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PubMed1982

Cholangiographic demonstration of relief of narcotic-induced spasm of the sphincter of Oddi.

Narcotics are known to cause spasm of the sphincter of Oddi. This spasm may be difficult to distinguish from obstruction of the distal common bile duct on operative cholangiograms in cases where narcotics are used perioperatively. A case is presented in which narcotic-induced spasm of the sphincter of Oddi, clearly demonstrated in an operative cholangiogram, is reversed by a narcotic antagonist, thereby avoiding an unnecessary common duct exploration.

Adult↗
PubMed1982

Effects of sleep on spontaneous activity in symptomatic diffuse esophageal spasm.

Diffuse esophageal spasm is a disease of unknown etiology in which neural or muscular control mechanisms malfunction, resulting in impaired and sometimes painful swallowing response, and inappropriate muscular contraction. An association between social stresses and disease activity suggesting elements of central control has been observed. In an effort to uncouple conscious central mechanisms from end organ response, we manometrically studied esophageal activity of four patients with symptomatic diffuse esophageal spasm while asleep (identified by electroencephalographic monitoring) as compared to wakeful states. We observed significant decreases from awake studies in number and duration of spontaneous contraction, during all sleep stages. We conclude that CNS mechanisms participate in the expression of the abnormal excitability of the esophagus in symptomatic diffuse esophageal spasm.

Adult↗
PubMed1982

[Arterial spasms of the limbs].

After rapidly reviewing the anatomy and the physiology of vasoconstrictive pathways and numbering predisposing factors involved in vasoconstrictive, the authors report different causes of peripheral arterial spasm. They particularly insist upon the causes of acute ischemia or the causes which may result on a long term in cutaneous sign of chronic ischemia. Arterial spasm due to arteriography itself is evoked. Studies are based on vascular radiographic opacification after arteriography: constituting a precise and easy technique, this allowing identification, localization as well as definition of the different images uncountered in arterial spasm. Arteriography is not mandatory for diagnostic evidence, but good technical conditions allow a precise view of the arterial status of the limbs taken as a whole, as well as a pathophysiological view of the mechanism involved in same vasomotor troubles. It may also reveal complications. In a great number of cases, indications for treatment can be adapted.

Extremities↗
PubMed1981

Incidence of choledochoduodenal sphincter spasm during fentanyl-supplemented anesthesia.

One hundred patients were studied prospectively to assess the incidence of spasm of the choledochoduodenal sphincter during biliary tract surgery performed under a fentanyl-supplemented anesthetic technique. The incidence of failure of passage of contrast medium into the duodenum was 3%. In each of the three patients with cholangiographic evidence of sphincter spasm, contrast medium flowed freely into the duodenum after the intravenous administration of 2 mg of glucagon. It is concluded that spasm of the choledochoduodenal sphincter is an uncommon occurrence during fentanyl-supplemented anesthesia and that this method of anesthesia is suitable for biliary tract surgery.

Ampulla of Vater↗
PubMed1980

Traumatic arterial spasm--rarity or nonentity.

Despite numerous opinions in literature questioning the existence of traumatic arterial spasm we believe that, although infrequent, the condition nevertheless occurs. A survey of the vascular literature on this subject appears to support this view. Spasm, when found, should be treated by resection of the arterial segment and its replacement with an appropriate graft unless spasm is relieved by vasodilation.

Adolescent↗
PubMed1980

Coronary artery spasm and perioperative cardiac arrest.

There has been increasing interest in coronary artery spasm as etiopathogenic mechanism for various syndromes associated with myocardial ischemia. A case with documented organic coronary artery disease is presented, in which coronary artery spasm was the probable cause of intraoperative and early postoperative cardiac arrest. We recommend that coronary spasm be considered in the differential diagnosis of perioperative cardiac arrest.

Angina Pectoris, Variant↗
PubMed1980

Microsurgical Vascular Decompression for Trigeminal Neuralgia and Hemifacial Spasm.

Vascular cross-compression of cranial nerves has been proposed as the cause of cranial neuropathies, including trigeminal neuralgia and hemifacial spasm. Over the last decade we have used microsurgical vascular decompression to treat these two disorders. Results in 50 patients treated for trigeminal neuralgia have been excellent in 42, good in 5 and poor in 2; and 1 patient was cured after a second operation. Results in 22 patients treated for hemifacial spasm have been excellent in 18, good in 2 and fair in 1. One patient died. There were no late recurrences of symptoms. The pathophysiological mechanisms of trigeminal neuralgia and hemifacial spasm remain unknown.

Adult↗
PubMed1995

[Hemifacial spasms. Causes, clinical findings and treatment].

Hemifacial spasm is a condition characterized by involuntary, episodic, synchronous contractions of muscles innervated by the facial nerve in one half of the face. The treatment can be medical or neurosurgical, but the most effective is injections of botulinum toxin. 13 patients who received this treatment for hemifacial spasm are described. The treatment of different forms of focal dystonias has been described before in this journal. The aetiology of hemifacial spasm is different from that of focal dystonia. It is probably due to compression of the facial nerve, causing ectopic generation of impulses. Treatment with botulinum toxin is shown to be effective also for this condition, but the dosage and the duration of effect differ from those reported for focal dystonias. This may be due to differences in the pathophysiological mechanisms of the two conditions.

