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PubMed1986

Investigations into the paralysis-inducing ability of Rhipicephalus evertsi mimeticus and that of hybrids between this subspecies and Rhipicephalus evertsi evertsi.

Studies performed on sheep showed that Rhipicephalus evertsi mimeticus is a paralysis-competent tick species whose toxicity is either the same as, or only slightly less than that of R.e. evertsi. It was also proved that the paresis or paralysis induced by the mimeticus females is characterized by a constant incubation period which is independent of the tick infestation rate and body mass of the host, and consequently of its age. This period is entirely determined by the state of repletion of the ticks and is regulated by the date of mating. It was further proved that a precise relationship exists between an increase of engorgement or salivation activity and the intensity as well as the persistence of clinical symptoms. Thus only female ticks in the mass range of 15-21 mg are toxic. Strain-dependent differences could not be demonstrated. The infestation rates of subspecific hybrid female ticks, and of their descendants, that are necessary to produce the respective symptoms showed no differences in toxicity. When infestations were limited to a small skin area minimum paresis could frequently not be induced, even though the actual number of ticks applied was sufficient to cause lethal paralysis.

Animals↗

PubMed1985

Gait abnormalities in tibial nerve paralysis: a biomechanical study.

Gastrocnemius-soleus dysfunction is a frequent result of cauda equina lesions and peripheral neurophathies and of stroke and brain injury. Temporary tibial nerve paralysis constitutes a comparable laboratory condition which allows the controlled examination of aspects of these disabilities. The biomechanical effects of temporary tibial nerve paralysis in six normal young adult volunteers were examined to quantitatively define the gait abnormalities resulting from gastrocnemius-soleus paralysis and to provide a basis for the assessment of the effectiveness of different orthotic designs in restoring a normal gait pattern. The motion of the right lower extremity, ground reactive forces acting on the right lower extremity, timing of gait events and step length were recorded, first during normal ambulation and then during ambulation after a right tibial nerve block. Step length was reduced bilaterally after the nerve block (p less than 0.005); the reduction was greater for the left (unblocked) step than for the right (blocked) step (p less than 0.005). Right heeloff was delayed until the time of left heelstrike in all subjects after the right tibial block. Right heeloff occurred later (p less than 0.005) while left heelstrike occurred earlier than normal (p less than 0.005). The shorter left step length and earlier left heelstrike resulted from a reduction in the forward progression of the right hip (p less than 0.001). When subjects were deprived of the plantarflexion activity necessary to counteract dorsiflexion moments at the ankle, they delayed the forward progression of the center of pressure (p less than 0.001) to avoid the unstable collapse of the foot into dorsiflexion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1985

Facial paralysis and Bell's palsy: a protocol for differential diagnosis.

In the past, most cases of facial paralysis have been erroneously labeled Bell's palsy. Bell's palsy has been synonymous with and defined as idiopathic facial paralysis affecting only the facial nerve within the confines of the temporal bone. In the last ten years, Bell's palsy has been redefined as viral polyneuritis, probably caused by herpes simplex reactivation, and its diagnosis is no longer reached by exclusion. This article discusses the signs, symptoms, and testing necessary to confidently and accurately differentiate Bell's palsy from other forms of facial paralysis. The nonspecificity of topographic diagnosis is discussed and statistical analysis of factors affecting prognosis are included.

Cranial Nerve Diseases↗

PubMed1979

Postpartum hypokalemic paralysis.

An attack of hypokalemic paralysis occurring in a 23-year-old woman during the immediate postpartum period of her fourth pregnancy is described. A flaccid paralysis of her extremities and markedly diminished deep tendon reflexes developed 3 hours after delivery, at which time her serum potassium level was found to be 1.7 mEq/liter. Hypokalemic paralysis has not been previously reported as an immediate postpartum complication. The pathophysiology and management of this condition are discussed, as are the treatment and follow-up of this specific patient.

Adult↗

PubMed1979

Serratus anterior paralysis in the young athlete.

