normal phonation with inspiratory stridor which may progress to complete respiratory obstruction. These symptoms are due to the stationary but flaccid midline position of the vocal cords which places them in a phonating position, where they both obstruct the airway and produce a faily clear voice or cry. This paradoxical combination of symptoms was frequently found to be responsible for a failure or delay in diagnosis.

Adolescent↗
PubMed1977

["Idiopathic" chronic paralysis and dilatation of the right atrium].

Electric and mechanical atrial paralysis is a condition usually associated with a primitive or secondary cardiopathy. Only extremely rare cases are characterized by early appearance in young subjects without evidence of cardiac disease of any kind whatever, without character of familiarity, with atrial paralysis being the only abnormality, and are thus defined as idiopathic atrial paralysis. One of these cases (the eighth in the literature, to our knowledge), presented with a complete study and the hypothesis that "chronic idiopathic atrial paralysis" and "idiopathic right atrial enlargement" (sometimes associated, as in this case) may be different manifestations of the same chronic myocardial disease.

Adult↗
PubMedDate not supplied

[Electric stimulation in cases of flaccid paralysis].

Forty-six patients with flaccid paralysis of muscles were treated with stimulation with exponential currents. In 7 groups of patients three grades of muscle paralysis were distinguished, on the basis of muscle reaction to a definite duration of electrical stimulus. The best therapeutic results were obtained in paresis, fairly good in moderate paralysis, less good in severe paralysis. The results depended on the degree of muscle denervation, the extent of damage to the peripheral motor neuron and to the conditions of regeneration of the peripheral nerve.

Adolescent↗
PubMed1977

Paralysis of the trapezius associated with myogenic torticollis. A report of 6 cases.

The authors report the follow-up results of forty-three patients operated on for myogenic torticollis between 1965 and 1975. The surgical treatment consisted of distal tenotomy in eight cases, distal and proximal tenotomy in twenty-three cases, tenomyomectomy in eight cases. The results were subdivided into three groups: excellent twenty-two, (57 per cent); good , fourteen (38 per cent); poor, two (five per cent). The most interesting finding that emerged was the association of paralysis of the trapezius muscle with myogenic torticollis: this was observed in six cases, three after and three before operation. Preoperative investigations, including an EMG test and confirmation at operation, appeared to show that the paralysis was secondary to compression of the accessory nerve in its passage through the sternocleidomastoid muscle. Neurolysis, performed in three cases, led to recovery of the paralysis. Compression of the accessory nerve is slowly progressive, and paralysis or paresis of the trapezius muscle therefore occurred late. In fact, the patients who presented with both lesions were well beyond infancy. The authors emphasize the importance of being aware of the association of this lesion with myogenic torticollis so that operation for the latter may complemented by neurolysis of the accessory nerve.

Accessory Nerve↗
PubMed1979

Modifications in the sarcoplasmic reticulum and subcellular calcium distribution in skeletal muscle in a case of Westphal's disease (hypokalemic periodic paralysis).

In a case of hypokalemic periodic paralysis with characteristic alterations of the sarcoplasmic reticulum (SR) in the skeletal muscle, subcellular calcium re-partition, as revealed with the pyroantimonate technique, appears disturbed during paralysis. Pyroantimonate precipitates, normally concentrated in the terminal cisternae of the SR, were localized in the T tubules, whereas the terminal cisternae appeared empty. The increase (about 14%) in muscular calcium during paralysis may result from the accumulation of calcium in the extracellular compartment (T tubules). Defects in calcium uptake and storage by the SR may be involved in the pathogenesis of the periodic paralysis syndrome.

Adolescent↗
PubMed1979

[Paralysis of the 3d cranial nerves in diabetes and common oculomotor vascularization].

The purpose of this paper is to present explanations for various patterns of IIIrd cranial nerve involvement in diabetes mellitsus, based on its vascularisation. Three clinical cases of diabetes with numerous attacks of IIIrd nerve paralysis are reported. The following patterns were observed: (1) isolated; (2) associated with Vth nerve involvement and; (3) associated with invovlement of the Vth, IVth, VIth, and occasionally IInd and VIIth nerves. An anatomical study of IIIrd nerve vascularisation demonstrates three territories which could correspond to the 3 patterns of clinical expression. The arterial branches to the IIIrd nerve give off no collaterals in the posterior region of the circle of Willis. In the supra-cavernous region, vascularisation of the IIIrd nerve may be associated with that of the IVth. Eventually, vascularisation of the IIIrd nerve in the intracavernous region is associated with that of the Vth, IVth, VIth, and occasionally IInd and VIIth cranial nerves. Thus, a painless paralysis of the IIIrd nerve (isolated or associated only with an involvement of the IVth) would predictably be related to a vascular disturbance limited to the first or second portion of this nerve, whereas a painful paralysis of the IIIrd nerve, without or with associated involvement of other cranial nerves, would relate to a vascular distrubance in the intra-cavernous region. The anatomo-clinical relationships that have been presented: (1) support the vascular basis of IIIrd nerve paralysis in diabetes; (2) explain the various clinical patterns of IIIrd nerve involvement in that disorder and; (3) act as a model which can be applied to the study of ischemic pathology in other cranial nerves and other etiologies.

Aged↗
PubMed1978

Hypokalaemic periodic paralysis and cardiomyopathy.

The results are reported of cardiological examinations, including echocardiography, in nine members of a family suffering from hypokalaemic periodic paralysis, associated with permanent muscular weakness. The studies were performed in periods between attacks of paralysis. The slowly progressive permanent muscular weakness which is found in most of the patients with hypokalaemic periodic paralysis resembles a limb-girdle type dystrophy. Involvement of cardiac muscle is not uncommon in patients with limb-girdle dystrophy. Using a combination of echocardiography and ECG examination, nowadays the most sensitive screening method for the detection of cardiomyopathy, no evidence was obtained for cardiac involvement in hypokalaemic periodic paralysis patients with permanent muscular weakness.

Acetazolamide↗
PubMed1978

Acoustic reflex and loudness discomfort in acute facial paralysis.

An extensive research protocol was used to evaluate the conditions of 48 consecutive patients with acute facial paralysis. The results indicated that after nerve excitability testing, the acoustic reflex was the most efficient indicator of impending nerve degeneration and predictor of recovery. The presence of increased sensitivity to intense acoustic stimuli (loudness discomfort level) indicated poor prognosis. The data demonstrate that dysacusis (hyperacusis) is not related to stapedial muscle paralysis and also question the validity of "topographic diagnosis" in determination of the site of the lesion in facial paralysis.

Adolescent↗
PubMed1975

Paralysis of the diaphragm.

Diaphragmatic paralysis has been mentioned infrequently as a cause of respiratory symptoms in children. During a three-year period, diaphragmatic paralysis has occurred in 12 neonates following birth trauma (six) or thoracotomy (six) and in four older children following thoracotomy. Spontaneous recovery occurred in all four older children and in five of the 12 neonates. Although two neonates became asymptomatic despite persistent paralysis, the remaining five neonates required prolonged intermittent positive-pressure breathing; two eventually died of secondary pneumonia, and three became asymptomatic only after plication of the affected diaphragm.

Adolescent↗
PubMed1975

Radiation-induced brachial plexus paralysis.

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

Axilla↗