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[Non-ischemic borderline brachial paralysis].

Non ischemic anterior borderzone brachial paralysis. Anterior borderzone brachial paralysis (ABBP) is a hemodynamic ischemic syndrome of the watershed zone between the anterior and middle cerebral arteries. Two cases of non ischemic reversible ABBP are reported. The first suffered from multiple sclerosis; a CT-scan showed a lesion of the corona radiata, at the level of the anterior hemispheric borderzone. The second suffered from lung adenocarcinoma. A CT-scan showed multiple metastases, one being surrounded with oedema at the level of the anterior borderzone. According to its reversibility, the ABBP was reported to the inflammatory-oedematous reaction and not to a demyelinating or metastatic lesion itself. As ABBP may occur unilaterally, the name "one-armed man syndrome" should be used instead of "man-in-the-barrel syndrome" (which always implies a bilateral paralysis).

Adult↗

[Long-term follow-up of autogenous fat injection for unilateral vocal cord paralysis].

OBJECTIVE: To study the long-term results of autogenous fat injection for unilateral vocal cord paralysis. METHODS: Twenty cases with unilateral vocal cord paralysis were treated by autogenous fat injection into the thyroarytenoid muscle to achieve medialization. The patients were divided into 3 groups by hoarse degree before operation, all of them were followed more than 12 months with serial video laryngoscope and voice evaluation. The ratio between paralyzed vocal cord upper surface and that of the normal vocal cord were adopted as the measurement for the vocal cord volume changes before and after operation. RESULTS: 1. The volume of paralyzed vocal cord was increased. The degree of hoarse and normalized noise energy (NNE) were evaluated by objective methods after operation. 2. The hoarse symptom was less severe after operation than that before operation. The cure cases 3 to 6 months and over 12 months after operation were nearly the same. 3. NNE of over 12 months and 3 to 6 months after operation were not significantly different, but the postoperative NNE were different with that before operation. CONCLUSIONS: Autologous fat injection was an effective method for treating unilateral vocal cord paralysis, and the long term effects were reliable.

Adipose Tissue↗

Functional profile in patients with facial paralysis treated in a myofunctional approach.

BACKGROUND: Clinical rehabilitation of peripheral facial paralysis (PFP). AIM: To delineate the contributions of myofunctional exercises during the flaccid phase of the disorder, before any sequelae. METHOD: 147 promptuaries of patients with facial paralysis were analyzed and divided in two groups according to the period in which rehabilitation began. For the analysis of development, the classifications proposed by House and Brackmann (1985) and Ross et al. (1994) were used. RESULTS: According to the classification of House and Brackmann (1985), all of the individuals who had sequelae reached level III. However, it was observed that even in cases of severe nerve lesion, cases in which the sequelae were non-acceptable, patients who started treatment at an early stage, revealed a better functional result when evaluated according to the classification of Ross et al. (1994). CONCLUSION: The myofunctional approach demonstrated to be an effective method for the functional reestablishment in cases of facial paralysis.

Age of Onset↗

Varicella zoster virus: beyond facial paralysis.

J. Ramsay Hunt's hypothesis that herpes zoster oticus results from a reactivation of the herpes zoster virus in the geniculate ganglion, has been supported by the demonstration of varicella zoster viral DNA in the geniculate ganglion of the side with facial paralysis in patients with Ramsay Hunt syndrome, with the use of the polymerase chain reaction. Similarly, DNA of the varicella zoster virus has been identified in the spiral and vestibular ganglion as well. We report on three patients with cochleovestibular symptoms as the first manifestations of Ramsay Hunt syndrome. A 64-year old woman and a 72-year old man presented with vertigo and an auricular herpetiform eruption. Only the woman developed later on a mild facial paralysis. A 58-year old man presented with an acute cochleovestibular syndrome, serologically proven to be a varicella zoster viral reactivation, which was followed three weeks later by the typical cutaneous recrudescence. We believe that these cases result from reactivation of latent varicella zoster virus in the spiral and/or vestibular ganglion. As the varicella zoster virus is dormant in the non-neuronal satellite cells, the facial symptoms in our patients as well as the high incidence of cochleovestibular symptoms in classical Ramsay Hunt syndrome can be explained by viral transmission across the nerves inside the internal auditory canal. Therefore, we think there are grounds to recommend a prompt treatment with an antiviral and a corticosteroid agent, not only in case of an acute facial paralysis but also when confronted with an acute cochleovestibular syndrome.

