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PubMed2002

Thyrotoxic hypokalemic periodic paralysis in a Hispanic male.

We report a case of a Hispanic male presenting with acute onset of bilateral lower extremity weakness, without any antecedent viral or bacterial illness, dietary changes, infiltrative orbitopathy, diffuse goiter, infiltrative dermopathy, and family history of periodic paralysis, who was later found to have Graves' disease. This demonstrates a rare case of periodic paralysis as the initial presentation of hyperthyroidism. Thyrotoxic hypokalemic periodic paralysis is common in Asian and Hispanic individuals and uncommon in whites and African Americans.

Adult↗
PubMedDate not supplied

[Paralysis of cranial nerves as a form of presentation of dissection of the internal carotid artery].

INTRODUCTION: Dissection of the internal carotid artery (DIC) is a known cause of cerebral infarct, especially in young patients. The classical clinical syndrome consists of unilateral pain of the head or neck, homolateral oculo-sympathetic paresis and ischaemic symptoms of the cerebral hemisphere involved. Presentation as paralysis of cranial nerves is rare and occurs in less than 12% of cases. The neurological involvement seems to be due to compression caused by the increased diameter of the artery involved. CASE REPORTS: Two patients are reported with paralysis of the lower cranial nerves secondary to DIC. In the first case there was paralysis of the left cranial nerves IX, X, and XII which was diagnosed on angiography using computerized tomography with spiral acquisition. The second patient had clinical involvement of cranial nerves IX, X, XI and XII and magnetic resonance angiography showed the dissection. Both cases were confirmed after digital subtraction angiography. CONCLUSION: Diagnosis of DIC requires a high level of suspicion in cases with atypical onset. The use of new techniques of non invasive imaging diagnosis such as computerized tomography and magnetic resonance angiography permit effective diagnosis of this disorder.

Adult↗
PubMed2002

[Evaluation of ventilation parameters based on flow volume loop in patients with unilateral vocal cord paralysis].

The vocal cord paralysis as a multidisciplinary problem requires commitment of different medical specialities. The diagnostic difficulties and necessity of laryngoscopic evaluation in cases suspected of vocal cord paralysis were pointed out. The analysis of ventilation parameters (flow-volume loop) was presented. The significant usefulness of inspiratory parameters, especially in upper airway obstruction was emphasized. The most useful parameters and coefficients were shown. Based on another authors data the criteria of airway obstruction classification were presented. The flow volume loop was found as a uniquely suited to the examination of upper airway obstruction. According to this examinations the unilateral vocal cord paralysis was defined as a variable extrathoracic obstruction which does not influence ventilation significantly.

Adult↗
PubMed1999

[Effect of decompression or transplantation of the facial nerve on serious advanced facial paralysis].

OBJECTIVE: To investigate operative effect on serious advanced facial paralysis. METHOD: 28 cases (28 sides) with serious facial paralysis underwent decompression or transplantation of facial nerve. RESULT: After following up 0.5-2 years postoperatively, the total, most or partial and no recovery were 14 cases (50%), 12 cases (42%) and 2 cases (7.1%) respectively. CONCLUSION: The operation performed as early as possible can be an effective procedure for correcting serious advanced facial paralysis if conservative treatment could be confirmed to be helpless.

Adolescent↗
PubMed2002

[Ruby laser arytenoidectomy in the treatment of bilateral vocal cord paralysis].

OBJECTIVE: To explore endoscopic ruby-laser arytenoidectomy for the treatment of bilateral vocal cord paralysis. METHOD: Ten cases with bilateral vocal cord paralysis were operated, six were male and four were female, all of whom had Ruby laser arytenoidectomy with tracheostomy and anesthesia through intubiting ahead. RESULT: There are no complications. During the following three to thirteen months, all patients operated breathed well with no synecdochical scar formed in the throat and their pronounciation improved apparently. Their glottis are broadened more than 4 mm after operation. CONCLUSION: Ruby-laser arytenoidectomy is a practicable therapy to bilateral vocal cord paralysis.

Adolescent↗
PubMed2003

[Etiology and diagnostic methods in vocal cord paralysis].

