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At least 433 records · Page 24Linked to original sources
PubMed1986

A new approach to the surgical management of paralysis of the laryngeal nerve after thyroidectomy.

Recurrent nerve palsy, immediate or delayed, or unilateral or bilateral, is a recognized complication of operations upon the thyroid gland and is not considered to be remediable as a presumed consequence of division of the nerve (or nerves). Removal of sutures and neurolysis of the nerve have met with variable success in restoration of function. In a prospective study over a period of 14 years, paralysis after thyroidectomy was assessed in 31 patients. Five had undergone previous operations upon the thyroid gland, four of these patients had known unilateral paralysis and 26 underwent operations which involved exploring the nerves. Immediate removal of the sutures was followed by complete recovery in four of the patients. Fifteen nerves of 13 patients with delayed paralysis were operated upon within six months of the original procedure; ligatures were removed in four patients, the nerve of one patient was sutured and the remaining underwent neurolysis. Some recovery of function within six months was seen in 13 nerves. Nine nerves were operated upon up to one year later, three divided nerves were sutured, one suture around a nerve was removed and five nerves were freed from fibrous tissue; recovery of function was seen in only two nerves. Of all the nerves which were sutured, slight mass movement of the corresponding vocal cord was seen in two. The results indicate that immediate paralysis after thyroidectomy should be investigated immediately, not only to excluded severance but also to relieve, if possible, physical involvement of the nerve by suture or ligature; the outcome of the operation is often beneficial. The benefits of neurolysis when the onset of paralysis is delayed due to fibrosis surrounding the nerve is also discussed; earlier intervention is associated with better results. Direct suture of the divided nerve is not recommended.

Female↗
PubMed1987

Phrenic nerve paralysis after pediatric cardiac surgery. Retrospective study of 125 cases.

Phrenic nerve paralysis was diagnosed in 125 children (1.6%) from a series of 7,670 cardiac surgical procedures in infants and children during a 12 year period. The incidence was 1.9% for open heart and 1.3% for closed heart operations. In order of decreasing incidence, the open heart procedures included Mustard procedure (6.7%), right ventricular outflow tract reconstruction (5.6%), and repair of tetralogy of Fallot (2.7%). The closed heart procedures included Glenn anastomosis (6.2%), Blalock-Hanlon atrial septectomy (5.9%), and right Blalock-Taussig shunt (5.1%). Procedures following previous operations or thoracotomies had almost twice the incidence of phrenic nerve paralysis: Mustard procedure 9.9%, right ventricular outflow tract reconstruction 10.8%, and tetralogy repair 5.5%. Seven patients (5.6%) with phrenic nerve paralysis died. Patients less than 2 years old with phrenic nerve paralysis were intubated for 0 to 57 (average 15.7) days after their cardiac operations and those over 2 years old for 13 to 35 (average 7.2) days (p less than 0.001). Twelve patients had diaphragmatic plication without mortality and were extubated 0 to 6 (average 2.3) days after plication. We have made the following conclusions: (1) Phrenic nerve paralysis may occur after both open and closed cardiac procedures and is more common in children requiring reoperation; (2) it is associated with considerable morbidity; (3) eventual recovery of phrenic nerve function occurs in 84% of children; and (4) diaphragmatic plication is safe, reliable, and of most value in patients who are under 2 years of age and require mechanical ventilation for more than 2 weeks.

Adolescent↗
PubMed1985

Relation of spastic and flaccid paralysis to retrograde transport of 125I-tetanus toxin and its 125I-Ibc fragment. Modulating effect of F (ab) antibodies directed to specific areas on the toxin molecule.

The injection into mice of small doses of tetanus toxin induces spastic paralysis as is well-known, whereas large doses of toxin produce flaccid paralysis. The hypothesis has been put forward that the type of symptoms produced may depend on the axonal transport or the lack of axonal transport of the toxin molecule to the central nervous system. In the present paper we show that the lethal flaccid paralysis occurring in mice injected with a very large dose of toxin develops in the absence of any uptake and axonal transport of the toxin molecule. We also confirm that a tetanus toxin-derived fragment, the Ibc fragment, which is not transported retrogradely, produces flaccid paralysis. The blockage with the aid of specific antibody F(ab) fragments of the area on the toxin molecule which is involved in binding and axonal transport does prevent the toxin from being transported to the CNS and causes it to produce flaccid paralysis.