Adult↗
PubMedDate not supplied

Microscopic cortical dysplasia in infantile spasms: evolution of white matter abnormalities.

PURPOSE: To determine whether microscopic cortical lamination defects in patients with infantile spasms, not initially identifiable on MR, may be inferred from evolving changes in the adjacent white matter. METHODS: Three infants between 3 and 6 months of age presented with infantile spasms. Based on negative metabolic assessment and normal MR findings, they were classified as cryptogenic. Despite therapy the children deteriorated with seizure recurrence and the advent of lateralizing clinical and neurophysiologic findings. MR studies were repeated and positron emission tomography was done. RESULTS: The second MR studies demonstrated abnormalities of myelination, corresponding to localized clinical and neurophysiologic findings. Positron emission tomography findings did not show a strong correlation; one was normal, one showed no abnormality in the major area of MR abnormality, and one showed significantly less abnormality than on MR. Two patients have undergone surgery, both with good response. DISCUSSION: Subtle lamination defects may be identifiable on positron emission tomography but are usually not detectable on MR. White matter abnormality on MR images is usually attributable to primary disease. We suggest that in certain cases progressive white matter changes may be induced as a secondary phenomenon by overlying microscopic cortical lamination defects. Serial MR imaging may be beneficial in children with infantile spasms in whom signs of laterality evolve.

Cerebral Cortex↗
PubMed1995

Unilateral porencephalic cyst presenting as infantile spasms: a case report.

Multiple etiological factors have been associated with infantile spasms (IS), and are usually linked to diffuse or multifocal brain damage. It is generally believed that infants with symptomatic IS have a significantly higher incidence of mental retardation and epilepsy than those with cryptogenic IS. However, IS secondary to focal brain lesions in which surgical removal of the lesions has resulted in cessation of generalized spasms and subsequent normal development are rarely reported. A seven-month-old male infant who manifested head nodding and generalized flexor spasms one month prior to the admission is reported. Waking interictal electroencephalography revealed a pattern of burst-suppression variant of hypsarrhythmia. Brain magnetic resonance imaging disclosed a huge porencephalic cyst over the left temporo-parietal region. The infant underwent craniotomy with corpus callosotomy, causing marked improvement in seizures. He attained subsequent stable psychomotor development.

Brain Diseases↗
PubMed1994

[Role of endoscopy and vascular decompression in the treatment of hemifacial spasm].

Although it has long been hypothesized that hemifacial spasm could arise from a conflict between the nerve and the artery, it is very difficult to distinguish between a normal arterial loop and a pathological conflict leading to facial symptoms. Several new elements would help in the definition of the cause and allow less traumatic treatment of idiopathic hemifacial spasm. They include magnetic resonance imagery with CISS sequences, limited retrosigmoid approach, endoscopy of the cerebellopontine angle and monitoring the facial nerve. In our experience with 20 cases, retrosigmoid approach with a combined surgical and endoscopic procedure has led to total involution of the spasms in 80% of the cases.

Adult↗
PubMed1994

Botulinum toxin A in blepharospasm and hemifacial spasm.

We report the first Indian experience of botulinum toxin A in the treatment of blepharospasm and hemifacial spasm. Sixteen patients, 7 with essential blepharospasm, 5 with Meige syndrome and 4 with hemifacial spasm received botulinum toxin A injection. One patient received 3 courses of injections, 2 received 2 courses and the rest received only one course. The effect was observed after a latent period of less than 48 hours in all patients and lasted for a mean of 16.65 weeks. More than 70% improvement occurred after 17/20 injections (85%). Poor response was more often seen when blepharospasm was associated with oromandibular dystonia (2/5 injections). Though the duration of response and subjective score of improvement was best in patients with hemifacial spasm, the numbers were very small for any statistical evaluation. The side effects were local, transient, mild and well tolerated. The commonest side effect was blepharoptosis.

Adult↗
PubMed1993

[Case of diffuse esophageal spasm treated by long myotomy].

Diffuse esophageal spasm is a rare condition, which has generally been treated conservatively in Japan. A case of this disorder treated successfully by long myotomy is reported with a knowledge of prolonged pressure monitoring of the esophagus. A 56-year-old woman was admitted to our hospital with dysphagia. Barium swallow and esophagoscopy showed contraction of the esophagus, and manometry showed normal peristalsis, so the diagnosis of achalasia was ruled out. Prolonged pressure monitoring of the esophagus showed spastic contractions with the pressure over 130 mmHg that continued for 25 sec during meals, which led us to the diagnosis of diffuse esophageal spasm. Extramucosal long myotomy of the esophagus and a modified Belsey Mark IV operation were performed. The postoperative course was satisfactory and esophageal functional tests showed no spasms. The patient regained weight without dysphagia.

