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PubMed2005

West Nile virus-associated flaccid paralysis.

The causes and frequency of acute paralysis and respiratory failure with West Nile virus (WNV) infection are incompletely understood. During the summer and fall of 2003, we conducted a prospective, population-based study among residents of a 3-county area in Colorado, United States, with developing WNV-associated paralysis. Thirty-two patients with developing paralysis and acute WNV infection were identified. Causes included a poliomyelitislike syndrome in 27 (84%) patients and a Guillain-Barré-like syndrome in 4 (13%); 1 had brachial plexus involvement alone. The incidence of poliomyelitislike syndrome was 3.7/100,000. Twelve patients (38%), including 1 with Guillain-Barré-like syndrome, had acute respiratory failure that required endotracheal intubation. At 4 months, 3 patients with respiratory failure died, 2 remained intubated, 25 showed various degrees of improvement, and 2 were lost to followup. A poliomyelitislike syndrome likely involving spinal anterior horn cells is the most common mechanism of WNV-associated paralysis and is associated with significant short- and long-term illness and death.

Adolescent↗

PubMed1993

[Facial nerve paralysis induced by herpes simplex virus infection in mice].

The etiology of Bell's palsy remains unknown but clinical serological investigations have suggested herpes simplex virus (HSV) induced facial neuritis to be a potential cause. In order to verify the viral etiology of Bell's palsy it must be proved by animal experimentation. The author first succeeded in producing a transient facial paralysis of mice, with a herpes simplex viral neuritis simulating human Bell's palsy. Type 1 HSV (strain KOS, 4.5 X 10(6) pfu/ml) was inoculated into the posterior aspect of the auricle. Fifty-nine out of 104 mice (56.7%) developed facial paralysis, on the experimental side, 6 to 9 days after the inoculation. The facial paralysis continued for 3 to 7 days and resolved spontaneously. In 36.8% of the animals with facial palsy, HSV antigens were identified mainly in the geniculate ganglion cells, satellite cells, Schwann cells and nerve fibers of the involved side using immunohistochemical methods. No HSV antigen was demonstrated in the facial nerve of the contralateral side in animals with facial paralysis, bilateral facial nerves in animals without facial palsy or in control animals. Histopathologically, the involved nerve showed findings of viral neuritis such as round cell infiltration and vacuolar degeneration of nerve fibers. Inflammatory changes were noted in and around the geniculate ganglion but were more pronounced in nerve fibers proximal to the ganglion. These findings persisted for as long as a month after normal facial function had been restored.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed2003

Licorice consumption causing severe hypokalemic paralysis.

Hypokalemic paralysis due to licorice consumption is extremely rare, with only 40 cases in the English literature describing paralysis secondary to exposure to licorice in candies, medications, chewing tobacco, and herbal preparations. We describe a patient who suffered life-threatening hypokalemic paralysis caused by consumption of licorice in the form of a tea sweetener superimposed on long-term consumption of licorice candy. Aggressive fluid and potassium replenishment produced complete and lasting recovery. To our knowledge, this is the first report of hypokalemic paralysis due to exposure to licorice as a tea sweetener, a common custom among the Arab population. The case emphasizes the importance of considering patients' cultural backgrounds and local customs, which often may lead the treating physician to the correct clinical diagnosis.

Adult↗

PubMed1981

Prevalence of residual paralysis from paralytic poliomyelitis in a rural population of Bangladesh.

To estimate the prevalence of residual paralysis from poliomyelitis in children in one area of rural Bangladesh, a survey of the amount and original cause of lameness was undertaken. The International Center for Diarrhoeal Disease Research, Bangladesh Matlab field area, which has been under demographic surveillance for 13 years, provided the study population of 25,000 children aged 5--14 years. The cause of the lameness identified for a child in the survey was based on criteria obtained from a health history questionnaire and a physical examination performed by a physician. The prevalence rate for residual paralysis of poliomyelitis estimated from the lameness survey was 0.84/1,000 children aged 5--14 years. Since lower extremity paralysis occurs in only about 80% of children with paralytic poliomyelitis, the prevalence rate for all cases of residual paralysis of poliomyelitis was calculated to be 1.05/1,000 children in this age group.

Adolescent↗

PubMed1990

[Spinal paralysis caused by spinal metastasis of prostatic cancer].