Animals↗
PubMedDate not supplied

[Periodic paralysis. Histological, histochemical and ultrastructural studies in five cases (author's transl)].

Muscle changed found in five patients with periodic paralysis are described. Three patients had familial hypokaliemic paralysis, one had familial periodic paralysis with hyperkaliemia, and one had periodic attacks of muscular weakness with thyrotoxicosis. According to the stage in the clinical course at which biopsy was performed, several pathological patterns are described. Vacuolization was the main feature in the early stages of periodic paralysis. Later in the clinical course, tubular aggregates were the characteristic findings. In addition, degenerative changes of the muscle fibres were found in patient exhibiting a permanent myopathic condition. In thyrotoxic periodic paralysis, the longer the clinical course, the more severe the changes appeared to be. Possible mechanisms leading to such structural abnormalities remain in question.

Adolescent↗
PubMed1983

Neurocontrol of upper motor neurone muscle paralysis.

An attempt was made to describe upper motor neurone dysfunctions on the basis of changes in volitional activity, the effects of reinforcement maneuvers on motor units and sustained and unsustained characteristics of segmental reflexes. According to the above criteria, patients with paralysis due to established spinal cord injury can be divided into groups with clinical and subclinical paralysis, clinical paralysis with subclinical evidence of residual suprasegmental motor control, and clinically incomplete paralysis with a subclinical variety of neurocontrol patterns of motor activities. This categorization of paralysis according to neurocontrol criteria is opening new avenues to the use of residual motor activity for the modification of abnormal motor control by peripheral nerve stimulation and spinal cord stimulation procedures for the alteration of upper motor neurone dysfunctions.

Humans↗
PubMed1982

Steroid therapy in recent "quiet nerve paralysis" in leprosy. Report of a study of twenty-five patients.

Nerve trunks may "quietly" get paralysed in a proportion of leprosy patients without going through a stage of acute or subacute neuritis. A study of 25 male patients with quiet paralysis of 57 nerves shows that such paralysis, which may be complete or incomplete, can occur in any type of leprosy and may involve any nerve trunk. Steroid therapy for six months reversed the motor paralysis to a satisfactory extent in about 75% of the nerves. Recovery rate was higher in nerves other than the ulnar nerve, and when paralysis was incomplete or of short duration. There was no recurrence of paralysis after stopping steroid therapy. Except for mooning of the face noticed in two patients, no serious side effects attributable to prolonged steroid therapy occurred in the subjects included in this trial.

Adolescent↗
PubMed1994

[Four cases of phrenic nerve paralysis following surgery of thoracic esophageal carcinoma].

Four cases of phrenic nerve paralysis (two cases in right side, two cases in bilateral side) were experienced after surgery of thoracic esophageal carcinoma with extended lymph node dissection in neck and upper mediastinum. In all of the four patients, phrenic nerve paralysis was indicated by difficulties in weaning the patients from respirator, and respiratory management was requiring so many effort that the periods under respirator were prolonged from 12 to 41 days, but all patients recovered from phrenic nerve paralysis with conservative therapy and discharged. Vital capacity of the four patients at more than one year after surgery reached more than 75% in three patients and about 65% in one patient in comparison with the preoperative vital capacity, respectively. Therefore, long term result of respiratory function of these patients was not worse than that of patients without phrenic nerve paralysis. Since phrenic nerve is located nearly at the range of lymph node dissection in neck and upper mediastinum, dissection in that range is considered to have relation to injury of the phrenic nerve, but the nerve was not thought to be transected in view of the clinical course of the four patients. Although phrenic nerve paralysis has not been reported as the complication of surgery of esophageal carcinoma, in our department from 1987 it was found in 1.9% of patients who underwent surgery of thoracic esophageal carcinoma and in 16% of patients who underwent extended lymph node dissection. These results suggest the importance of care for the phrenic nerve during surgery of esophageal carcinoma with extended lymph node dissection.

Esophageal Neoplasms↗
PubMed1996

[Diaphragmatic paralysis in the postoperative period after heart surgery in children].