INTRODUCTION: The etiology of vocal cord paralysis (VCP) is varied. There is lack of consensus regarding the choice of investigations to be used in the evaluation of VCP. The aim of this study was to establish the etiology, assess the diagnostic methods used in the evaluation, and outline an algorithm for future evaluation of unilateral vocal cord paralysis (UVCP). MATERIAL AND METHODS: Charts of all patients (n = 94) with the diagnostic code of VCP were reviewed, and reexaminations were performed of patients in whom no etiology was found after the initial symptoms. RESULTS: The etiology of UVCP was neoplasm in 34%, surgical trauma in 12%, and miscellaneous causes in 54%. The etiology of bilateral vocal cord paralysis (BVCP) was neoplasm in 24%, surgical trauma in 24%, and miscellaneous causes in 52%. The reexaminations did not reveal any cancer diseases in the patients concerned. The most effective diagnostic method was CT-scanning while the least effective was thyroid scanning. DISCUSSION: Because cancer is a common cause of VCP a thorough evaluation is necessary. For UVCP we recommend history and physical examination, X-ray of the chest, ultrasonography of the neck, and CT-scanning of the superior mediastinum. If these prove negative, panendoscopy should be performed. Workup of patients with idiopathic VCP should include examination, X-ray of the chest at 6-month intervals, and annual CT-scanning for two years.

Aged↗
PubMed2002

[A case of Crow-Fukase syndrome with respiratory failure due to bilateral diaphragmatic paralysis].

A 62-year-old man with well-controlled diabetes mellitus developed numbness of the bilateral feet and hands, followed by subacutely progressive weakness and amyotrophy of extremities. He became bed-ridden state, and dyspnea also appeared, so he was referred to our hospital. Physical examination revealed a lean man, with dark-reddish skin pigmentation, crabbed fingers, bilateral pretibial pitting edema, and bristles in extremities. Thoracoabdominal paradoxical respiration was observed and pulmonary vesicular sounds was decreased markedly in the both lungs. Laboratory data revealed hypoproteinemia, abnormalities of endocrine system, but M-protein was not detected. Serum vascular endothelial growth factor level was quite high. Chest radiography revealed elevation of the bilateral diaphragm, the % vital capacity (%VC) was 24%, and arterial blood gas analysis showed marked hypoxia with hypercapnia. These findings suggested that his respiratory failure was induced by bilateral diaphragmatic paralysis caused by bilateral phrenic nerve palsy due to Crow-Fukase syndrome. He became somnolent because of hypercapnic narcosis, so non-invasive positive pressure ventilation (NIPPV) was started. We treated him with intravenous immunoglobulin and oral corticosteroids therapies, and after these therapies, his symptoms were remarkably recovered and NIPPV became unnecessary soon. The most frequent causes of respiratory failure in Crow-Fukase syndrome are pleural effusion and pulmonary hypertension, and only two cases of this syndrome with respiratory failure caused by bilateral diaphragmatic paralysis were reported until now. When the patients with Crow-Fukase syndrome complain of dyspnea, we should take the diaphragmatic paralysis into consideration, which may be improved by appropriate therapies.

Humans↗
PubMed2002

[Thyrotoxicosis periodic hypokalemic paralysis].

Periodic hypokaliemic paralysis is an usual cause of severe hypokaliemia. Thyrotoxicosis periodic paralysis (TPP) is less common. Incidence is high in Asian people and rarely reported in caucasian people. We describe the case of a young caucasian male, with a TPP. Clinical symptoms of hypokaliemia are strong, when thyrotoxicosis symptoms appear only on blood tests. The clinical course is good with beta-blockers and antithyroid treatment. These treatments induce a total clinical and biological cure. In all the cases of hypokaliemic paralysis, even without symptom, an hyperthyroïdia must be searched for.

Adrenergic beta-Antagonists↗
PubMed1976

[CSF-evaluation in unilateral, bilateral and alternant facial paralysis (author's transl)].

Etiology of idiopathic facial paralysis remains mostly unknown because further investigations seem unnecessary being the only symptom. Differentiated evaluation of CSF however for cytological or proteinous abnormalities should be performed aside serological examinations. In 9 patients treated within 8 months in our hospital diagnosis could be made by these procedures. Inflammation, if cause of facial paralysis, can only call pleocytosis, if localised within or next to the leptomeninges; protein of CSF perhaps will increase, if local inflammation of the nerve is more distant to subarachnoid space. "Idiopathic facial paralysis" however will not exclude focal inflammation far from subarachnoid space. Surgical decompression should not be performed without previous examination of CSF in regard of it's uncertain success.

