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PubMed1990

Parental perceptions of newborn pharmacologic paralysis.

This is a descriptive exploratory study of 9 parent-dyads who experienced pharmacologic paralysis of their newborn within a prior 6-month period. Perceptual responses included feelings, values, and needs related to the pharmacologic paralysis therapy. Newborns receiving pharmacologic paralysis had direct dependence to the caretaker for mechanical ventilation, precise monitoring of physiological parameters, and extensive life support due to altered sensory-motor function and breathing. The appearance of the immobile newborn and the protocols for the administration of paralyzing agents, which eliminate excessive stimulation and handling, were suspected of impacting parental interaction. The convenience sample of parents was representative of three newborn critical care units. Open-ended, retrospective interviews were completed in either the parents' home or in a private room of the critical care complex. Physiologic complications precluded use of a prospective interview technique. Chart reviews and a background questionnaire provided demographic data. Data collection consisted of a parent-directed interview. Data were subjected to content analysis and descriptive statistics. The mother's and father's responses were coded separately. The identified common perceptual themes within the pharmacologic paralysis experience were empathy, normalcy, acceptance, and sedative association. Ancillary experiences include the perinatal period and newborn illness. Analysis of ancillary experiences revealed continued themes of empathy and normalcy as well as guilt, separation, shock and anxiety, and uncertainty. Nurses may provide parents whose ill newborn undergoes pharmacologic paralysis a supportive team approach and guidance within a framework of their feelings, values, and needs.

Adaptation, Psychological↗
PubMed1985

[Hypokalemic periodic paralysis provoked by "Ambene"].

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

Adult↗
PubMed1986

Further studies on the prevalence of isolated sleep paralysis in black subjects.

In a previous study, one of the authors (C.C.B.) found isolated sleep paralysis was common in blacks. In this study, conducted by interviews, a recurrent pattern (one or more episodes per month) of isolated sleep paralysis episodes in blacks was described by at least 25 percent of the afflicted sample studied. Frequent episodes were associated with stress, and subjects with isolated sleep paralysis had an unusually high prevalence of panic disorder (15.5 percent). The genetic transmission of sleep paralysis was studied in a large black family, and in addition to stressful environmental factors being associated with the condition, there appears to be a dominant genetic factor associated with the predisposition for developing sleep paralysis. The implications of these findings for stress, anxiety, sleep, and psychophysiologic disorders are discussed.

Adult↗
PubMedDate not supplied

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

The clinical features of 16 males and 2 females with hypokalemic periodic paralysis (HPP) are presented. Five patients had familial HPP, 4 thyrotoxic HPP and 9 sporadic disease. The age of onset ranged from 6 to 42 years. Clinical pictures varied from paraparesis to severe quadriplegia. The disease onset was earlier in familial HPP (p < 0.05) while sporadic cases showed the most severe, albeit shorter paralysis (p < 0.05). On admission, serum potassium levels ranged from 1.5 to 3.3 mEq/L; they did not correlate with the severity of paralysis. Glucose-insulin provocation test was positive in 5/5 patients. Oral potassium chloride and amiloride were useful to prevent paralysis. Contrasting with reports from USA and Europe, in México, HPP is not exceptional, and should be considered in the differential diagnosis of acute paralysis.

Adolescent↗
PubMed1996

Laryngeal and pharyngeal dysfunction in horses homozygous for hyperkalemic periodic paralysis.