Ten cases of isolated, complete paralysis of the serratus anterior muscle were diagnosed in young athletes during a three-year period. One patient had recurrent partial paralysis of the serratus anterior muscle, the first such case reported. From studies on cadavera and clinical observations, we concluded that paralysis of the serratus anterior muscle results from a traction injury to the long thoracic nerve of Bell. Since full recovery usually occurs in an average of nine months, surgical methods of treatment should be reserved for patients in whom function fails to return after a two-year period. Non-strenuous use of the involved extremity with avoidance of the precipitating activity, followed by exercises designed to maintain the range of motion of the shoulder and to increase the strength of associated muscles, is advocated for treatment of acute or repetitive injuries to the long thoracic nerve of Bell.

Adult↗

PubMedDate not supplied

[Regional pulmonary function in hemidiaphragmatic paralysis (author's transl)].

Gaseous exchange and regional pulmonary function (using 133Xe) were studied in 10 subjects with hemidiaphragmatic paralysis; the paralysis was presumably idiopathic in nine subjects. Global and regional investigations were performed on the same morning, the subjects being studied in the sitting position. Six subjects were obese; nevertheless overweight was moderate except in one case. Lung volumes were moderately decreased (vital capacity ranged from 69 to 100 percent of the predicted value). PaO2 was normal or nearly normal: mean = 75.8 +/- 7.5 torr in the sitting position. PaO2 did not vary significantly in the supine, nor in the lateral recumbent position. AaDO2, breathing air or during hyperoxia, was slightly increased. Qs/Qt was markedly increased in only three cases. Regional lung function data suggest that the paralysed side still plays an appreciable part in pulmonary volume (43.5 +/- 6.3 percent), ventilation (39.1 +/- 8.2 percent) and perfusion (40.4 +/- 9.3 percent). Impairment of the paralysed side was mainly localized in the lower zone; in the middle zone only ventilation was significantly reduced. Results of regional ventilation and perfusion, expressed as absolute values, suggest a redistribution of ventilation and perfusion from the base towards the apex, not only for the paralysed side but also for the opposite side. This adjustment is probably due to the hemidiaphragmatic paralysis but the possible role of obesity (present in six cases) must be kept in mind. Possible therapeutic deductions are discussed.

Aged↗

PubMed1984

Intrinsic paralysis of the hand.

Two types of tendon transfers are described that can be used to treat paralysis of the hand caused by either a low ulnar nerve paralysis or a combined median and ulnar nerve paralysis.

Hand↗

PubMed1983

[Neonatal facial paralysis. Our experience apropos of 44 cases].

Forty-four cases of neonatal facial paralysis have been treated in the ENT department for children in the hôpital Trousseau, paris. In nearly half of the cases the etiology was related to nervous or muscular aplasia, while in the other cases of traumatic, infective, or doubtful etiology, the severity and course of the paralysis served as a guide to choice of therapy. Surgery was indicated in only 13 cases and recovery was obtained in 4 infants, with more or less marked sequelae. Prognosis is very poor in cases treated at a late stage, especially when the nerve appears to be greatly altered or compressed by callus. Surgical exploration should therefore be undertaken reasonably early (6 weeks to 2 months) when total paralysis persists or becomes worse after initial improvement.

Birth Injuries↗

PubMed1980

Facial paralysis of neoplastic origin: diagnosis and management.

The individual with a progressive (weeks to months) facial weakness should be considered to have a tumor involving the facial nerve until proved otherwise. All individuals experiencing a facial paralysis must undergo a thorough neurotologic evaluation to establish the etiology. Bell's palsy is a diagnosis by exclusion. While computerized axial tomography (CAT) scans, polytomography and arteriograms are extremely helpful, these studies very often fail to demonstrate intrinsic tumors involving the facial nerve. For this reason all individuals experiencing a progressive facial paralysis should have an exploration of their facial nerve from the internal auditory canal (IAC) through the stylomastoid foramen into the parotid gland. The purpose of this paper is to present a series of cases of facial paralysis having as their etiology intrinsic or extrinsic neoplasms. Clinical patterns are established, diagnostic protocols formulated and the results of surgical management reviewed.

Adolescent↗

PubMed1982

[Familial recurrent laryngeal nerve paralysis, a genetically fixed syndrome -- additional remark on linkage of deficiency gene and HLA (author's transl)].