Adult↗
PubMed2002

[Reinnervation of the posterior cricoarytenoid muscle by the phrenic nerve for bilateral vocal cord paralysis in humans].

OBJECTIVE: To reestablish the respiratory abduction of the paralyzed vocal cord through reinnervation of the posterior cricoarytenoid(PCA) muscle by the phrenic nerve in humans. METHODS: In six cases with bilateral recurrent laryngeal nerve paralysis, the phrenic nerve was anastomosed to the anterior branch of recurrent laryngeal nerve, while the adductor branch of recurrent laryngeal nerve was severed and its proximal end was implanted into the PCA muscle belly in one side, for the other side nerve-muscle pedicle technique was used. All cases had been subjected to preoperative and postoperative video laryngoscopy, stroboscopy, electromyography, voice recording and acoustic analysis. RESULTS: Among the 6 patients, it is observed in five cases' phrenic nerve reinnervation side the inspiratory abducent motion evidently recovered, and the abducent range was from 3 to 5 mm, While only slight abductent motion or no motion could be recorded on the other side reinnervated with nerve-muscle pedicle technique, and the vocal cord excursion on this side was less than 1 mm in all cases. It is because the glottis is broad enough for the patients to have daily activities without short of breath, so all of them were decannulated postoperatively. The reinnervated PCA muscle by the phrenic nerve showed typical inspiratory high frequency discharge with 100-200 ms delay as compared with the other side, indicating the phrenic motoneuron pattern. No long-term diaphragmatic paralysis and lesion of respiratory function was found. All cases' voice was not weakened, and no aspiration occurred. CONCLUSION: The phrenic reinnervation is feasible clinically for treating vocal cord paralysis, and it is found to be more effective for restoring inspiratory abducent function than the nerve-muscle pedicle technique.

Adult↗
PubMed2003

Contact laser surgery in treatment of vocal fold paralysis.

Vocal fold paralysis is a pathological condition characterised by varying degrees of respiratory distress in relation to the degree of glottic stenosis. Dyspnoea may be present even when resting and may even require emergency tracheotomy. Frequently, the patient arrives for attention after the onset of exertional dyspnoea associated with a certain degree of dysphonia. The causes may be central or peripheral, more commonly iatrogenic following thyroid or tracheal surgery or secondary to injury. The aim of all surgical techniques used in the treatment of vocal fold paralysis is to restore a lumen sufficient to guarantee adequate breathing through the natural airway, without the patient having to permanently maintain the tracheotomy tube, while preserving acceptable phonatory quality. Between 1990 and 2001, at the Padua Hospital Unit of Endoscopic Airway Surgery, 48 patients (27 female, 21 male) were treated for respiratory distress secondary to vocal fold paralysis. At the beginning of this experience, 7 patients underwent arytenoidectomy with the Ossoff technique. In 34 cases, a modified Dennis-Kashima posterior cordectomy was performed. In 7 patients, since widening of the airway was necessary, cordectomy was extended to the false homolateral chord in 5 cases and to the arytenoid vocal process in another 2. In 9 patients, the operation was carried out with a Nd Yag (1064 nm) contact laser; the remaining 39 were treated with a GaArAl (810 nm) diode laser in use since 1995. Satisfactory results were obtained in all patients first treated by us and not already tracheotomised (35). In 23 cases (66%), results were considered "good" since no exertional dyspnoea occurred. In 12 patients (34%), the result was considered "sufficient" since there was no resting dyspnoea and normal everyday activity could be undertaken. Of the 13 patients already tracheotomised on arrival, 11 (85%) were decanulated on average 2 months after surgery. In conclusion, the present results show that endoscopic posterior cordectomy, performed by contact diode laser, gives reliable results, is rapid and simpler to perform than arytenoidectomy and guarantees a sufficient airway without impairing swallowing, while maintaining entirely acceptable voice quality.