OBJECTIVE: The purpose of our study was to determine the incidence, pathological features, clinical relevance and treatment of diaphragmatic paralysis (DP) after pediatric cardiac surgery. PATIENTS AND METHODS: Five hundred fifty-six children who had undergone cardiac surgery between 1990 and 1994 were retrospectively analyzed. Persistent raising of one or both hemidiaphragms on chest x-ray films lead to the diagnosis in all cases. RESULTS: Diaphragmatic paralysis was diagnosed in 13 patients (2.3%) ranging from 3 days to 13 years of age. Atrial septal defect closure (3 cases) and systemic-pulmonary shunt derivations (3 cases) were the type of operations most frequently involved. The other cases included, 2 arterial switch in transposition of the great vessels, 1 repair of total anomalous pulmonary venous drainage, 1 tetralogy of Fallot repair, 1 coarctation and aortic stenosis repair, 1 resection of subpulmonary stenosis of transposition of the great vessels and 1 pacemaker implantation. There was no significant association with the use of extracorporeal circulation. There were seven cases of right hemidiaphragmatic paralysis, but no bilateral paralysis was found. Ipsilateral thoracotomy section concordance was found in all patients and no relation with central venous line placement was found. Diagnosis was made by chest x-ray in all cases, and further confirmation was done using fluoroscopy in 6 patients and ultrasound studies in 2. Prolonged mechanical ventilation was needed in 3 patients, and one patient required diaphragmatic plication. No long term complications were found. CONCLUSIONS: Diaphragmatic paralysis is a rare complication of pediatric cardiac surgery which must be suspected when failed attempts of respiratory weaning, not attributable to cardiac or pulmonary problems, are present.

Adolescent↗
PubMed1997

Prediction of recovery from upper extremity paralysis after stroke by measuring evoked potentials.

Paralysis of the upper extremity is a severe motor impairment that can occur after stroke. Prediction of recovery from paralysis is difficult and is primarily based on subjective clinical evaluation. However, the integrity of the sensorimotor system can be assessed objectively and quantitatively by measuring evoked potentials. In this retrospective exploratory study, we evaluated the predictive value of motor and somatosensory evoked potentials for recovery from paralysis of the upper extremity. Motor and somatosensory evoked potentials were recorded in 29 patients who had had their first-ever infarction in the territory of the middle cerebral artery and who exhibited paralysis of the upper extremity. At follow-up, seven patients showed motor recovery. The evoked potential data were dichotomized into present or absent and related to the occurrence of motor recovery. Analysis revealed a significant association between the presence of evoked potentials early after stroke and the observed occurrence of motor recovery. These results suggest strongly that evoked potentials predict the occurrence of motor recovery of upper extremity paralysis in patients suffering from first-ever infarction in the territory of the middle cerebral artery.

Adult↗
PubMed1998

[The occurrence of lumbar paralysis in goats and the appearance of Elaphostrongylus cervi in red deer in the canton Ticino].

The aim of the study was to examine the incidence of lumbar paralysis in goats and the possible role of Elaphostrongylus cervi as an agent. For this reason questionnaires concerning the clinical pictures and the incidence of lumbar paralysis were sent to 200 owners of goats and to 9 veterinarians. The study showed that the symptoms of lumbar paralysis had been observed for many years mainly during the winter. Most of the animals suffering from lumbar paralysis originated from the Valley of Leventina and Blenio. The symptoms of lumbar paralysis could be observed from 29 owners of goats. Fecal examination of 36 red deer in the autumn of 1995 was carried out for studying if deer plays a role in spreading the larvae of E. cervi. Twenty-five red deer passed the E. cervi larvae. This could be indicating that deer plays an possible role in the infection of goats with E. cervi.

Animals↗
PubMed1998

Prevalence of seizures and paralysis in a rural community.

A cross-sectional study covering four adjoining villages in Haryana during 1993 was carried out among 8595 subjects to find out cases having seizures or paralysis. The prevalence of seizures (n = 69) was found to be 8.03 per 1000 population. Out of 69 seizures, 48(69%) were true seizures and 21(31%) were febrile seizures. The prevalence of seizures was highest (14.05 per 1000) in the age group of > 1-4 years. Of 40 males with seizures, 22(55%) had epileptic seizures and 18(45%) had febrile seizures. Of the 29 females, 26(89%) had epileptic seizures and 3(11%) had febrile seizures. There were 25 cases of pseudoseizures. The prevalence of paralysis (n = 60) was 6.98 per 1000. Of these, 38 cases (63%) were due to poliomyelitis which is the highest so far the paralysis is concerned. Of 60 cases, 34 occurred among males and 26 among females. The prevalence of paralysis was highest (12.42 per 1000) among 0-1 year age group. As the prevalence of seizures is sufficiently high in rural areas, the primary health care doctors should be trained in counselling and therapy of seizures. As regarding paralysis due to poliomyelitis the recent success of pulse polio immunisations is commendable and which in near future is expected to eradicate poliomyelitis.