OBJECTIVE: Evaluate histories, clinical signs, and laboratory data of 69 horses homozygous by DNA testing for hyperkalemic periodic paralysis (HPP). DESIGN: Cohort study. SAMPLE POPULATION: 69 of 189 horses testing homozygous for HPP between October 1992 and November 1994. PROCEDURE: Questionnaires addressing signalment, training regimes, medical history, and current status of affected horses were sent to owners, trainers, or attending veterinarians. Data from completed questionnaires were tabulated and evaluated, using descriptive statistics. RESULTS: Sixty-nine (37%) of 189 questionnaires were completed and returned. Clinical episodes of muscle weakness or paralysis varied in severity and frequency from mild muscle fasciculations to recumbency and death. Sixty-three of 68 HPP-affected horses were reported to have had stridor associated with exercise, excitement, stress, or episodes of muscle paralysis. Common endoscopic findings in affected horses included pharyngeal collapse, pharyngeal edema, laryngopalatal dislocation, and laryngeal paralysis. Twelve of 27 horses receiving acetazolamide had decreases in stridor while receiving medication. CLINICAL IMPLICATIONS: Most horses testing homozygous for HPP had clinical signs associated with pharyngeal and laryngeal dysfunction. Hyperkalemic periodic paralysis should be included on a differential list for horses examined for signs of laryngeal or pharyngeal dysfunction or stridor. Treatment with acetazolamide may help to control respiratory tract signs associated with this disease.

Animals↗
PubMed1998

[Thyrotoxic hypokalemic periodic paralysis in a male Kurd].

Thyrotoxic hypokalemic periodic paralysis has been described to occur quite frequently in male Asiatic patients. The syndrome is, however, very rare in patients of Caucasian origin. To our knowledge it has never been described in Austria so far. This is the reason why we present the following case: A 22-year old male patient of Kurdish origin suffered from two periods of typical flaccid paralysis of the extremities after strenuous physical exertion, that were 4 months apart. The periods of paralysis were quickly reversed by substitution with potassium. Graves' disease was retrospectively diagnosed to have existed already during the first period. The patient was treated with an ablative dose of 131-I (25 mCi) and can perform strenuous exercise without symptoms since. This case and the review of the literature clearly illustrates the advantage of screening for thyroid dysfunction in patients with flaccid paralysis: unnecessary further periods of paralysis can be avoided by the correct treatment of thyrotoxicosis in such patients.

Adult↗
PubMedDate not supplied

An overlooked association of brachial plexus palsy: diaphragmatic paralysis.

Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can be overlooked if thorough examination isn't done. We present a two-weeks-old baby with a birth weight of 3800 grams who had a left-sided brachial plexus palsy and torticollis with an undiagnosed left diaphragmatic paralysis even though he was examined by different physicians several times. The role of physical examination, the chest x-rays of patients with brachial paralysis and the treatment modalities of diaphragmatic paralysis due to obstetrical factors are discussed.

Brachial Plexus Neuropathies↗
PubMedDate not supplied

Use of the endoscopic forehead-lift to improve brow position in persistent facial paralysis.

Traditionally, the asymmetrical brow in facial paralysis has been treated with open procedures. There are few data that support the use of endoscopic procedures to treat patients with facial palsy or paralysis. We sought to evaluate a single surgeon's experience with the use of endoscopic forehead-lifts to treat asymmetrical brow positioning resulting from facial nerve disorders. All cases involving patients who underwent endoscopic brow-lifts by the senior author (Y.D.) from 1997 through 2003 with a minimum follow-up of 12 months were retrospectively reviewed. Demographic data were collected, and patient satisfaction was determined from postoperative interviews conducted at follow-up visits. Standard photographs were used to measure the degree of preoperative and postoperative brow asymmetry. A total of 31 cases were available for review. The average age of our patient population was 47 years (age range, 22-76 years), with a male-female ratio of almost 1.5:1. Twenty-three patients had a complete paralysis, and 8 patients had a palsy. The average preoperative difference in height at the desired apex of brow was 5.9 mm, with a range of 3.0 to 9.0 mm. The average postoperative difference (as measured at 12 months) in brow position was only 1.3 mm, with a range of 0 to 3 mm. Adjunctive periorbital procedures were performed in the majority of patients (90%) at the time of endoscopic brow-lifting. All patients felt that their brow position was much improved after surgery. No major complications were encountered. A single patient underwent a secondary open direct browpexy to optimize his result. Endoscopic brow-lifting may be associated with favorable outcomes in the majority of patients with facial nerve palsy or paralysis. Performing concurrent adjunctive periorbital procedures as deemed necessary to optimize lower eyelid position, eyelid closure, and upper eyelid symmetry appears to be safe and reliable.