Hereditary laryngeal paralysis has been rarely reported. Some authors describe additional neurological signs in connection with the cranial nerve, or mental retardation. It has been assumed that there is a causal connection with genetic deficiency. Familial studies, presented with this article, showed abductor and adductor paralysis in the mother and in the son, aged 13, abductor paralysis in the daughters, who were 11 and 5 years old, respectively, and normal laryngeal function in the father and in one 10-year old daughter. There were no neurological signs or mental deficits in any member of the family. Genetic analysis of blood-group and HLA systems confirmed linkage of the HLA system and vocal cord disorder, as suggested by Mace et al. (5). Hence, further observations and investigations will be necessary to prove this statement.

Adolescent↗

PubMedDate not supplied

[Diaphragmatic eventration and paralysis in children].

Diaphragmatic relaxation is either congenital, due to muscular dysplasia ("eventration"), or acquired and related to phrenic nerve lesion ("paralysis"); phrenic nerve paralysis can be a complication of a difficult delivery (breech presentation or forceps) or of a surgical--mostly cardiac--procedure. The authors review their own experience (12 eventrations and 9 paralysis) and recall the pathophysiology, the symptoms and treatment of this condition. They recommend the surgical plication, as most experienced authors do, when the symptoms are not completely alleviated by medical treatment which should be of short duration and must include intubation and assisted ventilation in case of acute respiratory distress.

Diaphragm↗

PubMed1982

[Therapeutic indications in facial paralysis of the newborn infant. Apropos of 9 cases].

Neither clinical examination nor electrical or radiological investigations were able to predict, pre-operatively, the malformatory or traumatic etiology in 9 cases of neonatal facial paralysis. Surgical exploration demonstrated that the paralysis was due to trauma in 3 cases and to malformations in the other 6. Exploration of the intrapetrous portion of the facial nerve in these 9 cases was not satisfactory, as in 6 patients nerve agencies was detected. Simultaneous investigation of the parotid region in 5 of these 6 infants demonstrated absence of the intraparotid part of the facial nerve. When confronted with a spontaneously non-regressive facial paralysis in a neonate, and when doubt persists after radiological and electrical examinations, the intraparotid portion of the facial nerve should be explored in the stylomastoid region. Its absence suggests agenesis of the nerve, and makes intramastoid exploration of no value.

Birth Injuries↗

PubMed1980

[Transitory paralysis of cranial nerves IX, X and XII as well as the left VII after angiography. Contribution to the ischemic pathology of the cranial nerves].

The authors report the case of a 28 year old woman who presented, after cerebral angiography performed for a transient hemispheric ischemic attack, a regressive paralysis of the IXth, Xth and XIIth as well as the VIIth left cranial nerves. The involvement of these nerves and the sparing of the XIth is explained by the normal disposition of their arterial supply. Such paralysis has previously been encountered after therapeutic angiography. This case is compared to similar ones involving paralysis of the lower cranial nerves in general disease such as diabetes or apparently idiopathic as reported by Edin et al (1976). This study should be seen in a context which also includes preceding ones performed by two of the authors: A. Annabi, P.L. and J.L. (1978) concerning the IIIrd, and J.L., I. Fernandez Manchola and P.L. (1980) concerning the VIIth and Vth cranial nerves. These observations demonstrate the existence of a vascular territorial pathology in cranial nerves involvement.

Adult↗

PubMed1980

Maximal nerve excitability testing versus neuromyography: prognostic value in patients with facial paralysis.

Neuromyography (NMG) is compared with maximal nerve excitability testing (NET) as a prognostic tool in facial paralysis. Normal latencies, summation muscle action potentials, and test/retest reliability were determined in three groups of subjects. NMG was performed in 33 control subjects of Group 1 to determine test/retest reliability. To determine the range of normal facial nerve conduction latency and amplitude and configuration of the summation muscle action potentials, NMG was performed in 172 otolaryngologic control patients without facial paralysis. NMG and NET were then compared in Group 3, which consisted of 43 patients with Bell's palsy. Fluctuations in NMG were then analyzed in a fourth test series of three subjects from Group 1, in whom summatin muscle action potentials at various positions of the electrodes were compared. The high rate of fluctuations observed indicates the need for further assessment of test/retest reliability and standardization of normal values in NMG. Our results indicate that maximal NET is more reliable than NMG for prognosis of facial paralysis.