From 1977 to 1986, in the Chiba University Hospital, 107 cases of prostatic cancer with bone metastasis were experienced. In 10 of them spinal paralysis caused by spinal metastasis of prostatic cancer was observed. Untreated five cases received endocrine therapy. One of them also underwent spine laminectomy and spinal instrumentation and regained the ability to walk. But the other cases treated by endocrine therapy showed only insufficient improvement of paralysis. Five cases with spinal paralysis which were resistant to endocrine therapy were treated by chemotherapy or radiation to the site of bone metastasis. One of them underwent laminectomy and spinal instrumentation. However, most cases showed no improvement of paralysis. It is concluded that spinal surgery is recommended in untreated cases for the sake of quality of life, but in cases with hormone resistance spinal surgery should cautiously be applied.

Aged↗

PubMed1999

Neurotologic evaluation of facial nerve paralysis caused by gunshot wounds.

Facial nerve injury is one of the most common neurotologic sequelae of a gunshot wound (GSW) to the head or neck. However, few neurotologic studies have been performed on the nature and time course of such facial nerve impairments. This study was designed to characterize the neurotologic manifestations and time course of facial nerve paralysis caused by GSWs to the head and neck. We conducted a battery of electrodiagnostic tests on 10 patients who had experienced traumatic facial paralysis due to a GSW to the head or neck. The etiologies of facial nerve paralysis--including direct injury, compression, fracture, and concussion of the temporal bone--were demonstrated by audiologic, radiologic, and surgical findings. Hearing loss and other cranial nerve injuries were also seen. Six of the 10 patients experienced a complete paralysis of the facial nerve and a poor recovery of its function. We also present a comprehensive case report on 1 patient as a means of discussing the evaluation of facial nerve function during the course of management.

Adult↗

PubMed1999

[Jugular bulb diverticular and facial paralysis].

The authors report a case where a woman presents a right jugular bulb procidence already known and responsible of a perception deafness. Secondarily, a right facial paralysis is appeared progressively and not regressive even with medical treatment. When the computed tomography as shown an intrapetrous diverticular, the facial paralysis treatment was surgical to decompress the facial nerve. The literature study shoes the rarity of this association facial paralysis and jugular bulb procidence (only two cases), more often responsible of deafness, tinnitus, and vertigo. The diagnosis is given by computed tomography. M.R.I. has not still be evaluated. Then the authors insist on the progressive character of the facial paralysis and on the necessity of a surgical treatment.

Adult↗

PubMedDate not supplied

[Thyrotoxic periodic paralysis. A report of 2 cases].

INTRODUCTION: Thyrotoxic hypokalemic periodic paralysis is characterized by recurrent episodes of motor weakness of variable intensity associated with thyroid overactivity. It is usually associated with low plasma potassium levels and is often precipitated by physical activity or ingestion of carbohydrates. CLINICAL CASES: We describe two men, aged 33 and 50, who complained of several episodes of muscular paralysis in the context of previously undiagnozed hyperthyroidism and associated with low plasma potassium levels. There were clearly raised levels of T3, T4 and free T4 and TSH was depressed due to hyperactive diffuse goitre. In one patient the precipitating factor was known to have been a large intake of carbohydrates and intense physical exercise. Antithyroid treatment, and the resulting correction of hyperthyroid function, prevented any further episodes of muscular weakness in both patients. CONCLUSIONS: Thyrotoxic periodic paralysis should be considered in the differential diagnosis of all acute episodes of motor paralysis in young patients. Determination of the plasma levels of potassium and thyroid hormones helps diagnosis. Early diagnosis is important so as to be able to establish antithyroid treatment and avoid further episodes of weakness.

Adult↗

PubMedDate not supplied

[Peripheral facial paralysis: etiology, diagnosis and treatment].

OBJECTIVE: Peripheral facial paralysis is one of the commonest mononeuropathies. The frequency of idiopathic peripheral paralysis or Bell's palsy varies between 62% and 93% of all cases, with an incidence of between 14 and 25 cases per 100,000 inhabitants per year. However, in spite of its relative frequency in the population, there is still no definite unanimously agreed strategy currently used by neurologists. Although its course is relatively benign, up to 16% of the patients show moderate or severe sequelae according to follow-up data in 1,011 untreated patients. In this article we review the aetiology, diagnostic methods and therapeutical strategies at the present time. DEVELOPMENT: The topographic diagnosis of the lesion is based on the symptoms associated with the paralysis. The neurophysiological studies (trigeminofacial reflection and electroneurogram), usually done after the first week are prognoses that permit differentiation of the degree of the lesion (neuropraxis, axonotmesis or neurotmesis). In spite of recent trials with combined therapy (acyclovir and steroids) the most generally accepted treatment at present is still prednisose at a dose of 1 mg/kg/day. CONCLUSIONS: Peripheral facial paralysis is a common condition, usually with no apparent cause and an eminently clinical diagnosis. The electrophysiological studies determine the prognosis. Currently the standard treatment is still oral prednisone.

