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PubMed1981

The effect of monocular paralysis on the lateral geniculate nucleus of the cat.

The proportions and some of the properties of X and Y cells in lateral geniculate nucleus (LGN) of adult cats were measured 14-16 days after monocular paralysis. The paralysis was produced by sectioning cranial nerves III, IV and VI. No difference from normal was observed in the proportions of X and Y cells either in the A layer driven by the paralyzed eye or in the A1 layer driven by the mobile eye. The distribution of latencies to chiasm stimulation and the average visual spatial resolution were within the normal range in both A and A1 layers. These experiments indicate that monocular paralysis in the adult cat does not affect the numbers of X and Y cells in the LGN. However, the averages of cell body size in layers A and A1 contralateral to the immobilized eye were roughly equal, whereas in the normal cat cells in layer A1 are larger than those in layer A.

Animals↗
PubMed1989

Effects of lanthanum on contractile inactivation and D600-induced paralysis in twitch muscle fibres of the frog.

The effects of the trivalent ion La upon force inactivation were investigated in voltage-clamped toe muscle fibres of the frog Rana temporaria. In the presence of La, the contracture plateau was remarkably lengthened and spontaneous relaxation which reflects force inactivation was reduced. Subsequent depolarizations led to a further decrease in the rate of relaxation, indicating that La slowed down force inactivation in a depolarization-dependent manner. Moreover, the development of paralysis in muscle fibres was also affected by La. In Ca-free solutions, paralysis was induced after a sequence of no more than three pulses to 0 mV; in the presence of D600 only one pulse was sufficient. Addition of La suppressed paralysis in Ca-free solutions and decelerated the action of D600. It is assumed that La alters the kinetics of force inactivation by binding to and replacing Ca at a site linked to a molecule in the T-tubular membrane which functions as voltage sensor in excitation-contraction (EC) coupling.

Animals↗
PubMed1994

Laryngeal electromyography with separated surface electrodes in patients with multiple system atrophy presenting with vocal cord paralysis.

When recording the activity of the posterior cricoarytenoid muscle (PCA) with surface electrodes, there is contamination from the surrounding muscles such as the cricopharyngeal muscle. We therefore devised a new oesophageal catheter electrode of the separate type, having three individual surface electrodes for the PCA, cricopharyngeal muscle and diaphragm. The records obtained with this catheter demonstrated satisfactory separation between PCA and cricopharyngeal muscle activities. We used this catheter in patients with multiple system atrophy presenting with vocal cord paralysis, who were awake or asleep. There were two interesting electromyographical findings, which were inspiratory activity of the adductor muscle (the thyroarytenoid muscle) and fade-out of the abductor muscle, that is, PCA activity during sleep. Although vocal cord paralysis is one of the most serious life-threatening complications, the precise mechanism has not been clarified. We believe that our catheter may be useful in investigating the mechanism of vocal cord paralysis which could cause sudden death in neurodegenerative disorders, including multiple system atrophy.

Aged↗
PubMed1984

Night shift paralysis.

12% of night nurses surveyed claimed to have suffered from a totally incapacitating paralysis that may be related to sleep paralysis, and contribute to impaired levels of safety on the night shift. The incidence of this paralysis is shown to be age-related, largely confined to the early hours of the morning, and to increase over consecutive night shifts.

Adult↗
PubMed1990

Vocal cord paralysis following carotid endarterectomy: the paradox of return of function.

In a series of 411 consecutive carotid endarterectomies 29 patients were identified with vocal cord paralysis. All patients were symptomatic, although in many these symptoms were subtle and rapidly resolved. There was a statistically significant predominance of left-sided paralysis. Excluding three patients who died during the initial year of follow-up return of normal voice was noted in 22 patients, but complete return of vocal cord function was present in only 15. Apposition of the contralateral vocal cord against a paralyzed vocal cord allowed for production of normal voice in five patients. Less than 1% of patients remained with symptoms at one year following endarterectomy. We conclude that vocal cord paralysis is a common complication of carotid endarterectomy; the voice becomes an unreliable guide as to its resolution. We recommend laryngoscopic examination of all patients who undergo bilateral carotid endarterectomy.

Carotid Artery Diseases↗
PubMed2004

Objective facial paralysis grading based on Pface and eigenflow.