Adolescent↗

PubMed1995

[Analysis of complications of thyroid surgery: recurrent paralysis et hypoparathyroidism. On a series of 588 cases].

The purpose of this report is to study the incidence of two main complications in thyroid surgery without systematic search for recurrent laryngeal nerve, by intracapsular thyroidectomy: temporary and chronic laryngeal recurrent paralysis (after six months), temporary hypoparathyroidism and chronic hypoparathyroidism (unrecovering normal function after six months). We have retrospectively analysed 588 patients from 1981 to 1994. There were 247 total or subtotal thyroidectomies and 341 loboisthmectomies (isolated thyroid nodules). We obtained over this 588 cases 0.3% of chronic laryngeal paralysis and 1.4% of chronic hypoparathyroidism. If the cost of surgery for thyroid nodules is low (0.3% of chronic recurrent paralysis and 0% of chronic hypoparathyroidism), it is more important for total or subtotal thyroidectomies (respectively 1.2% and 3.2%). We conclude that in thyroid surgery, there is no higher risk for the recurrent nerve without dissection of this one, but we note that, without obvious explanation, rates of permanent hypoparathyroidism are not better than in others publications.

Humans↗

PubMedDate not supplied

[Palliative treatment of a series of 103 cases of paralysis from elongation of the brachial plexus. Spontaneous changes and results].

The authors have observed 103 cases of brachial plexus paralysis due to trauma. There were 65 total and 38 partial paralysis. The follow-up was for more than 5 years in half of the cases. Twenty-one of the 65 total paralysis showed no recovery. Total or partial recovery occurred in other cases. Recovery was more complete when it began earlier, within a few days or weeks, but, in a number of cases, isolated muscles such as biceps recovered after two, three or even four years. The authors analyse the results of peripheral surgery. Amputation did not improve patient function. Arthrodesis of the shoulder, tendon transfers for the restoration of finger extension and Stenidler procedures at the elbow gave good results. Tendon transfers at the shoulder (Clark procedure), operations for restoration of opposition of the thumb and transfers of triceps to biceps were beneficial. Poor results were obtained after arthrodesis of the wrist, complex tendon transfers in the hand and transfers of latissimus dorsi and teres major. A direct surgical approach to the lesion is indicated when there is no recovery after two months.

Adolescent↗

PubMed1995

Injectable Teflon for vocal cord paralysis.

Injection of PTFE for vocal cord paralysis has proved to be a reliable and successful technique for rehabilitation of the dysphonia and aspiration related to recurrent laryngeal nerve paralysis. With appropriate patient selection, Polytef injection remains a viable and acceptable technique for rehabilitation of affected patients. The incidence of complications of Polytef injection is strongly related to technique and to the characteristics of the PTFE itself. At the Mayo Clinic since 1982, 360 patients have undergone vocal fold injections with Polytef paste. During that time, 16 patients have undergone removal of PTFE. Only a portion of the injections requiring revision were performed at this institution. It is certainly possible that patients who had Polytef injections performed at this institution presented at other facilities for treatment of complications related to Polytef placement. Therefore, the true incidence of difficulty related to PTFE injection is uncertain but very low. The patient prognosis (related to the cause of vocal fold paralysis), vocal demands, cost, and physician preference are additional factors whether Polytef injection or an alternative method of vocal fold medialization is undertaken.

Humans↗

PubMed1995

Cruciate paralysis caused by injury of the upper cervical spine.

Cruciate paralysis is an uncommon injury to the cervicomedullary junction. Five patients with injuries of the upper cervical spine and the clinical manifestation of cruciate paralysis are presented. This injury pattern is characterized by bilateral upper extremity paralysis, with minimal or no lower extremity involvement. The neuroanatomic basis and the diagnosis of this clinical entity are discussed, and the related reports in the literature are reviewed.

Adult↗