Acyclovir↗

[Endoscopic extralaryngeal approach subtotal arytenoidectomy in the treatment of bilateral vocal cord paralysis].

OBJECTIVE: To evaluate endoscopic extralaryngeal approach subtotal arytenoidectomy for the treatment of bilateral vocal cord paralysis. METHOD: Thirteen cases of bilateral median vocal cord paralysis was operated by endoscopic extralaryngeal approach unilateral subtotal arytenoidectomy. All of them had tracheostomy before. The airway was modified about 5-6 mm via endoscopic in operating. The airway was evaluated by fibro laryngoscopy, and the voice quality was assessed subjectively by the patients and the surgeon before and after surgery. RESULT: All cases were followed-up 6-36 months. The function of airway successfully restored, and the voice quality was kept satisfactory. All patients were decannulated after 8 to 15 days within the mean time 11.5 days post-operation. There were no granulation and no aspiration at the surgical site post operateally. CONCLUSION: The operation of extralaryngeal approach unilateral subtotal arytenoidectomy in endoscopy is a better restoration of airway with satisfying voice and without aspiration after operation. The procedure is simple, reliable and efficient for treatment of patients with bilateral median vocal cord paralysis.

Aged↗

Facial paralysis caused by metastasis of breast carcinoma to the temporal bone.

Metastatic tumors to the temporal bone are very rare. The most common sites of origin of temporal bone metastases are breast, lung, kidney, gastrointestinal tract, larynx, prostate gland, and thyroid gland. The pathogenesis of spread to the temporal bone is most commonly by the hematogenous route. The common otologic symptoms that manifest with facial nerve paralysis are often thought to be due to a mastoid infection. Here is a report on a case of breast carcinoma presenting with otalgia, otorrhea, and facial paralysis for 2 months. The patient was initially diagnosed as mastoiditis, and later the clinical impression was revised to metastatic breast carcinoma to temporal bone, based on the pathologic findings. Metastatic disease should be considered as a possible etiology in patients with a clinical history of malignant neoplasms presenting with common otologic or vestibular symptoms, especially with facial nerve paralysis.

Aged↗

[Bilateral recurrent laryngeal nerve paralysis in a child following a neurosurgical operation].

We experienced a case of 7-year-old boy who developed bilateral recurrent laryngeal nerve paralysis following an elective neurosurgical operation under oxygen-nitrous oxide-isoflurane anesthesia. He underwent a removal of brain tumor in the supratentorial region on supine position. After the removal of the endotracheal tube in the intensive care unit, he developed marked respiratory effort and inspiratory stridor. A diagnosis of bilateral recurrent laryngeal nerve paralysis was made by a direct diagnostic laryngoscopy. The patient needed continuous care for his airway patency with tracheotomy tube in place, and his normal vocal cord mobility recovered on the 23 rd postoperative day. Common cause of recurrent nerve injury following general anesthesia is either the procedure of endotracheal intubation itself or trauma due to surgical manipulation. In the present case, an endotracheal tube, a transesophageal stethoscope and a nasogastric tube inserted into the narrow laryngeal space might have been a cause of this complication. Moreover, accidental extreme flexion of his neck which occurred during the surgery might also be an additional cause. This case suggests that recurrent laryngeal nerve paralysis due to anesthetic instruments around the larynx is a possible cause of complications during general anesthesia in pediatric patients.

Anesthesia, General↗

[The restoration of chronic facial paralysis with a modified technique of sternocleidomastoid muscle transposition].

OBJECTIVE: To evaluate a modified technique of sternocleidomastoid muscle transposition for the dynamic reanimation of the chronic facial paralysis. METHODS: Both of the sternal and cleidus extremities of the sternocleidomastoid muscle were elevated from their bony attachment. The mastoid extremity was left in the place as a pedicle for the blood supply. The muscle stripes were then transposed into the face through the tunnel under the skin and the ends were sutured to the opposite orbicularis oris muscle of the upper and lower lips to correct the deformity of the mouth and nose. RESULTS: Forty-four patients with the chronic facial paralysis had successfully been treated by using the above-mentioned technique. The static asymmetry of mouth corner and the independent oral activity of the paralyzed side were corrected without any failure. With the follow-ups up to 3 years, the results were satisfied. CONCLUSIONS: The chronic facial paralysis with the deformity of the mouth and nose could be corrected with the sternocleidomastoid muscle transposition technique. A part expression of the mouth could also be achieved.