Adult↗
PubMed2003

[Intravenous regional anesthesia in patients with hypokalemic periodic paralysis].

Hypokalemic periodic paralysis is a familial autosomal dominant trait. The paralytic attacks are precipitated by large carbohydrate-rich meals, cold, mental or surgical stress, infections, exercise, drugs, electrolytes and endocrine abnormalities. Death may occur from respiratory arrest, infections, aspiration or cardiac arrhythmias. Anesthesia and surgical procedures may induce an attack and complicate the perioperative patient condition. Guidelines for anesthetic management should include preventive measures i.e. reduce mental stress and carbohydrate intake and correction of electrolytes and endocrine abnormalities. During the operation, measures should include prevention of cold and monitoring of muscle relaxants and ECG. When paralysis is diagnosed, slow (50 mEq/hr) i.v. infusion of potassium is suggested, while monitoring plasma levels of potassium ECG, and facial nerve conduction. We present two patients with hypokalemic periodic paralysis who underwent uneventful orthopedic procedures under i.v. regional block.

Adult↗
PubMed1975

[Objective measurements of airway resistance in recurrent nerve paralysis and hypotonic dysphonia].

Respiratory obstructions of the glottis may be reliably diagnosed at any time with a body plethysmograph used in pulmonary function testing. While respiratory resistance at 27.1 mm H2O/l and sec was only slightly increased in 35 patients with unilateral recurrent nerve paralysis and not even perceived by most of them, considerably increased resistance was found in 65 patients with bilateral paralysis. Critical lifeendangering obstructions of the respiratory system were not observed. Intra- and extralaryngeal lateral fixations of the vocal cord were carried out in 29 subjects. We observed unrestricted breathing and alveolar ventilation with respiratory resistance of 25 to 44 mm H2O/l and sec even under physical strain. Additional optimal phoniatric results and speech function is present in this range. 14 patients operated according to the endolaryngeal method of Thornell 1948 showed the best functional results. In cases of unilateral recurrent paralysis and hypotonic dysphonia we were able to measure the glottic resistance during phonation by using the modified interruption technique. The values were clearly subnormal at a median of 65 to 79 mm H2O/l and sec. In 43 cases treated with teflon injections a 50% increase of the airway resistance during phonation was observed. These findings correlate with the positive subjective experiences of the patients.

Adult↗
PubMed1957

Poliomyelitis; effect of Salk vaccine on severity of paralysis.

The severity of paralysis in 642 nonvaccinated patients with poliomyelitis and in 93 vaccinated patients was observed at the Los Angeles County General Hospital in 1956. In the vaccinated group of patients the proportion of nonparalytic and mild paralytic cases was consistently greater in each 5-year age group under age 15 than in the nonvaccinated. In the entire 0 to 14 age bracket, 12 per cent of the vaccinated patients had moderate or marked degrees of paralysis as compared to nearly 50 per cent of the nonvaccinated cases. There were too few vaccinated patients for comparison over this age. In the vaccinated group as a whole there was no apparent difference in severity as between patients who had had one inoculation and those who had had two. Among the small number of vaccinated patients under age 5, however, there was a suggestive decrease in severity between patients with one and with two inoculations. In nonvaccinated patients, the disease tended to be most severe in the 0 to 4 age group and young adults, ages 20 to 35. The largest number of deaths and of cases in which a respirator was needed occurred among young adults. None of the vaccinated patients died or needed a respirator, but tracheotomy was necessary for three. The concentration of mild cases in the vaccinated group is believed to indicate that partial protection was conferred by the vaccine, resulting in a shift to lesser degrees of severity. Such a shift would obscure the conversion of nonparalytic cases to inapparent infections. Convalescent follow-up examinations of 62 vaccinated and 68 nonvaccinated patients mostly in the 5 to 9 age group, revealed that in both series of patients approximately 90 per cent of the muscle groups graded as having "slight paralysis" at the time of discharge, were nonparalytic on the later examination.

Adult↗
PubMed1992

Facial nerve paralysis secondary to chronic otitis media without cholesteatoma.

