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PubMed2005

Do predictive mechanisms improve the angular vestibulo-ocular reflex in vestibular neuritis?

Recovery from vestibular neuritis (VN) is often incomplete which leads to persistent vestibular imbalance during rapid head movements. Patients with unilateral vestibular lesions have a larger gain of the horizontal vestibulo-ocular reflex during active compared to passive head movements. To test whether this gain increase is related to predictive mechanisms we studied 15 patients with VN and 14 control subjects during predictable and unpredictable passive horizontal head impulses in the light and darkness. The vestibulo-ocular reflex showed a significantly shorter latency and higher gain in the light for predictable head impulses towards the ipsilesional side. However, this effect is small and might contribute but cannot exclusively account for the gain increase during active head movements.

Adult↗
PubMed2006

Transient evoked otoacoustic emissions in vestibular neuritis.

OBJECTIVES: Partial or total degeneration of the vestibulocochlear anastomosis at its takeoff from the saccular ganglion and regenerating efferent neural buds under the cochlear outer hair cells (OHCs) have been found in the temporal bones of human patients with a history of vestibular neuritis (VN). We sought to test whether VN has any functional impact on the ipsilateral OHCs by means of transient evoked otoacoustic emission (TEOAE) testing. METHODS: We retrospectively analyzed prospectively collected TEOAE data of 28 patients (19 female, 9 male; age range, 21 to 60 years; median age, 42.5 years). The pure tone air conduction hearing thresholds at each standard audiometric frequency (0.125 to 8 kHz) and the amplitudes of the TEOAEs at the 1-, 2-, 3-, and 4-kHz frequency bands were compared between the lesional and contralateral sides by use of the nonparametric sign test for 2 paired samples. RESULTS: No significant difference was found in the pure tone air conduction hearing thresholds between the lesional and contralateral ears at any of the 11 standard tested frequencies. No significant difference was found between the TEOAE amplitudes of the lesional and contralateral sides. CONCLUSIONS: Subclinical OHC functional impairment is not present in VN. Moreover, no apparent significant changes in medial olivocochlear bundle resting activity accompany VN.

Adult↗
PubMed2003

Acute painful neuropathy (insulin neuritis) in a boy following rapid glycemic control for type 1 diabetes mellitus.

We report a case of acute, painful polyneuropathy in a boy with newly diagnosed type 1 diabetes mellitus associated with a precipitous drop in hemoglobin A1c. After initiation of insulin, the patient's hemoglobin A1c dropped from 14.1 to 7.6%, and he developed severe pain in his feet, which prevented him from walking. Nerve conduction studies were consistent with mild to moderate sensorimotor peripheral neuropathy. Initially, he required opiate analgesics for pain control. Three months after presentation, the patient showed dramatic improvement and regained his ability to walk. Although not well described in the pediatric literature, this case represents insulin neuritis, one of the few diabetic neuropathies that has a favorable outcome.

Adolescent↗
PubMed2006

Low recurrence rate of vestibular neuritis: a long-term follow-up.

We examined 103 patients with vestibular neuritis (VN) in a follow-up study (5.7 to 20.5 years, mean 9.8 years). Two patients (1.9%) had developed a second occurrence of VN 29 to 39 months after the first. VN affected the contralateral ear in both and caused less severe distressing vertigo and postural imbalance. Unlike Bell's palsy and sudden hearing loss, a relapse in the same ear did not occur.

Adult↗
PubMedDate not supplied

[Specific vestibular exercises in the treatment of vestibular neuritis].

INTRODUCTION: Vestibular neuritis rapidly damages unilateral vestibular periphery, inducing severe balance disorders. In most cases, such vestibular imbalance is gradually restored to within the normal level after clinical therapies. This successive clinical recovery occurs due to regeneration of vestibular periphery and/or accomplishment of central vestibular compensation. REHABILITATION: The program of vestibular rehabilitation presents a major achievement in the field of treatment of balance disorders. Vestibular compensation is associated with central sensory reintegration and bilaterally equalizes the vestibular tonus over a period of time. MATERIAL AND METHODS: In this retrospective study of a series of cases authors present their results in 58 patients undergoing a program of vestibular rehabilitation. Patients were divided into two groups. Thirty patients were in group I, and 28 in group II. Specific vestibular exercises were conducted in group I, and non-specific exercises in group II. Analysis of effects of vestibular compensation was made due electronystagmography. RESULTS: Results were satisfactory in both groups of patients. Absence of spontaneous nystagmus was detected in 83.3% of patients in group I (specific vestibular exercises) and in 53.5% of patients in group II (non-specific exercises), with an average treatment time of up to 2 months. Harmonization of pendular stimulation was detected in 83.3% and 60.7% of patients in groups I and II, respectively. CONCLUSION: Early physiotherapeutic vestibular rehabilitation supports the vestibular compensation mechanism. At the same time vestibular rehabilitation may prevent panic disorder caused by hyperventilation syndrome.