Adolescent↗

[Posterior interosseous nerve paralysis after overexertion. A case report].

Entrapment neuropathies in the upper extremity are common. Spontaneous paralysis of the posterior intersosseous nerve may occur by compression at the arcade of Frohse, where the nerve enters the plane between the superficial and deep muscle bellies of the supinator. Benign soft tissue tumors, minor trauma, and local inflammation have led to paralysis of the posterior interosseous nerve in several cases. An additional report on paralysis of this nerve a few days after overexertion with later spontaneous recovery is presented.

Adult↗

[Clinical observation on double moxibustion at Yifeng (TE 17) combined with electroacupuncture for treatment of facial paralysis].

OBJECTIVE: To compare clinical therapeutic effects of double moxibustion at Yifeng (TE 17) combined with electroacupuncture. and simple electroacupuncture on facial paralysis. METHODS: Eighty-seven cases of facial paralysis were randomly divided into a treatment group (n = 47) treated by double moxibustion at Yifeng (TE 17) combined with electroacupuncture, and a control group (n = 40) treated by simple electroacupuncture. Their therapeutic effects were investigated after 30 days. RESULTS: The total effective rate was 100.0% in treatment group and 87.5% in the control group with a significant difference between the two groups (P < 0.05). CONCLUSION: Double moxibustion at Yifeng (TE 17) combined with electroacupuncture in clinical therapeutic effect on peripheral facial paralysis is superior to simple electroacupuncture.

Acupuncture Points↗

[Observation on therapeutic effect of abdominal acupuncture on spastic paralysis after cerebrovascular disorder].

OBJECTIVE: To observe clinical therapeutic effect of abdominal acupuncture on spastic paralysis after cerebrovascular disorder. METHODS: Sixty cases of spastic paralysis after cerebrovascular disorder were randomly divided into an abdominal acupuncture group and a body acupuncture group, 30 cases in each group. They all were treated for 5 times each week, for a 3 consecutive weeks, and then the therapeutic effects were observed. RESULTS: The spasm in the abdominal acupuncture group improved significantly, but in the body acupuncture group did not significantly improve. The therapeutic effect in the abdominal acupuncture group was significantly better than that in the body acupuncture group. CONCLUSION: Abdominal acupuncture is a safe and effective therapy for spastic paralysis after cerebrovascular disorder.

Abdomen↗

[The value of laryngeal electromyography in the prognosis of vocal cord paralysis].

OBJECTIVES: We investigated the value of laryngeal electromyography (EMG) in monitoring patients with vocal cord paralysis. PATIENTS AND METHODS: Cricothyroid and thyroarytenoid muscles of 40 patients (10 females, 30 males; mean age 32 years; range 18 to 61 years) with vocal cord paralysis were monitored with laryngeal electromyography. The patients were divided into two groups according to time to presentation after symptom onset, i.e. within 1-3 months (group 1; n=14), and after at least 12 months (group 2; n=26). Electromyography was repeated every three months in group 1, and in the third and sixth months in group 2. RESULTS: Initial EMG examinations showed polyphasic reinnervation potentials and partial axonal degeneration in 21 laryngeal nerves in group 1. Recovery was expected in these patients. Repeat EMGs revealed normal findings in 17 laryngeal nerves, yielding a prognostic estimation of 80.9% (17/21). In group 2, none of the patients demonstrated polyphasic potentials or motor unit potentials suggesting reinnervation on admission. The earliest and latest recoveries were observed in the fourth and eleventh months (mean 6.4 months) in group 1, respectively. However, group 2 patients were followed-up for at least 18 months after the onset of their symptoms and none manifested clinical and electrophysiologic improvement. CONCLUSION: Our data suggest that EMG is a useful technique in the estimation of prognosis of patients presenting in the early period of vocal cord paralysis.

Adolescent↗

Vocal cord paralysis in a fighter pilot.