Esophageal Spasm, Diffuse↗
PubMed1993

A comparative study of tear secretion in blepharospasm and hemifacial spasm patients treated with botulinum toxin.

In the neuro-ophthalmology clinic at St. Vincent's Hospital, Melbourne, 57 patients with blepharospasm and 50 patients with hemifacial spasm were treated with botulinum toxin. Schirmer tear tests were conducted on all the patients prior to each treatment and at 1 week following treatment where possible. The results were compared with a control group of 107 patients selected by age and sex. The blepharospasm patients were found to have a significantly lower tear secretion than that of the control group, using the Mann-Whitney test (median = 3.5 mm, compared with median-11.0 mm, p < .0001). This did not improve following treatment. The patients with hemifacial spasm did not have significantly different tear secretion from that of the control group (t = 1.0, p > .05). To investigate whether there was any relationship between the symptoms and the result of the Schirmer test, a survey was also conducted on the patients with blepharospasm and hemifacial spasm regarding symptoms, frequency, and type of drops/ointment used.

Aged↗
PubMedDate not supplied

Hemifacial spasm. Nerve block with phenol under electromyographic control.

Seven cases of hemifacial spasm are described. Six were operated upon with intra-osseal exposure of the facial nerve. In all 6 cases transient peripheral facial paresis developed. When the paresis disappeared the patients had a recurrence of the spasms. As an alternative to surgical procedures a method for selective nerve block under E. M. G. control with 3% phenol is described and 5 cases have been treated with this method. Ambulatory treatment with deposition of 3% phenol in the main branch of the facial nerve appears to have an equally good effect to the surgical methods hitherto used. Examination with E. M. G. suggested that the hemifacial spasm is of central origin.

Electromyography↗
PubMed1977

[Can the lifting of heavy weights provoke a spasm of ciliary muscles conducive in turn to retinal detachment?].

It was reported by Harms (discussion remark 62, DOG Heidelberg 1959, p. 234) that, during the lifting of a heavy weight, excessive accommodation occurs. If this is the case, the causing ciliary spasm could possibly be regarded as a predisposing factor in the pathogenesis of a retinal detachment. To obtain objective data whether there is an accommodative spasm under the above mentioned condition, the thickness of the lens of emmetropic young persons was measured by ultrasound. Three series of measurement were performed: (1) during accommodation; (2) during the lifting of a 25-kg-heavy weight without excluding the possibility of focusing nearer objects at the same time, and (3) during lifting of the same weight with the exclusion of any possibility of focusing nearer objects at the same time. According to the results of these experiments, there is only very little likelihood that the lifting of heavy weights could provoke a considerable ciliary spasm.

Accommodation, Ocular↗
PubMed1996

[Cerebellopontine angle epithelial cyst presenting as hemifacial spasm].

A rare case of cerebellopontine angle epithelial cyst presenting as hemifacial spasm is reported. The patient was a 35-year-old man with right hemifacial spasm of 2 months duration. A preoperative CT scan showed a well-demarcated low density area in the right cerebellopontine angle. The cyst was totally excised under an operating microscope. The postoperative course was uneventful, and the right hemifacial spasm resolved immediately. Histologically, the cyst wall was composed of a stratified epithelial lining composed of non-ciliated cuboidal or squamous cells. Ultrastructurally, the epithelial layer consisted of two types of cells: non-ciliated cells with microvilli coated with electron-dense material, and basally located cells with tonofilaments and well-developed desmosomes. The latter type of cells appear identical to the basal cells characteristically seen in the upper respiratory tract and the gastrointestinal tract. This findings suggest that the cyst was of endodermal origin rather than neuroectodermal origin.

Adult↗
PubMed1996

Completion arteriography in paramalleolar bypasses: effect of configurational changes, with special reference to spasm, on long-term outcome.

PURPOSE: The purpose of this study was to ascertain the durability of paramalleolar bypasses and elucidate the effect of configurational changes, especially spasm, seen on the completion arteriography upon the outcome. DESIGN: Retrospective study. SETTING: University hospital experience. PATIENTS AND METHODS: Nineteen paramalleolar bypass operations in sixteen patients performed between April 1988 and March 1995 were studied retrospectively. Reversed saphenous vein grafts were used in all cases. One patient required an additional microvascular free flap transfer to cover a foot amputation stump. Seventeen completion arteriograms were obtained. Patients were followed for an average of 37 months. RESULTS: One patient died in hospital, giving a hospital death rate of 5.9%. Two grafts failed immediately and could not be salvaged. Inadvertent perforation of one graft required partial replacement with a polytetrafluoroethylene graft; it eventually failed after 42 months. There were no other graft failures during follow-up. Nine completion arteriograms showed spastic change of the run-off artery, but this change had disappeared on repeat angiograms obtained before discharge. CONCLUSION: Spasm of run-off artery is a frequent finding in distal bypass surgery and adversely affects the immediate outcome. Heparinization during the first 24 hours after surgery may reduce the consequences of spasm, and long-term patency can be expected providing that the whole graft consists of autogenous vein.

Adult↗