Adult↗
PubMed1999

M. leprae infection of vascular and lymphatic endothelial cells of the epineurium and perineurium in experimental lepromatous neuritis.

Infection of peripheral nerve by M. leprae, the histopathologic hallmark of leprosy, is a major factor in this disease, but the route and mechanisms by which bacilli localize to peripheral nerve are unknown. Experimentally infected armadillos have recently been recognized as a model of lepromatous neuritis; the major site of early accumulation of M. leprae is epineurial. To determine the epineurial cells involved, 1 cm. segments of 44 nerves from armadillos were screened for acid-fast bacilli (AFB), and thin sections were examined ultrastructurally. Of 596 blocks containing nerve, 36% contained AFB. Overall, M. leprae were found in endothelial cells in 40% of epineurial blood vessels and 75% of lymphatics, and in 25% of endoneurial vessels. Comparison of epineurial and endoneurial findings suggested that colonization of epineurial vessels preceded endoneurial infection. Such colonization of epineurial nutrient vessels may greatly increase the risk of endoneurial M. leprae bacteremia, and also enhance the risk of ischemia following even mild increases in inflammation or mechanical stress. These findings also raise the possibility that early, specific mechanisms in the localization of M. leprae to peripheral nerve may involve adhesion events between M. leprae (or M. leprae-parasitized macrophages) and the endothelial cells of the vasa nervorum.

Animals↗
PubMed1991

Treatment of leprous neuritis by neurolysis combined with perineural corticosteroid injection.

A study on leprous neuritis, involving the ulnar nerve, was carried out on 39 patients. The evaluation of nerve function was done before and after treatment by a score chart. Patients were divided into two groups. Group A (21 patients) was subjected to neurolysis only, and group B (18 patients) were given the combined treatment of neurolysis and perineural corticosteroid injection at the same time as neurolysis and subsequently at the end of the second and third weeks. In group B, 83.3% of patients showed 10% or more increase in the posttreatment score in comparison with 57.1% in group A. Improvement was more marked in paucibacillary cases and when the duration of nerve involvement was less than 3 months. Patients with short segments of nerve involvement with minimal thickening had better recovery. This procedure was observed to be simple, easy and well accepted by the patients, with a marked beneficial effect.

Adolescent↗
PubMed2004

Torsional vestibulo-ocular reflex during whole-body oscillation in the upright and the supine position: II. Responses in patients after vestibular neuritis.

In a recent study we demonstrated that otolith input modifies the torsional angular vestibulo-ocular reflex (torVOR) of healthy human subjects: Compared to turntable oscillations in supine position, oscillations in upright position increased the gain of torVOR by 0.1 and cancelled the phase lead originating from low-frequency semicircular canal signals. We asked whether these otolith-related changes of torVOR are still present in patients after vestibular neuritis (VN). Eight patients were sinusoidally oscillated about their naso-occipital axis in supine (canal-only stimulation) and upright (canal-and-otolith stimulation) position. Three-dimensional eye movements were recorded with dual search coils. The patients showed similar otolith-related gain and phase changes of the torVOR as healthy subjects: the gain increased by about 0.1 (p < 0.05) and the low-frequency phase lead from semicircular canal signals was abolished. These results indicate that otolith function after VN is still sufficient to interact with semicircular canal signals to optimize torsional gaze stabilization when the head is upright.

Adult↗
PubMed2004

Complete relief of pain in acute painful diabetic neuropathy of rapid glycaemic control (insulin neuritis) with venlafaxine HCL.

This article reports a case of a diabetic patient who suffered from acute painful diabetic neuropathy, following an intensive insulin treatment after a poor glycaemic control period of 8 yr. On the 15th day of the insulin treatment, which enabled rapid successful glycaemic control, the patient began complaining of pain and a burning sensation in the lower extremities, especially during the night. Venlafaxine HCL was initiated and the patient was completely free of pain on the third day of the treatment. As insulin neuritis is infrequent among diabetic patients we consider it is worth reporting the dramatic effect of the venlafaxine HCL treatment.

Acute Disease↗
PubMed2005

Treatment and rehabilitation in vestibular neuritis.

During the acute phase, symptomatic treatment is practically the only option, and a wide variety of drugs are available. For years, much has been focused on the possibility of using corticosteroids in the treatment of vestibular neuritis. Clearly, if we suspect an inflammatory cause, a treatment that reduces that inflammatory process would, if not reduce the severity of the attack, at least help recovery. If the different studies on this matter failed to concord in many aspects, they do however agree that the use of corticosteroids in the acute phase entails long term beneficial effects for the recovery of vestibular function and allows for a better vestibular compensation. The second part of the treatment is the rehabilitation. In my experience most of the patients undergo a spontaneous vestibular compensation in a short time. Nevertheless, some exercises of visual fixation while the patient is still bed-ridden, can accelerate the recovery process. Those patients, in whom certain instability persists, who are too anxious after their experience or those who will demand this type of treatment, are candidates to undergo a rehabilitative vestibular program. In this paper I will comment on the instrumental and non-instrumental techniques that I use in my daily practice.