To provide physicians with an objective and quantitative measurement of single-sided facial paralysis, the paper presents a computer-based approach that is different from the nine existing, subjective and hand-performed international scales, such as House-Brackman. For voluntary expressions of a patient, this approach used Pface, which stems from Dface, to measure the asymmetry between two sides of the face and used eigenflow to measure the expression variations between the patient and normal subjects. The results from Pface and eigenflow were then combined by the support vector machine produce to Pdegree. A study of 25 subjects revealed that Pdegree could differentiate paralysis states (Pdegree > or = 0) and normal states (Pdegree < 0), with the ability to grade facial paralysis automatically. Moreover, the Pface of specific facial areas can be used in the supervision of the rehabilitation process.

Adolescent↗
PubMed2005

Acute paralysis following "a bad potato": a case of botulism.

PURPOSE: Intensivists often encounter patients with respiratory failure as a result of neuromuscular disease, however, acute neuro-muscular syndromes are less common. We present a case of food borne Clostridium botulism and discuss the diagnostic and therapeutic considerations. CLINICAL FINDINGS: A 35-yr-old healthy male presented with abdominal pain and blurred vision 12 hr after ingesting a "bad" potato. During the next 17 hr, the patient demonstrated a gradual descending paralysis which ultimately resulted in no cranial nerve function and 0/5 strength in all extremities. Sensation was intact. The patient required intubation and mechanical ventilation. His blood count, biochemical profile, computerized tomography and magnetic resonance imaging of the head were normal. A lumbar puncture revealed no abnormalities. Due to the rapid deterioration and presentation of 'descending' paralysis, botulism was suspected. The patient was treated empirically with botulinum anti-toxin. Samples of blood, stool and gastric contents were cultured for the presence of Clostridium botulinum and its toxin and these tests were positive for botulinum toxin A 12 days later. The patient's neuromuscular function gradually improved over a prolonged period of time. Six and one-half months after his initial presentation, the patient was discharged home after completing an aggressive rehabilitation program. CONCLUSIONS: Botulism is a rare syndrome and presents as an acute, afebrile, descending paralysis beginning with the cranial nerves. If suspected, botulinum anti-toxin should be considered, particularly within the first 24 hr of onset of symptoms. Confirmation of the presence of botulinum requires days therefore the diagnosis and management rely on history and physical examination.

Acute Disease↗
PubMed1998

A thyrotropin-secreting pituitary adenoma as a cause of thyrotoxic periodic paralysis.

We describe a patient with thyrotoxic periodic paralysis (TPP) caused by a thyrotropin-secreting pituitary adenoma. The diagnosis TPP was based on the combination of episodes of reversible hypokalaemic paralysis, hyperthyroidism and electrophysiological findings. A thyrotropin-secreting pituitary adenoma was diagnosed on the basis of endocrinological function tests and MRI of the pituitary gland. Before transsphenoidal resection of the adenoma, treatment with octreotide restored euthyroidism both clinically and biochemically. Immunocytochemistry of the pituitary adenoma was positive for TSH exclusively. Incubation with octreotide or quinagolide induced decreased TSH and alpha-subunit production by the cultured adenoma cells, in agreement with the pre-operative in vivo data. This paper is the first to describe in vivo and in vitro characteristics of a thyrotropin-secreting pituitary adenoma in a patient presenting with periodic paralysis.

Adenoma↗
PubMed2001

[Bilateral recurrent laryngeal nerve paralysis].

This paper seeks to provide the reader with a state-of-the-art review of the aetiology, diagnosis and clinical management of bilateral recurrent nerve paralysis. The recurrent laryngeal nerves are more frequently involved in bilateral paralysis than any other cranial nerve. Most of the underlying lesions are iatrogenic, with thyroid surgery being the single most important causative factor. However, a variety of different reasons can lead to such a condition. Whenever the aetiology is uncertain, a complete diagnostic work-up is mandatory. Massive stridor on inspiration is the key symptom. Indirect laryngoscopy confirms the diagnosis. Laryngeal electromyography is of great value because it differentiates between paralysis and ankylosis of the cricoarytenoid joint. Moreover, in many cases, laryngeal electromyography yields reliable prognosis of clinical outcome. While unfavorable results can be predicted with high accuracy, correct prognosis of complete recovery is more difficult. Clinical management is surgical in the vast majority of cases. A variety of endoscopic techniques for widening the glottic airway are available today and are discussed in detail. Compared to permanent tracheostomy, these procedures have much less impact on the patient's quality of life and should be preferred whenever possible. Since such an operation is irreversible, a decision should be made only in the presence of a reliable electrophysiological prognosis and/or after 6-9 months of watchful waiting. Inevitably, voice quality is traded for airway normalisation. However, modern surgical techniques accomplish very tolerable phonatory results. Timing, type and extent of surgery need to be customised for every patient individually.