Adolescent↗
PubMed1998

Vocal cord paralysis.

Vocal cord paralysis is a multifacted problem that affects patients of all ages and presents initially to a wide range of healthcare professionals. It can cause laryngeal dysfunction ranging from slight hoarseness to life-threatening airway obstruction. When confronted with a patient with new onset vocal cord paralysis, the physician should determine the etiology of the paralysis. Only after an accurate diagnosis, can restoration of laryngeal function be addressed. Peripheral lesions injuring the vagus nerve or its branches are responsible for 90% of all vocal cord paralysis. Etiologies include neoplasms, surgical iatrogenic injury, and blunt and penetrating trauma in the head, neck, and thorax. Thyroid surgery has historically been accountable for almost a third of reported unilateral vocal cord paralyses. However, recent review has demonstrated a dramatic reduction in this incidence to less than 5%. Numerous treatment options exist for patients with vocal cord paralysis. These treatments can drastically reduce the social and economic disability incurred by these patients.

Humans↗
PubMed1998

[Analytical study of the treatment of facial paralysis by hypoglossal-facial anastomosis. Apropos of 25 cases].

Hypoglosso-facial anastomosis (HFA) is an already old alternative for the surgical treatment of facial paralysis. 25 patients, 17 men and 8 women, with complete facial paralysis were operated according to this technique, 6 to 12 months after onset of the paralysis. Based on analysis of the results, the authors describe the advantages and disadvantages of this technique. The advantages are: facial symmetry at rest, protection of the cornea, voluntary movements of facial muscles. The disadvantages are: paralysis and atrophy of one side of the tongue, absence of expression of emotional and involuntary states on one half of the face, synkinesia, disorders of mastication. Disorders of deglutition improve with time. In this series of 25 patients, the authors never observed eyelid movements independent of movements of the labial commissure. By comparing these advantages and disadvantages, the authors consider that HFA should no longer be proposed for the treatment of facial paralysis. In the current state of microsurgery, if the facial nerve cannot be repaired by direct suture or graft, the authors recommend revascularized, reinnervated muscle transfer onto the facial nerve of the healthy side.

Adult↗
PubMed1999

Clinical and metabolic features of thyrotoxic periodic paralysis in 24 episodes.

BACKGROUND: Hypokalemia is a well-known, consistent finding in thyrotoxic periodic paralysis (TPP). It is less well known that hypophosphatemia and mild hypomagnesemia are often present in TPP and that rebound hyperkalemia can occur as a result of potassium therapy. OBJECTIVE: To report the prevalence of these electrolyte abnormalities in 24 episodes of TPP in 19 patients admitted to a single university-affiliated public hospital during a 15-year period. METHODS: The medical records of all patients admitted to the Santa Clara Valley Medical Center in San Jose, Calif, between August 1, 1982, and June 1, 1997, with any type of hypokalemic periodic paralysis were reviewed. In patients with TPP, serum potassium, phosphorus, and magnesium levels were evaluated during and after episodes of paralysis. The administered dose of potassium chloride, recovery time from hypokalemia, and prevalence of rebound hyperkalemia after recovery were also ascertained. Data are presented as mean +/- SD. RESULTS: Hypokalemia was present in all 24 initial episodes of TPP, with serum potassium levels ranging from 1.1 to 3.4 mmol/L (mean, 1.9+/-0.5 mmol/L). After recovery from hypokalemia, the maximum serum potassium level significantly increased, ranging from 4.0 to 6.6 mmol/L (mean, 4.9+/-0.5 mmol/L; P<.001). In 10 (42%) of 24 episodes, rebound hyperkalemia (serum potassium level >5.0 mmol/L) was present. Recovery time did not correlate with the potassium chloride dose administered (r = 0.17). Initial serum phosphorus levels ranged from 0.36 to 0.97 mmol/L (mean, 0.61+/-0.23 mmol/L) (1.1-3.0 mg/dL [mean, 1.9+/-0.7 mg/dL]), with hypophosphatemia present in 12 (80%) of 15 episodes. Serum phosphorus levels significantly increased (P<.01), to 1.26 to 1.74 mmol/L (mean, 1.48+/-0.16 mmol/L) (3.9-5.4 mg/dL [mean, 4.6+/-0.5 mg/dL]), with or without phosphorus replacement therapy. A slight increase in serum magnesium levels after paralysis resolved was observed in all patients (P<.07). No further episodes of paralysis occurred in any patients after they became euthyroid. CONCLUSIONS: Hypokalemia, hypophosphatemia, and mild hypomagnesemia are characteristic features of TPP. Hypokalemia occurred in 100% and hypophosphatemia in 80% of the episodes in our study. Rebound hyperkalemia is a potential hazard of potassium administration and occurred in 42% of 24 episodes.

