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PubMed1983

Histological findings in arytenoid cartilages after long-lasting recurrent nerve paralysis.

The histological findings in 15 excised arytenoid cartilages are reported. In all the cases there was a long-term recurrent nerve paralysis without additional inflammatory disease. In one of the cases there was fibrous ankylosis of the crico-arytenoid joint. This is the first report made on the histological findings in the arytenoid cartilage in cases of paralysis. It is confirmed that there are differences in joint pathology between cases of immobility due to inflammatory conditions and those due to pure noninflammatory recurrent paralysis. The fixation caused by arthritis of the joint has a relatively poor prognosis after surgery while, if the fixation is due to recurrent nerve paralysis, the chances of recovery are good in long-term cases.

Adult↗

PubMed2006

Myasthenia gravis mimicking unilateral vocal fold paralysis at presentation.

OBJECTIVES: To demonstrate the importance of detailed clinical analysis in the differential diagnosis of unilateral vocal fold paralysis, and to provide an update on current knowledge and treatment of myasthenia gravis. CASE REPORT: A female patient presented with left unilateral vocal fold immobility. Diagnostic investigation revealed a 10 mm thyroid adenoma, but no other abnormality likely to cause unilateral vocal fold paralysis. Follow-up flexible endoscopy at three months showed laryngeal remobilisation with persistent left vocal fold bowing and vertical asymmetry of the vocal folds on phonation. Over the following months, voice quality varied between normal and breathy, with the breathy periods lasting from three days to one month. Laryngeal electromyography (EMG) showed a slight bilateral paradoxical activation of both posterior crico-arytenoid muscles on phonation. Magnetic resonance imaging of the brain and brainstem was normal. A diagnostic test for myasthenia gravis with intravenous edrophonium bromide (Tensilon) lead to an immediate improvement in voice quality. The patient was subsequently treated with pyridostigmine bromide, with complete resolution of dysphonia. CONCLUSIONS: Myasthenia gravis affecting the larynx may mimic unilateral vocal fold paresis or paralysis. A personal or family history of auto-immune disease, fluctuating symptoms, motor deficits in cranial nerve territories, and normal or subnormal laryngeal EMG results should lead the physician to reconsider a diagnosis of idiopathic unilateral vocal fold paralysis and to perform specific testing.

Adult↗

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↗

PubMed2000

Assessment of diaphragm paralysis with oesophageal electromyography and unilateral magnetic phrenic nerve stimulation.

The purpose of this study was to establish a sensitive and reliable method of diagnosing diaphragm paralysis by recording the diaphragm compound muscle action potential (CMAP) using a multipair oesophageal electrode and unilateral magnetic phrenic nerve stimulation. An oesophageal electrode catheter was designed containing six coils (1 cm wide and 3 cm apart), creating an array of four sequential electrode pairs. The oesophageal catheter was taped at the nose with the proximal electrode pair 40 cm from the nares. Eight patients with unilateral (n=5) or bilateral (n=3) diaphragm paralysis were studied. Five to seven phrenic nerve stimulations were performed at 80% of maximum magnetic stimulator output and the CMAPs were recorded simultaneously from the four pairs of electrodes. In the five patients with unilateral diaphragm paralysis, the CMAP amplitudes and latencies were 1.16+/-0.29 mV and 7.6+/-1.5 ms for functioning sides. No diaphragm CMAP could be detected when stimulating nonfunctioning phrenic nerves. This study shows that diaphragm paralysis can be reliably diagnosed by unilateral magnetic stimulation combined with a multipaired oesophageal electrode.

Adolescent↗

PubMed1993

Induction of relapsing paralysis in experimental autoimmune encephalomyelitis by bacterial superantigen.

The role of infection in the pathogenesis of clinical relapses that occur in most autoimmune diseases, including multiple sclerosis, remains to be established. Experimental autoimmune encephalomyelitis (EAE) serves as a model for multiple sclerosis, with episodes of relapsing paralysis. In certain strains of mice, T-lymphocytes expressing the V beta 8 T-cell receptor (TCR) engage the amino-terminal epitope Ac1-11 of myelin basic protein, leading to EAE. The bacterial superantigen staphylococcal enterotoxin B (SEB) activates V beta 8-expressing T cells. Here we show that after immunization with Ac1-11, or after transfer of encephalitogenic T-cell lines or clones reactive to Ac1-11, SEB induces exacerbation or relapses of paralytic disease in mice that are in clinical remission following an initial episode of paralysis, and triggers paralysis in mice with subclinical disease. Tumour necrosis factor has a critical role in the mechanism underlying SEB-induced exacerbation of disease, because anti-tumour necrosis factor antibody given in vivo delays the onset of paralysis triggered by SEB. On reactivation of autoaggressive cells through their T-cell receptor, superantigens may induce clinical relapses of autoimmune disease.