Humans↗
PubMed2001

[Ductus arteriosus apertus as the cause of recurrent nerve paralysis. A case report].

There are various reasons for paralysis of the vocal folds, which consequently imposes great demands on differential diagnostics. Angiocardiopathies are regarded as very rare cases of etiopathogenesis. In the present case, a persistent arterial duct could be identified as the reason for the paralysis of the left recurrent nerve of a 59-year-old female patient. The necessity of interdisciplinary diagnostics going beyond the field of otorhinolaryngology is emphasized, especially in cases of a paralysis of the recurrent nerve.

Diagnosis, Differential↗
PubMed2000

[Descending paralysis caused by wound botulism. A case report].

We report on the history and clinical findings of an injecting drug abuser in the Canton of Zurich who presented with multiple deep abscesses in the arms and legs. A diagnosis of wound botulism was made based on his clinical presentation with a rapidly progressing descending paralysis starting at the cranial nerves, a neuromuscular junction disorder on neurophysiologic testing, and normal findings on lumbar puncture. Several cases of wound botulism have occurred in i.v. drug abuse in Switzerland since 1997. We suspect subcutaneous injections of contaminated heroin containing Clostridium spores as sites of entry. Wound botulism caused by Clostridium botulinum is a rare cause of rapidly progressing, generalized, flaccid paralysis and should be considered in patients with a history of i.v. drug abuse presenting with descending paralysis.

Adult↗
PubMed2004

Nasal mask bilevel positive airway pressure ventilation for diaphragmatic paralysis after pediatric open-heart surgery.

A 2-year-old boy underwent surgical repair of tetralogy of Fallot. Topical cooling of the heart with ice slush was used during the operation. Diaphragmatic paralysis occurred after the operation, inducing severe respiratory distress. To avoid repeated intubation and tracheostomy, the patient was placed on nasal mask bilevel positive airway pressure (BiPAP) ventilation. After ventilatory support with BiPAP for 40 days, the patient recovered spontaneously from the paralysis. No sedation was required during this time. This report illustrates the usefulness of BiPAP for a pediatric patient with diaphragmatic paralysis after cardiac surgery.

Child, Preschool↗
PubMed2003

Unilateral phrenic nerve paralysis in a patient with Wegener's granulomatosis.

A 35-year-old male diagnosed with Wegener's granulomatosis (WG) in 1989 recently came to our hospital with the complaint of left lumbar pain. He was found to have left nephrolithiasis and left diaphragmatic elevation. Fluoroscopic study and electromyographic examination revealed findings compatible with unilateral phrenic paralysis. We could not detect any cause other than WG which could be responsible for the unilateral diaphragmatic paralysis. Although different types of lung involvement have been reported in WG, to our knowledge this is the first in which unilateral phrenic nerve paralysis and diaphragmatic elevation associated with WG have been diagnosed.

Adult↗
PubMed2003

Delayed onset of vocal cord paralysis after explantation of a vagus nerve stimulator in a child.

INTRODUCTION: Vagus nerve stimulation for the management of intractable seizure disorders is increasingly being used, especially in younger children. Although complications such as infection or vocal cord paralysis are uncommon, some may be unreported. CLINICAL PRESENTATION: A 3.5-year-old boy with intractable complex partial and generalized seizures had a left vagus nerve stimulator (VNS) successfully implanted. Two weeks later, the cervical incision showed signs of infection, antibiotics were started, and the VNS generator and leads were explanted. Three weeks later the child's mother noted a change in the voice of her son, as well as increased coughing and gagging. Flexible laryngoscopy identified a left vocal cord paralysis, which eventually resolved after 6 months. CONCLUSION: Infection requiring explantation of a VNS is uncommon. The risk is higher in younger children, especially in those who are developmentally delayed. These children may continuously drool, with saliva or food soiling the fresh incision, or even pick at the incision to the point of twisting or even pulling out the electrodes. Less common is a vocal cord paralysis, especially occurring in a delayed fashion.