Endoscopy↗
PubMed2004

Laboratory tests to determine the cause of hypokalemia and paralysis.

BACKGROUND: Hypokalemia and paralysis may be due to a short-term shift of potassium into cells in hypokalemic periodic paralysis (HPP) or due to a large deficit of potassium in non-HPP. Failure to make a distinction between HPP and non-HPP may lead to improper management. Therefore, we evaluated the diagnostic value of spot urine tests in patients with hypokalemia and paralysis during 3 years. METHODS: Before therapy, the urine potassium concentration, potassium-creatinine ratio, and transtubular potassium concentration gradient were determined in a second voided urine sample. RESULTS: Forty-three patients with hypokalemia and paralysis were identified: 30 had HPP and 13 had non-HPP. There was no significant difference in the plasma potassium or bicarbonate concentrations and in the pH of arterial blood between the 2 groups. All but 2 patients in the non-HPP group had urine potassium concentration values less than 20 mmol/L. Although the potassium concentration was significantly lower in the HPP group, there was some overlap. In contrast, the transtubular potassium concentration gradient and potassium-creatinine ratio differentiated patients with HPP vs non-HPP. Although only a mean +/- SD of 63 +/- 36 mmol of potassium chloride was administered in the patients with HPP, rebound hyperkalemia (>5 mmol/L) occurred in 19 (63%) of these 30 patients. CONCLUSIONS: Calculating the transtubular potassium concentration gradient and potassium-creatinine ratio provided a simple and reliable test to distinguish HPP from non-HPP. Minimal potassium chloride supplementation should be given to avoid rebound hyperkalemia in patients with HPP.

Adult↗
PubMed1981

Paralysis of cranial nerves III, IV, and VI. Cause and prognosis in 1,000 cases.

An unselected series of 1,000 cases of paralysis of cranial nerves III, IV, and VI was retrospectively analyzed regarding ultimate recovery and final causal diagnosis. The frequency of involvement of the third, fourth, and sixth cranial nerves was relatively unchanged from earlier similar reports. The number of patients (263) whose cranial nerve paralysis was initially of undetermined cause was surprisingly high despite the availability of computerized tomographic scanning. Subsequently, the cause for the paralysis was diagnosed in only ten of the 127 patients who could be traced. About half (51%) of the patients with no known cause for paralysis underwent spontaneous remission. Forty-eight percent of all patients recovered. Cranial nerve impairment due to vascular disease (diabetes mellitus, atherosclerosis, or hypertension) was temporary in 71% of the patients, regardless of the cranial nerve affected. Patients with palsies caused by aneurysm, trauma, and neoplasm was predictably less likely to recover.

Abducens Nerve↗
PubMed2001

Localization of the gene for familial laryngeal abductor paralysis to chromosome 6q16.

BACKGROUND: Vocal fold paralysis is a common cause of neonatal stridor. Although it is usually classified as idiopathic or iatrogenic in origin, a small subset of patients have a family history of this disorder, indicating a possible genetic cause. OBJECTIVE: To identify the genetic locus of the gene that causes familial laryngeal abductor paralysis. DESIGN: A standard nonorganic protocol was used to extract DNA from whole-blood samples. The DNA samples were quantified by DNA fluorometry, and the concentration of all samples was standardized at 40 ng/microL. A pooled DNA strategy was used to facilitate rapid polymerase chain reaction screening of markers in the Weber v8.0 genome screening set. Polymerase chain reaction screening of individual DNA samples was performed using possible linked markers initially identified as having an allele that appeared with a higher incidence in the affected DNA pools. Statistical analysis of possible linkage was performed using the LINKAGE 5.1 set of linkage analysis computer programs. SUBJECTS: A family in which a form of familial laryngeal abductor paralysis segregates was ascertained. Whole blood samples were drawn from 40 participating individuals within this family after the subjects' fully informed consent was obtained. RESULTS: Initial screening of the pooled DNA specimens revealed a band pattern for D6S1021 on chromosome 6q16, indicating an allele with a higher incidence in the affected vs the nonaffected pool. Two-point analysis of individual allele patterns confirmed linkage to D6S1021 with an lod score of 3.86 (straight theta = 0.0) at a penetrance value of 0.8. Haplotype analysis with flanking markers defined a 5-centiray critical region between D6S283 and AFMA047YG1. CONCLUSION: An autosomal dominant form of familial laryngeal abductor paralysis is linked to a 5-centiray region on chromosome 6q16 surrounding D6S1021.