Adult↗
PubMed1993

Sjögren's syndrome presenting as hypokalemic periodic paralysis.

We describe a 21-year-old Hispanic woman who presented with hypokalemic paralysis as the initial manifestation of Sjögren's syndrome (SS). Our review of the English literature revealed 12 previously reported cases of SS and renal tubular acidosis (RTA). Paralysis often preceded the sicca complex in those patients. Renal function in the patients with hypokalemic paralysis was reduced compared with that in patients who had primary SS and RTA but no history of hypokalemic paralysis (P < 0.002). Hypokalemic periodic paralysis is a rare manifestation of SS. It is seen more often in patients with primary SS, may precede the classic sicca complex, and may serve as a clinical marker for more severe renal disease in patients who have primary SS and RTA.

Adult↗
PubMed1991

Calcium-tension relationships of muscle fibers from patients with periodic paralysis.

Lateral gastrocnemius muscle biopsies from a 26-year-old man with hyperkalemic periodic paralysis and a 23-year-old man with hypokalemic periodic paralysis were studied. Both patients came from families in which older relatives had developed a vacuolar myopathy in association with their periodic paralysis. Muscle fibers were chemically skinned, and individual fibers were studied with a low-compliance strain gauge. The tension generated by fibers was studied in baths with calcium concentrations from 10(-8) mol/L to 2.5 x 10(-5) mol/L. The Ca-tension relationships and maximal tensions (normalized to fiber cross-sectional area) of fast and slow twitch fibers were indistinguishable from those found in fibers from 5 normal subjects. The results reinforce earlier findings which suggested that loss of Ca-induced myofibril contraction was not the cause of paralysis in periodic paralysis.

Adult↗
PubMed1993

Sleep paralysis.

Sleep paralysis is a common condition with a prevalence of 5-62%. Although most affected people have single or infrequent episodes, sleep paralysis may be recurrent, or occur in association with the narcoleptic syndrome. In a study of 22 subjects with frequent sleep paralysis and also excessive daytime sleepiness, episodes continued for between 5 and 35 years. In contrast to subjects with the narcoleptic syndrome, these patients did not have cataplexy, daytime sleepiness and insomnia were less severe, and there was no HLA DR2(15) or DQ1(6) association. Sleep paralysis was familial in 19 of these subjects. A non-HLA linked genetic factor, in addition to environmental factors, may thus predispose to sleep paralysis.

Cataplexy↗
PubMed2005

Abnormal brain activation during movement observation in patients with conversion paralysis.

Dissociative paralysis in conversion disorders has variably been attributed to a lack of movement initiation or an inhibition of movement. While psychodynamic theory suggests altered movement conceptualization, brain activation associated with observation and replication of movements has so far not been assessed neurobiologically. Here, we measured brain activation by functional magnetic resonance imaging during observation and subsequent imitative execution of movements in four patients with dissociative hand paralysis. Compared to healthy controls conversion disorder patients showed decreased activation of cortical hand areas during movement observation. This effect was specific to the side of their dissociative paralysis. No brain activation compatible with movement inhibition was observed. These findings indicate that in dissociative paralysis, there is not only derangement of movement initiation but already of movement conceptualization. This raises the possibility that strategies targeted at reestablishing appropriate movement conceptualization may contribute to the therapy of dissociative paralysis.

Adult↗