Child, Preschool↗
PubMed2003

Paralysis of the femoral nerve following totally extraperitoneal laparascopic inguinal hernia repair.

Totally extraperitoneal preparation (TEP) of an inguinal hernia is an established method of treating inguinal hernias associated with an acceptable complication rate (2-12%) and low rate of recurrence (0-3%). This is the first reported case of sensorimotor paralysis of the femoral nerve following the complete endoscopic mesh treatment of a primary inguinal hernia to the left side. Following a discussion of the necessary diagnostic and therapeutic steps, traumatic postsurgical paralysis of the nerve as well as spontaneous paralysis of the femoral nerve are discussed. The prognosis is positive given the lack of macroscopic evidence of any direct damage to the nerve.

Femoral Neuropathy↗
PubMed1984

Bilateral diaphragmatic paralysis complicating local cardiac hypothermia during open heart surgery.

Filling the pericardial sac with ice and saline during open heart surgery protects the myocardium during periods of ischemic arrest. Bilateral diaphragmatic paralysis complicated intense local hypothermia in five patients undergoing coronary artery bypass surgery. All complained of severe orthopnea, exertional dyspnea, insomnia, and excessive daytime somnolence. All exhibited paradoxic inward movement of the abdominal wall with inspiration. The diagnosis of bilateral diaphragmatic paralysis was confirmed with upright and supine spirometry and, in one patient, with transdiaphragmatic pressure measurements. Although paralysis has resolved in four patients, all experienced months of disabling impairment. One patient required four months of mechanical ventilatory support prior to her recovery. Alternative methods of intraoperative myocardial preservation that avoid this complication should be developed.

Aged↗
PubMed1986

Thyrotoxic periodic paralysis.

A case of thyrotoxic periodic paralysis is reported in a Hispanic man with an unusual recurrence six weeks after radioactive iodine treatment. Thyrotoxic periodic paralysis has now been well characterized in the literature: it occurs primarily in Orientals with an overwhelming male preponderance and a higher association of specific HLA antigens. Clinical manifestations include onset after high carbohydrate ingestion or heavy exertion, with progressive symmetric weakness leading to flaccid paralysis of the extremities and other muscle groups, lasting several hours. If hypokalemia is present, potassium administration may help abort the attack. Although propranolol can be efficacious in preventing further episodes, the only definitive treatment is establishing a euthyroid state. The pathophysiology is still controversial, but reflects altered potassium and calcium dynamics as well as certain morphologic characteristics within the muscle unit itself.

Adult↗
PubMed1988

Associated norepinephrine loss following calcium-induced spinal paralysis.

A 10% calcium chloride solution or normal physiological saline was instilled onto the intact dorsal surface of the spinal cord via a specially constructed catheter-canopy system fixed above the T9 level in conscious rats. Within 5 min after calcium instillation rats developed flaccid paralysis of the lower limbs with sensory loss. Sensory loss was accompanied by abnormal or negative evoked potentials. Rats instilled with physiological or 10% sodium chloride remained normal. Rats were sacrificed at 1, 16 and 48 h post-calcium exposure and following full functional recovery from paralysis. Spinal cords were removed for histologic and high-performance liquid chromatography (HPLC) analysis. Histologic examination for catecholamines using SPG histofluorescence showed loss of catecholamine-containing varicosities in gray matter below calcium exposure which returned to normal levels upon sensorimotor recovery of hindlimbs about 14 days pce. Light microscopic examination of vascular permeability and general morphology of cord tissue axons and neurons remained normal in calcium and saline instilled rats. HPLC analysis of spinal cord below calcium exposure, also showed norepinephrine (NE) and 3-methoxy-4-hydroxyphenylglycol (MHPG) tissue level reductions which returned to normal upon sensorimotor recovery of paralysis about 2 weeks later. No significant changes were noted in dopamine or serotonin levels in any group. Our findings suggest an impairment of ascending and descending tract transmitter transport, specifically reflected in the noradrenergic bulbospinal pathway. The results implicate a neurofilament-microtubule disassembly in axonal cytoskeleton triggered by the sudden calcium influx.

Animals↗