Alleles↗
PubMed1993

Anticus-lateralis muscle suturing. Treatment of recurrent nerve paralysis.

We have devised a new surgical method that sutures the cricothyroid (anticus) muscle to the paralyzed lateral cricoarytenoid (lateralis) muscle for the dynamic reconstruction of the larynx. Because this method achieved remobilization of the paralyzed vocal cord in dogs, we applied it to seven patients with unilateral recurrent laryngeal nerve paralysis (four patients had postsurgical paralysis and three patients had idiopathic paralysis). We obtained the following satisfactory results: (1) vocal cord tension and voice quality improved in all patients, and (2) in four patients, remobilization of the paralyzed vocal cord was obtained. We believe that this surgical method could serve as a new dynamic method of reconstruction for the treatment of unilateral recurrent laryngeal nerve paralysis.

Anastomosis, Surgical↗
PubMed1999

Magnetic resonance navigator echo diaphragm monitoring in patients with suspected diaphragm paralysis.

Real-time magnetic resonance (MR) navigator echo (NE) monitoring of the diaphragm is now possible. Using this technique, temporal changes in diaphragm position can be analyzed in a non-invasive fashion, without x-ray exposure. In this preliminary study, we have optimized three NE parameters (the NE column area, the NE repeat time, and the location of the NE on the diaphragm surface), and demonstrated the clinical application of MR NE diaphragm monitoring in patients with suspected diaphragm paralysis. The NE parameters were defined in 10 healthy volunteers, and diaphragm traces were scored for variance in NE diaphragm position registration. Using the optimal NE column parameters, we investigated four patients with diaphragm paralysis, one of whom required positive pressure ventilation while in the MR scanner, to show the utility of this technique. The NE diaphragm position registration was significantly affected by the area of the NE column, with poor position registration for the smallest column area (2.25 cm2 vs. 4 cm2 vs. 6.25 cm2, variance 6.3 vs. 0.6 vs. 0.3, P = 0.006). Diaphragm position registration was also significantly affected by the NE repeat time, with misregistration for the shortest repeat time (250 msec vs. 500 msec vs. 1000 msec, variance 11.9 vs. 0.6 vs. 1.0, P = 0.02), and data clipping, with loss of end-expiratory and end-inspiratory position registration, for the longest repeat time. Finally, if the NE was positioned too anteriorly, the diaphragm traces were of poor quality (anterior vs. dome vs. posterior, variance 11.8vs. 0.6vs. 3.2, P < 0.001). Application of the technique confirmed diaphragm paralysis in all four patients. The technique can be applied during positive pressure ventilation if necessary. The optimal NE parameters for diaphragm monitoring at 0.5 T were: column area, 400 mm2; NE repeat time; 500 msec; NE column positioned on the diaphragm dome. MR NE diaphragm monitoring provides a safe, non-invasive method of assessing diaphragm motion in patients with suspected diaphragm paralysis and may prove useful for long-term follow-up and monitoring of therapeutic interventions in these subjects.

Adult↗
PubMed1989

An outbreak of acute flaccid paralysis in Jamaica associated with echovirus type 22.