Amino Acid Sequence↗

PubMed1980

Unilateral diaphragmatic paralysis in spinal cord injury patients.

Since the inception of the Spinal Cord Injury Center of The Institute for Rehabilitation and Research in 1961, over 1600 spinal cord injury patients have been admitted. Of these patients, approximately 51 per cent or 821 are tetraplegics. A review of the medical records shows that 22 patients had unilateral diaphragmatic paralysis. All but one of these patients are male, and they range in age from 15 to 73 years of age at onset. All cases with unilateral diaphragmatic paralysis are reviewed as to side of paralysis, incidence of tracheotomy, initial vital capacity, final vital capacity, and estimation as to the duration of diaphragmatic paralysis.

Adolescent↗

PubMed1996

Epidemiology of spinal cord paralysis in Fiji: 1985-1994.

This descriptive analytical ten year (1985-1994) retrospective study assessed the pattern of spinal cord paralysis (SCP) in the Fiji Islands utilising medical rehabilitation hospital data. Fiji Islands is an archipelago of 300 islands in the south western Pacific with a multi-ethnic population of over three quarters of a million. Rehabilitation of all SCP is provided at the Medical Rehabilitation Unit (MRU). Data was collected from medical records of new SCP (n = 140) admitted to MRU and analysed with Epi Info 5 assessing associations between cause and other variables. The incidence of new SCP admitted to the MRU was 18.7/million/year. There were 75 (53.6%) traumatic and 65 (46.4%) non-traumatic SCP. The incidence varied according to gender and ethnicity with Fijian male being at the highest (41.85) risk. Amongst traumatic SCP, 38.7% were due to falls, 25.3% motor vehicle accidents, 20% sports, 8% shallow water dive and 4% each deep sea diving and others, whereas among non-traumatic SCP, 52.3% were due to unknown causes, 32.3% infections, 9.2% neoplasms and 6.2% others. The male/female ratio was 4:1. The 16-30 year age group accounted for 35% of SCP. 31% had tetraplegia and 52.1% had complete lesions. The subset of the sample who experienced traumatic SCP were more likely to be employed, aged between 16-30 years at the time of paralysis and to have complete tetraplegia. Those who experienced incomplete paraplegia were more likely to be unemployed, aged 46-60 years and educated to primary level at the time of paralysis. There was a high proportion of complete spinal lesion when compared with other studies. The incidence of secondary complications such as pressure sores and UTI was also found to be high when compared with other studies. The results support the view that young Fijian males are most prone to sustaining traumatic spinal cord paralysis, and that there is a high incidence of secondary preventable complications. The need for preventative measures and adequate rehabilitation are emphasised.

Adolescent↗

PubMed2004

Relevance of sleep paralysis and hypnic hallucinations to psychiatry.

OBJECTIVE: To describe a patient who presented with psychopathology in the wake of sleep paralysis and hypnopompic hallucinations, and to discuss the importance of these phenomena to psychiatric diagnoses. METHODS: Case report. RESULTS: A 25-year-old black South African woman developed paranoid beliefs and a sad and anxious mood in the wake of her first experience of sleep paralysis and hypnic hallucinations. She had no history of other sleep-related events. Reassurance, explanation of the physiological basis of her experience, and a short course of low-dose diazepam were provided. Her mood and sleep improved promptly and she no longer held paranoid beliefs. She did not experience further episodes of sleep paralysis or hypnic hallucinations and improvement was sustained at 6 months. CONCLUSIONS: It pays to probe for the core experiences or events that patients may be explaining by devising "delusions". Acute, nocturnal-onset, first-time psychopathology warrants inquiry for sleep paralysis and hypnic hallucinations. Sleep-related side-effects of psychotropic medications need to be studied more closely.

Adult↗

PubMed2001

Questionnaire relating to sleep paralysis.

A sleep survey was conducted on 8162 citizens. The cumulative experience rate of sleep paralysis was 39.6%. The initial occurrence of sleep paralysis peaked at age 16 years. In addition to being higher in young people than in older subjects, the incidence of sleep paralysis was also higher among women than among men, and was significantly higher among shift worker than non-shift worker, and among persons engaged in the nursing profession than those not engaged in the nursing profession. The experience rate of sleep paralysis demonstrated a strong correlation with the frequency of dreaming, the experience rate of nightmares, times and regularity of going to bed and waking up, and particularly with the degree of insomnia.