Numerous papers have been written on facial nerve paralysis caused by chronic suppurative otitis media. However the authors found none documenting the results of therapy in a series of patients in whom facial nerve dysfunction was caused by chronic otitis media without cholesteatoma. Thus, there is little factual information available to help select a specific therapeutic plan for such cases. Over the past decade, the senior author has managed five cases (6 ears) of chronic suppurative otitis media without cholesteatoma in which facial paresis (4 ears) or paralysis (2 ears) developed 10 days or less before surgery. The chronic otitis media involved the mastoid and middle ear in five cases; and the mastoid, middle ear, and petrous apex in one case. Modified radical mastoidectomy was performed in four ears, tympanomastoidectomy with facial recess exposure in one ear, and complete mastoidectomy with middle cranial fossa petrous apicectomy in one ear. Five patients had complete recovery of facial nerve function (House grade I), and one patient had 90 percent recovery (House grade II). The results provide support for semi-emergent surgery in the management of chronic suppurative otitis media when facial nerve paralysis supervenes.

Adolescent↗
PubMed1992

[Recurrence paralysis: computed tomographic analysis of intrathoracic findings].

The long and singular course of the inferior (recurrent) laryngeal nerve makes it very vulnerable to infiltration by tumors of various locations. In particular, mediastinal and pulmonary lesions must be considered in the case of left vocal chord palsy. Recurrent nerve paralysis caused by a tumor indicates advanced disease. We retrospectively reviewed the computed tomography (CT) findings in 29 patients with bronchogenic carcinoma or mediastinal tumors and recurrent nerve paralysis with respect to the site, size and extent of the tumor and the lymph node status. The review revealed a marked predominance of left upper lobe tumors with extensive lymph node metastases to the anterior mediastinum and the aortopulmonary window. The extent of mediastinal involvement exceeded the average involvement in a control group of 30 randomly selected patients with bronchogenic carcinoma at the time of presentation. In all patients CT demonstrated tumor tissue which could have caused the paralysis at one or more sites along the anatomical course of the recurrent nerve. In most cases the tumor was located at the aortic arch. The left paratracheal region, right paratracheal region and right pulmonary apex were affected in one case each. We conclude that in patients with cancer, CT is a suitable method for localizing a recurrent nerve lesion.

Carcinoma, Bronchogenic↗
PubMed2003

[Modified type I thyroplasty for treating unilateral vocal cord paralysis].

OBJECTIVE: To explore a new surgical approach for treating unilateral vocal cord paralysis. METHODS: Five cases of unilateral vocal cord paralysis due to various causes were treated with modified type I thyroplasty. Laryngostroboscopy and electroglottography were performed before and after the operations. RESULTS: The vocal cords were shifted very close to the median line in all the 5 cases postoperatively as shown by laryngostroboscopy and electroglottography. Complete closure of the glottis was achieved. The patients had almost normal results of electroglottography, and the vocal sound nearly recovered normal or was significantly improved. CONCLUSION: Modified type I thyroplasty is effective, safe and easy in treating unilateral vocal cord paralysis.

Adult↗
PubMedDate not supplied

Enhancement by cimetidine of neuromuscular paralysis induced with atracurium in rats.

The neuromuscular action of cimetidine, the prototype of H2 antagonists, was examined in urethane-anaesthetized and mechanically ventilated rats that were paralyzed with the non-depolarizing agent atracurium. Cimetidine, administered i.v. at doses of 3.2 to 56.2 mg/kg (13 to 223 microM/kg), produced an immediate potentiation of a steady 50% atracurium paralysis which was observed within 28 +/- 5 sec and which plateaued after 24 +/- 3 min. The dose of cimetidine that produced a 50% potentiation during peak effect was 14.5 mg/kg (58 microM/kg) and was associated with a serum cimetidine concentration of 47.5 micrograms/ml (or 188 microM). In a separate experiment, cimetidine, administered i.v. in a dose of 56.2 mg/kg (223 microM/kg), shifted the atracurium dose-effect curve to the left by 1.32-fold. Cimetidine alone, at either 10 or 100 mg/kg, did not affect the neuromuscular function by itself. These results suggest that high doses of cimetidine potentiate the neuromuscular paralysis induced with atracurium. This effect is opposite to that noted previously with ranitidine, a newer H2 antagonist which reverses atracurium neuromuscular paralysis in rats.

Animals↗