An outbreak of acute flaccid paralysis in Jamaica in 1986 associated with echovirus type 22 is described. Six patients aged 1 to 27 years developed acute onset of severe flaccid paralysis, with inability to walk. Three cases had facial weakness, four required intensive care with assisted ventilation, and two died. Echovirus type 22 was isolated from the stool of two patients who showed a significant increase in antibody titre. Echovirus type 22 was also isolated from the stool of another patient who had aseptic meningitis without any neurological deficit. There was no evidence of poliovirus infection in any of these patients, most of whom were fully immunized. Of the four surviving cases with flaccid paralysis, three had residual weakness in their lower limbs and walked with an abnormal gait 3 years after the acute paralytic attack. This is the first report in the literature of acute flaccid paralysis associated with type 22 echovirus.

Acute Disease↗
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↗
PubMed2006

Facial paralysis.

Detailed knowledge of embryology, anatomy, and function of the facial nerve is essential in treating the devastating functional, aesthetic, and psychological sequelae of facial paralysis. Two basic factors influence the method of repair and the subsequent outcome of the effort to combat facial paralysis. First is the availability of a viable proximal nerve stump which can be used as the source for motor axons, and which is related to the level of the injury. Second is the duration of the paralysis, which will dictate the possibility of reinnervating the facial muscles. Early restoration of nerve continuity, and therefore reestablishment of the neuromuscular junction and preservation of the function of the facial muscles, lead to superior functional and aesthetic rehabilitation. Secondary reconstruction, after the establishment of atrophy of the motor endplates of the facial muscles, is possible with nerve grafts and microsurgical free functional muscle transfer. These techniques, although not perfect, greatly improve aesthetic balance and alleviate the functional and psychological implications of the paralysis.

Facial Nerve↗
PubMed2003

Wasp venom blocks central cholinergic synapses to induce transient paralysis in cockroach prey.

The parasitoid wasp Ampulex compressa induces a set of unique behavioral effects upon stinging its prey, the cockroach. It stings into the first thoracic segment inducing 2 to 3 min of transient flaccid paralysis of the front legs. This facilitates a second sting in the cockroach's head that induces 30 min of excessive grooming followed by a 2 to 5-week long lethargic state. In the present study, we examine the immediate effect of the first sting, which is a transient paralysis of the front legs. Using radiolabeled wasps, we demonstrate that the wasp injects its venom directly into the cockroach's first thoracic ganglion. The artificial injection of milked venom into a thoracic ganglion abolishes spontaneous and evoked responses of the motoneurons associated with leg movements. To investigate the physiological mechanism of action of the venom, we injected venom into the last abdominal ganglion of the cockroach, which houses a well-characterized cholinergic synapse. Injected venom abolishes both sensory-evoked and agonist-evoked postsynaptic potentials recorded in the postsynaptic neuron for 2 to 3 min without affecting action potential propagation. Thus, the venom blocking effect has a postsynaptic component that follows the same time course as the transient paralysis induced by the thoracic sting. Finally, injection of a nicotinic antagonist in the front thoracic ganglion induces paralysis of the front legs. We conclude that the transient paralytic effect of the thoracic sting can be mainly accounted for by the presence of a venom active component that induces a postsynaptic block of central cholinergic synaptic transmission.

Action Potentials↗
PubMed1989

Facial reinnervation after facial paralysis: is it ever too late?

Following Conley's work on facial nerve cross-over surgery in long-standing facial paralysis, we have reviewed five cases of paralysis of 2.5-7 years' duration. All had complete absence of electrical activity on preoperative EMG and ENG studies. In four of the five cases the facial nerve was not severely atrophic and a "cross-over" technique was feasible. Post-operatively, the results were electrically and clinically good to excellent. To foresee the results of facial nerve cross-over surgery, we have found that the degree of atrophy of the affected nerve at the time of reconstructive surgery is a more important factor than the time lapse since the beginning of the paralysis. Those results also seem better in younger patients. Our findings suggest that hypoglossal-facial cross-overs be considered even 3 years after a paralysis, mostly in younger patients, when the nerve is not severely atrophic. In some cases this technique can be complemented by muscular transfers or selected cosmetic surgery.

Adult↗