Adolescent↗

PubMed2003

Thyrotoxic, hypokalaemic periodic paralysis in Australasian men.

Abstract The present study describes the clinical and laboratory features of 11 patients with thyrotoxic, hypokalaemic periodic paralysis, presenting to five Melbourne teaching hospitals between 1991 and 2000. All 11 patients were Asian or Polynesian men aged 18-41 years, and most had experienced previous episodes of acute, unexplained paralysis. All cases resolved without significant morbidity. Thyrotoxic, hypokalaemic periodic paralysis is a potentially life-threatening and terrifying condition, which is often under-recognized and will present with increasing frequency in the community. The diagnosis should be considered in any Asian-Australian male presenting with sudden onset paralysis.

Adolescent↗

PubMed1998

[The value of sonography in the intensive care unit for the diagnosis of diaphragmatic paralysis].

PURPOSE: To assess the value of bedside sonography in the detection of diaphragmatic paralysis in patients in the intensive care unit. METHODS: In this study, 100 patients who were admitted to the intensive care unit after thoracic operations were evaluated. Sonography of each hemidiaphragm was performed with coronal scans at the mid-axillary line on both sides with the patient supine. Absent and paradoxical diaphragmatic movement was considered to be indicative of diaphragmatic paralysis. All patients underwent additional fluoroscopy within 5 days. RESULTS: In 13 patients (13%) sonography revealed diaphragmatic paralysis. All these results were confirmed with fluoroscopy resulting in a sensitivity and specificity for sonography of 100%. CONCLUSION: Bedside sonography of the diaphragm at the intensive care unit is a reliable tool for diagnosing diaphragmatic paralysis.

Adult↗

PubMed1994

[Applications of the "Speech Viewer II" in voice training in vocal cord paralysis].

Referring to traditional therapeutical concepts of vocal fold paralysis a microphone-controlled computer programme was used for voice treatment in 13 patients with unilateral vocal fold paralysis. 6 of these patients were female, 7 were male. The age ranged from 18 to 72 years (mean: 50 years). The etiology of the paralysis was distributed as follows: post strumectomy (4 cases), post operation of the aortic arch (3 cases), post mediastinoscopy (1 case), post operation of the cervical vertebrae (1 case). 2 cases are not decided yet, 2 are probably idiopathic. The vocal fold dysfunction lasted between 24 hours and 8 years before our first examination, less than 4 weeks in 11 cases. With 1 exception (intermediate) the vocal fold position was classified as paramedian. 8 patients suffered from left, and 5 patients from right vocal fold paralysis. The voice treatment took place with a microphone-controlled speech viewer including an audio capture and playback adapter. 7 of the 15 training modules of the computer programme were chosen to be useful for voice training. Those modules can be differentiated in physical-technical modules showing voice spectra or pitch scales and in object-related modules showing images such as landscapes, animals and others. These programme-specific modules (monitor exercises) were primarily built to train the following voice qualities separately: loudness, pitch, voicing, voice onset, fundamental frequency, sustained phonation etc. Modifying certain therapeutic instructions (see Tables 1 and 2) the monitor exercises were used to improve the coordination of different voice parameters, thus resembling physiological speech.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2002

Motor imagery during hypnotic arm paralysis in high and low hypnotizable subjects.

Previous research suggests that conversion disordered patients with hand/arm paralysis exhibit slowed reaction times for mental hand-rotation tasks that correspond to their affected arm when the tasks are explicitly instructed and not when they are implicitly cued. Because of the many similarities between hypnotic phenomena and conversion symptoms, the authors tested whether similar motor imagery impairment would occur among normal high hypnotizable subjects when paralysis is suggested. Nine high and 8 low hypnotizable subjects were administered an implicit and an explicit mental hand-rotation task during hypnotically suggested paralysis of the right arm. On the implicit task, there were no significant reaction time (RT) differences between highs and lows. On the explicit task, only highs showed a significantly larger RT increase per degree of rotation with the paralyzed arm, compared to the normal arm. These preliminary findings suggest that the motor imagery impairment observed in conversion paralysis can be induced in highs using hypnosis.

Adult↗

PubMed1992

Hypokalaemic paralysis in malnourished children.

Six malnourished children presenting with acute flaccid paralysis caused by hypokalaemia are described. Their ages ranged from 6 to 36 months. The extent of paralysis varied from neck flop to quadriparesis. Two cases had respiratory paralysis requiring ventilatory support for 48-72 hours. All were successfully treated with potassium supplementation. Hypokalaemia should be considered in the differential diagnosis of acute flaccid paralysis in malnourished children.