Adrenal Cortex Hormones↗
PubMed2006

[Animal model of facial neuritis induced by herpes simplex virus].

OBJECTIVE: To study the role of herpes simplex virus type 1 ( HSV-1 ) in facial paralysis by developing an experimental animal model of viral facial paralysis. METHODS: Both sides of posterior auricular branch of facial nerve were anatomies and incised in 66 mice. The HSV-1 was inoculated into right ear branch and fetal bovine serum was inoculated into left ear branch as control. The symmetry of mouse face was observed and scored. The temporal bones were serially sectioned and stained with hematoxylin and eosin. The extratemporal facial nerves were stained with osmium tetroxide. HSV-1 DNA in bilateral facial nerve, brain stem, trigeminal ganglion and spinal cord was detected by the polymerase chain reaction. RESULTS: Twenty-eight (42. 42%) mice developed right facial paralysis between 2 and 5 days after inoculation. Continuing 3-6 days, the facial paralysis recovered spontaneously. Thirty-eight mice had no signs of facial paralysis. Compared with the left, nerve swelling, inflammatory cell infiltration were manifested in right temporal facial nerve of paralyzed mice. The ratio of the cross-sectional area of the facial nerve to the facial canal ( FN/FC ) was significantly higher than that on the control side (P < 0.01). Demyelinated nerve fibers were seen in the right extratemporal facial nerve. Not only in paralyzed mice, but also in non-paralyzed mice, HSV DNA was detected in some nerve tissues. CONCLUSIONS: Inoculating HSV-1 into posterior auricular branch of facial nerve can produce an acute and transient facial paralysis in mice. The possible pathophysiologic mechanism of the facial paralysis is viral invasion and transportation from distal branch to main trunk. Then the viral facial neuritis causes facial paralysis.

Animals↗
PubMedDate not supplied

Local phenol injection in the treatment of interdigital neuritis of the foot (Morton's neuroma).

The symptomatic treatment of Civinini-Morton syndrome (interdigital neuritis: IDN) may be performed directly on the nervous trunk involved using orthotic, local pharmacological or surgical methods. Alcoholization with phenol in the percutaneous treatment of IDN has the purpose of provoking a permanent chemical neurolysis, obtaining remission of the neuritic pain symptoms. A total of 71 cases were treated by a dorsal approach to the intermetatarsal space using a needle-electrode connected to the electro-stimulator. Once the nervous trunk with a reproduction of the paresthesia to the fingers was localized, 2.5 ml of phenol at 5% water solution was injected, immediately followed by local anesthetic with a postsurgical analgesic purpose. Mean follow-up was 36 +/- 8 months. The patients were evaluated by visual analogue scale for pain (VAS). Alcoholization of the common interdigital nerve proved to be effective in treating pain in 80.3% of cases (57/71). Treatment must be considered a percutaneous mini-invasive surgical procedure. The results are better than those reported in the literature with conservative and infiltrative treatment and they appear to be comparable today with those obtained when surgical treatment was used, with no complications occurring.

Adult↗
PubMed1975

Experimental autoimmune demyelinating diseases: experimental allergic encephalomyelitis and experimental allergic neuritis.

Experimental allergic encephalomyelitis (EAE) and experimental allergic neuritis (EAN) are reproducible models of auto-allergic demyelinating diseases of central and peripheral neurons tissue respectively. EAE bears a close resemblance to naturally-occuring post-infectious encephalomyelitis and EAN to Laundry-Guillain-Barré polyneuritis, in humans. In the experimental models the antigen responsible for disease induction is a different myelin basic protein in each disease. Although a variety of humoral antibodies to various neural fractions are found in both disorders, it has been shown that disease results from cell-mediated immune reactions to specific myelin antigens.

Autoantibodies↗
PubMed1996

[Central visual field in patients with multiple sclerosis without symptoms of optic neuritis].

PURPOSE: To estimate central visual field (30 degrees) of patients suffering from multiple sclerosis (SM). SM was confirmed by magnetic resonance imaging. MATERIAL AND METHODS: There was no posterior optic neuritis in the history of the disease. The visual acuity of examined the 28 eyes was 1,0. The results of static perimetry were analysed by regression analysis. RESULTS: There were significant relationships between mean sensitivity (MS) and duration of the disease, stage of the disease (in Kurtzke gradation scale) and age. Mean defect (MD) was significantly higher in the upper half of central visual field and between 15-30 degrees (p < 0.05). We observed positive relationships between MD, short time fluctuation (STF) and corrected loss variance (CLV). We found negative correlations between MS, MD, CLV and STF. Mean reliability factor RF was < 10%. CONCLUSION: Static perimetry seems to be a useful test in early diagnosis and monitoring of optic nerve neuropathy in SM.

Adult↗