Acyclovir↗

PubMed2001

Acute flaccid paralysis in infants and young children with enterovirus 71 infection: MR imaging findings and clinical correlates.

BACKGROUND AND PURPOSE: Enterovirus 71 (EV71) infection is now considered an important cause of childhood acute flaccid paralysis. The purpose of our study was to determine whether EV71-infection-related acute flaccid paralysis in infants and young children has characteristic MR imaging patterns. METHODS: Seven infants and young children with acute paralysis of the upper or lower extremities and positive EV71 cultures underwent spinal MR studies during an outbreak of hand-foot-and-mouth disease in Taiwan in 1998. RESULTS: Acute paralysis was observed in one upper extremity in two patients, in one lower extremity in three patients, and in both lower extremities in two patients. None of the patients had sensory impairment or bulbar palsy. MR studies showed unilateral or bilateral hyperintense lesions in the anterior horn regions of the cord on T2-weighted images in six patients. No abnormal signal was present in one patient. Two of three patients who received intravenous injections of contrast material had ventral root enhancement on T1-weighted images. One of them also had enhancement of the unilateral anterior horn cells. At clinical follow-up, both patients with bilateral anterior horn abnormalities had residual motor weakness, whereas only one of the five patients with unilateral involvement had residual weakness. CONCLUSION: EV71 radiculomyelitis tends to be unilateral and to specifically involve both the anterior horn cells of the cord and the ventral roots. MR imaging allows early detection of spinal cord and root lesions.

Acute Disease↗

PubMed1998

[Treatment of the unilateral paralysis of vocal fold--comparison between laryngeal framework surgery and reinnervation].

OBJECTIVE: To compare the effects of laryngeal framework surgery and reinnervation in the treatment of unilateral paralysis vocal fold. METHODS: Twenty-three cases of unilateral vocal fold paralysis were operated with laryngeal framework surgery and reinnervation and the voice assessment, acoustic analysis, laryngoscopy, electromyography were done pre- and postoperatively. RESULTS: The short and long term curative effects of the laryngeal framework were good, but with regard to long term result, the reinnervation that can recover the thickness, elasticity and tension of vocal fold was better, and the earlier was the operation done, the better would be the result. CONCLUSION: These two operations were both effective in the treatment of unilateral paralysis of vocal fold, but it should be selected according to the requirement of patient, the pattern of damage, the degree of paralysis and movement of cricoarythenoid joint.

Adult↗

PubMed2002

[Importance of tussometry in unilateral laryngeal paralysis].

Cough is a physiological gesture witch requires a perfect laryngeal competence. Tussometry was described as a reliable and reproducible method of analysis based on the measure of oral air flow rate during cough. This test allows to quantify the efficiency of laryngeal occlusion in normal situation and in case of unilateral laryngeal paralysis. The measure of the time lag between the beginning of the cough and the maximal air flow rate (peak value time) is the most reliable parameter (8). Present study is designed to asses the reproducibility of tussometry realized on a vocal analysis workstation EVA II and to test the efficiency of intracordal injection of autologus fat in case of unilateral laryngeal paralysis following thoracotomy. 10 control subjects were recorded at two moments. 6 patients presenting unilateral laryngeal paralysis following thoracic surgery were recorded before and after injection of autologus fat in the paralysed vocal cord. Reproducibility of tussometry is good (r = 0.96). The mean peak value time is significantly improved (p = 0.048). In conclusion, tussometry is a reliable routine test on EVA III workstation. Intracordal autologus fat injection improves occlusive function of larynx during cough in case of unilateral paralysis.

Adipose Tissue↗

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↗

PubMed2003

[Effects of L-nitroarginine on the recovery of traumatic facial paralysis].

OBJECTIVE: To study the effects of constitutive nitric oxide synthase inhibitor L-nitroarginine on the recovery of traumatic facial paralysis in rats and the changes of the expression of cNOS and OX42 in the facial nucleus. METHODS: L-nitroarginine was intraperitoneally injected into rats and the recovery of facial paralysis was observed at different time point. and the changes of cNOS and OX42 positive neurons were studied in facial nucleus. RESULTS: Treatment of L-nitroarginine could remarkably inhibit the recovery of traumatic facial paralysis. The cNOS immunoactivity was obvious inhibited in facial nucleus, while the OX42 immunoactivity was obvious increased. CONCLUSION: Endogenous nitric oxide may play an important mediator role on the recovery of traumatic facial paralysis.

Animals↗

PubMed2003

Vaccine-associated paralytic poliomyelitis and other diseases with acute flaccid paralysis syndrome in Belarus.