We present in this case report the return to flying duty of a pilot with vocal cord paralysis secondary to removal of a thymoma. We discuss the importance of glottic function as it pertains to the unique aviation environment. We also discuss the anatomy and physiology of the glottis, the evaluation for vocal cord paralysis, and surgical approaches for paralyzed vocal cords. Although the incidence of recurrent laryngeal nerve paralysis is low in the military aviation community, it is important to recognize that its sequelae can be managed so that the aviator may return to flight duties.

Antineoplastic Combined Chemotherapy Protocols↗

[Analysis on therapeutic effects of different acupuncture times on peripheral facial paralysis].

OBJECTIVE: To observe clinical therapeutic effects of different acupuncture times on peripheral facial paralysis. METHODS: Forty-nine cases of peripheral facial paralysis were randomly divided into 2 groups, group A and B. The group A received acupuncture, once daily, and the group B twice each week. Their therapeutic effects were assessed after 3 courses. RESULTS: The acupuncture times were not direct proportion to the therapeutic effect (P<0.01), with no significant difference between the two groups in the cured rate (P>0.05). CONCLUSION: Acupuncture treatment can select twice each week for peripheral facial paralysis.

Acupuncture Points↗

[Clinical analysis of facial nerve decompression on the treatment of facial paralysis].

OBJECTIVE: To study the occasion and curative effect of facial nerve decompression on the treatment of facial paralysis. METHOD: Facial nerve decompression was applied to 57 cases of severe facial paralysis from 1997 -2004 in our hospital. They were divided into two groups: A group received treatment within two months and B group after two months. Their curative effects were compared and the chi2 test between groups was applied. RESULT: The clinical curative ratio of group A was significantly higher than that of group B (P < 0.05). CONCLUSION: To treat facial paralysis, the application of facial nerve decompression at early stage can improve the clinical curative ratio significantly.

Adolescent↗

[Thyrotoxic periodic paralysis: a case report].

Thyrotoxic periodic paralysis (TPP) is characterized by recurrent episodes of muscle weakness and hypokalemia associated with thyroid hyperactivity. Reported predominantly among individuals of Asian descent, TPP is a rare manifestation of hyperthyroidism in western populations. We describe a typical case of TPP in a 33-year-old portuguese male, who presented with acute tetraparesis associated with hypokalemia (K+ 2.6 mEq/L). The patient had a 8-week history of several episodes of paraparesis of variable intensity; these attacks were usually nocturnal, preceded by strenuous exercise and resolved spontaneously after a few hours. The presence of tachycardia, weight loss, and goiter led to the diagnosis of Graves's disease. The correction of the hyperthyroid function with metimazol and propranolol prevented further episodes of muscle weakness. Thyrotoxic periodic paralysis should be considered in the differential diagnosis of acute episodes of motor paralysis in young patients. The maintenance of a euthyroid status is an essential part of management as this prevents the paralytic episodes.

Adult↗

Herpes simplex virus in idiopathic facial paralysis (Bell palsy).

Sera from all 41 adult patients with idiopathic facil paralysis (Bell palsy) and 35 (85%) of 41 matched controls who had never had Bell palsy contained antibodies to herpes simplex virus (P smaller than.05). The frequency of antibodies to herpes zoster virus did not differ in patients and controls. A rise in antibody titer, indicating primary herpes simplex virus infection, was not found in these patients. That Bell palsy may be caused by reactivation of herpes simplex virus is suggested by (1) clinical, neurologic, laboratory, and immunologic similarities between idiopathic facial paralysis and known manifestations of reactivated herpes simplex virus infection, and (2) the known neurotropism of herpes simplex virus, including its presence in latent form in the trigeminal ganglia, and parallels with known facial paralysis due to varicella zoster virus, a closely related agent. The presence of antibodies to herpes simplex virus is the only common factor among the patients tested in this study.

Adenoviridae↗

Severe rapid-onset paralysis in a part-time soldier.

We report a case of severe rapid-onset paralysis in a 28- year-old previously healthy man, necessitating intubation and mechanical ventilation, after a presumed bite or sting. Despite no other systemic manifestations of envenoming, the paralysis rapidly responded to polyvalent snake antivenom. The rapidity and severity of clinical effects make this case most concerning. We outline a differential diagnosis of acute paralysis and comment on issues relating to the management of the envenomed patient.

Adult↗