Acute Disease↗

PubMed2001

Endoscopic forehead lift for ptosis of the brow caused by facial paralysis.

Twelve patients with ptosis of the brow caused by facial nerve paralysis were treated by endoscopic forehead lift. Four had an isolated paralysis of the temporal branch of the facial nerve and in eight the entire facial nerve was affected. In two of these patients the facial paralysis was bilateral, caused by Finnish hereditary amyloidosis. A standard subperiosteal endoforehead approach was used and the forehead was fixed by biodegradable pins (n = 8), anchor screws (n = 3), or a suture to the posterior scalp (n = 1). The procedure was a success in 10 patients, and failed in two after initially good results. The endoscopic brow lift is a good method of treating ptosis of the brow caused by paralysis of the temporal branch of the facial nerve.

Adult↗

PubMed2001

Cancer of the prostate in myelopathy patients: lower risk with higher levels of paralysis.

PURPOSE: The prevalence of cancer of the prostate (CAP) among patients with myelopathy is lower among the more severely paralyzed. The objective of this study was to determine whether this phenomenon could be more precisely defined. METHODS: Men 50 years of age or older who were registered with the spinal cord injury (SCI) service of the Department of Veterans Affairs Medical Center (West Roxbury, Massachusetts) in 1989 were classified by level and grade of paralysis. Cases of CAP were identified by review of the hospital tumor registry and autopsies over the ensuing 11 years. The difference in the incidence of CAP between patients with high and low levels of paralysis was tested by comparison of proportions. RESULTS: Eight cases of CAP were found in 2594 patient-years of follow-up. CAP developed in 3 of 218 patients paralyzed at C2 to T10 and in 5 of 60 patients paralyzed at T11 to S2. Incidence rates were 0.15 versus 0.91 per 100 patient-years, respectively (P = .015). When patients with incomplete paralysis were excluded, the incidence rates were 0 and 2.1 per 100 patient-years for the higher and lower lesions, respectively (P < .001). CONCLUSION: The incidence of CAP is lower in myelopathy patients with higher levels of paralysis (T10 or above) than in those with lesions at T11 or below.

Age Factors↗

PubMed2003

Permanent paralysis at sites of dermal exposure to chlorpyrifos.

OBJECTIVE: Poisoning with organophosphate pesticides can cause sensory and motor neuropathy with permanent paralysis. Paralysis at the site of dermal exposure has not been reported. CASE REPORT: A 61-year-old carpenter sprayed a nest of termites with an insecticide containing chlorpyrifos without protective equipment and with direct contact of pesticide solution to hands, lower arms, feet, and lower legs, as well as inhalation of vapors from spraying. After 30 min he became ill with nausea, abdominal cramping, arm and leg weakness, bilateral shoulder pain, chest pain, and numbness in the left hand and arm. At a hospital, he was treated with atropine 1 mg IV and pralidoxime Cl 2 g IV There was 0/5 strength in the hands and wrists and 3/5 elsewhere, a left peritoneal palsy, and urinary retention. He was transferred to a tertiary care hospital where paralysis persisted. Electromyogram studies documented widespread peripheral neuropathy. With continued progression of neuropathy, pralidoxime was repeated on the third day. By day 12, motor strength improved except for the hands and left lower leg. Right interosseous muscle strength was 1/5 and left was 0/5. Right-hand grip was 2/5, and left-hand grip was 0/5. He was transferred to a rehabilitation center. He never regained use of his hands and was disabled from employment as a carpenter. There was a disturbed gait, with inability to clear his left foot with walking. Urinary retention persisted and required self-catherization. CONCLUSION: Dermal exposure of the hands and feet to chlorpyrifos was associated with atrophy and permanent paralysis of exposed areas. The importance of protective equipment is emphasized.

Atropine↗

PubMed1969

Regulation of antibody synthesis against Escherichia coli endotoxin. IV. Induction of paralysis in vitro by treating normal lymphoid cells with antigen.

Normal mouse lymphoid cells have been shown to become specifically paralyzed after in vitro exposure to high doses of detoxified endotoxin of Escherichia coli 055:B5. The immune status of the treated cells was tested after transfer to secondary irradiated hosts. Paralysis was shown to be initiated by events taking place in vitro, since the amount of antigen retained on the cells after the in vitro exposure was insufficient to induce paralysis in vivo. The induction of paralysis was dependent on the concentration of antigen added to the cells in vitro. Certain variables, such as time of exposure and temperature at exposure, influenced the ease by which the cells could be paralyzed. Cells pretreated with trypsin were not susceptible to induction of paralysis by the above procedure.

Animals↗