According to the WHO global polio eradication initiative acute flaccid paralysis (AFP) surveillance has been conducted in Belarus since 1996. For the period 1996-2002, 295AFP cases were reported. The main indices ofAFP surveillance in Belarus met the WHO criteria. A11 AFP cases, with the exception of one, were virologically examined. Polioviruses (PV) were isolated from 28 (9.5%) of them. Results of intratypic differentiation (a neutralization test with type-specific monoclonal antibodies and a restriction fragment length polymorphism assay) proved vaccine origin of all isolated PV. According to the final classification, 11 AFP cases were classified as vaccine-associated paralytic poliomyelitis (VAPP). Nine VAPP cases were recipient [six of them developed after the first, two--after the third and one--after the fourth oral poliovirus vaccine (OPV) dose] and two cases in non-vaccinated children were classified as contact VAPP cases. PV of all three serotypes were isolated with an equal frequency from the recipient cases and only PV2--from contact ones. Immunological investigations of children with VAPP showed that the majority of them had disorders in B-cell immunity. A risk of one VAPP case per 96,000 first OPV doses and per 745,000 distributed ones was estimated. The other 284 AFP cases were classified as AFP of non-polio etiology (non-polio AFP). Among them Guillain-Barré syndrome (118 cases, 41.5% of all non-polio AFP cases), traumatic neuritis (63 cases, 22.2%), transient monoparesis of limb (35 cases, 12.3%), myelitis (26 cases, 9.2%) were registered most frequently. Vaccine PV were isolated from 19 (6.7%) children with non-polio AFP, 28 (9.9%) children excreted non-polio enteric viruses. In contrast to VAPP, other AFP with PV isolation had no clinical picture typical of poliomyelitis, and had no any residual paralysis 60 days after the onset of paralysis. PV isolation from them seemed to be not related to the etiology of the disease, but was a mere coincidence of paralysis with the recent vaccination. Results of AFP surveillance supported the previous data on the absence of classical poliomyelitis cases caused by wild PV in Belarus for more than 35 years.

Adolescent↗

PubMedDate not supplied

Thyrotoxic hypokalemic periodic paralysis in a Native American patient: case report and literature review.

OBJECTIVE: To describe a rare case of thyrotoxic hypokalemic periodic paralysis in a half Native American and half African American person. METHODS: We present a case of a man of Native American descent with thyrotoxic periodic paralysis and review the pertinent literature. RESULTS: In a 53-year-old man with untreated hyperthyroidism, bilateral lower extremity weakness developed as a result of hypokalemia. Two months before admission, the patient had thyroid function test results that were consistent with hyperthyroidism. He also had undergone a thyroid radioiodine uptake study and scan, which demonstrated a diffuse 60% uptake in the thyroid at 24 hours. His symptoms resolved promptly after treatment with potassium, a 3-adrenergic blocking agent, and propylthiouracil. The pathophysiologic features of this disorder have not been entirely elucidated but most likely involve a sudden increase in intracellular shift of potassium and progressive depolarization of the resting membrane potential. Therapy consists of replacing the potassium and treating the cause. CONCLUSION: Thyrotoxic hypokalemic periodic paralysis, although rare in the Native American and African American population, should be considered in the differential diagnosis of hypokalemia and flaccid paralysis. Timely recognition and prompt treatment can reduce the risk of severe morbidity.

Adrenergic beta-Antagonists↗

PubMed2004

[Unilateral laryngeal paralysis].

Investigations, diagnosis and treatment of laryngeal paralysis depend upon history taking and examination of phonation, swallowing and of the pharyngo-larynx. In unilateral paralysis, the main symptom is dysphonia. Dysphagia lasting more than 10 days may indicate a proximal vagus nerve lesion. Voice and swallowing therapy may be undertaken. If this remains insufficient after one month, a temporary or definitive vocal fold medialisation may be considered. Paralysis is considered to be definitive if lasting for more than 12 months. A minimal of one-year follow-up is indicated in case of idiopathic paralysis.

Adult↗

PubMed2004

[Cause of unilateral vocal cord paralysis in aged (report of 51 cases)].

OBJECTIVE: To investigate the cause of unilateral vocal cord paralysis in aged. METHOD: Fifty-one patients with unilateral vocal cord paralysis in aged were retrospectively analyzed. RESULT: The main cause of unilateral vocal cord paralysis in aged was malignant tumor. CONCLUSION: Extralaryngeal malignant tumor should be greatly suspected in aged with unilateral vocal cord paralysis. When the cause could not be identified through systematic examination, the patient should be followed up regularly.

Aged↗