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At least 1,405 records · Page 78Linked to original sources
PubMed2002

Cruciate paralysis or man-in-the-barrel syndrome? Report of a case of brachial diplegia.

A patient who developed isolated brachial diplegia following cardiac surgery is described. The underlying cerebral lesion could not be localized using magnetic resonance imaging (MRI). Evoked potentials disclosed normal findings, while pathological latencies were seen on cortical magnetic stimulation. Their marked improvement over the following year was accompanied by almost complete clinical recovery. The preserved arm reflexes, together with the observed slow firing motor units in electromyography argued against bilateral lesions of the brachial plexus. We attribute the observed diplegia to a medullary lesion at the level of the pyramidal decussation, presumably caused by an intraoperative embolic occlusion of the anterior spinal artery. Cruciate paralysis and man-in-barrel-syndrome (MIBS) both are terms used to describe brachial diplegia; cruciate paralysis when caused by medullary lesions, MIBS when caused either by supratentorial or by medullary lesions. Exclusive use of the term MIBS for bilateral frontal lobe lesions, as in the original description, would provide more clarity in terminology.

Anterior Spinal Artery Syndrome↗
PubMed1989

Hysterical spinal paralysis.

Seventeen patients were diagnosed as having hysterical paralysis. Although a variety of patterns of motor and sensory loss were seen, 15 out of 17 patients had normal reflexes, and all the patients had bowel and bladder control, an important diagnostic point. All but 1 were improved after an average 3.8 days hospital stay with 13 being fully recovered. When a patient is encountered with paralysis, normal reflexes and bowel and bladder control, the only initial diagnostic study indicated is routine X-rays.

Adolescent↗
PubMed1997

Neuropsychological aspects of the rehabilitation of patients with paralysis from a spinal injury who also have a brain injury.

In order to examine the rehabilitation process of patients suffering from a severe spinal cord injury and who also have a cerebral injury, 322 patients with paralysis from a spinal injury were subjected to neuro-psychiatric and neuro-psychological examinations. On average 20.2% of these patients showed an associated cerebral lesion. The psychological results of such cerebral lesions are summarized under the concept of the co-called organic psychic syndrome (OPS). In 27.7% of these patients no organic psychic syndrome resulted, and in these patients a conventional paralysis rehabilitation could be carried out. 41.6% showed very minor to moderate injuries, with 30.7% being severely disabled from the cerebral injury. Rehabilitation for these patients was modified, using new therapeutic approaches, and also traditional therapeutic methods adapted to the abilities and needs of this patient group. In 25.5% of the patients there was no substantial improvement during the treatment period of initial rehabilitation (x = 12.5 weeks for the treatment of cerebral injury); but in 36.2% of the patients there was substantial improvement and in 38.3% full remission of organic psychic disorders occurred. Improvements in this sphere have a direct bearing on the rehabilitation capacity of this patient group.

Adult↗
PubMed2003

Earwax and level of paralysis.

STUDY DESIGN: Inception cohort. OBJECTIVES: The clinical impression that earwax is uncommonly frequent among spinal cord injury patients with high levels of paralysis was tested. SETTING: Veterans Administration Hospital, USA. METHODS: A cohort of 15 chronically paralyzed patients, motor complete, living as residents in a long-term care facility was offered monthly irrigations of the ears for removal of wax over a 6-month period. The number of requests was tabulated. All ears were examined once on a single day to determine point prevalence. The accumulated wax graded as absent or small, moderate or large. RESULTS: Two patients with C2 lesions, aged 37 and 52 years and paralyzed 15 and 16 years, were compared with 13 patients at C4-T6 aged 44-78 years, median 62 years, and paralyzed 2-33 years, median 24 years. Over a 6-month observation period, 10 irrigations were requested by the C2 patients and three by the C4-T6 patients. The reasons were hearing loss. Wax was found and removed, and symptoms were relieved in all instances, P&<0.001. The spot survey revealed earwax of moderate or large amounts in four of four C2 patient ears and in two of 24 C4-T6 patient ears, P=0.001. CONCLUSION: Patients with C2 tetraplegia accumulate more earwax and request its removal more often than patients with lower levels of paralysis.

Adult↗
PubMed2001

Incidence of diaphragmatic paralysis following supraclavicular brachial plexus block and its effect on pulmonary function.

Thirty unpremedicated ASA physical status 1-3 patients aged between 18 and 69 years, scheduled for upper limb surgery, received a conventional supraclavicular brachial plexus block using a nerve stimulator and bupivacaine 0.375% 0.5 ml.kg-1. Spirometric measurements of pulmonary function and ultrasonographic assessments of diaphragmatic function were made before the block and at 10-min intervals after injection until full motor block of the brachial plexus had developed. Complete paralysis of the ipsilateral hemidiaphragm occurred in 50% of patients. Seventeen per cent of patients had reduced diaphragmatic movement and the rest (33%) had no change in diaphragmatic movement. Those with complete paralysis all showed significant decreases in pulmonary function, whereas those with reduced or normal movement had minimal change. All patients remained asymptomatic throughout, with normal oxygen saturation on room air.

Adult↗
PubMed1999

Unilateral vocal fold paralysis: causes, options and outcomes.

BACKGROUND: This study presents the current aetiology of and management options for vocal fold paralysis. METHODS: One hundred and eight patients with unilateral vocal fold paralysis, managed by The Sydney Voice Clinic from 1989 to 1996, are reviewed. Aetiology of the palsy was classified as iatrogenic (45 of 108), idiopathic (36 of 108) and other defined causes (27 of 108). Nineteen patients were observed with the rest being managed with speech therapy alone (38 of 108), surgery (24 of 108) or surgery with adjuvant speech therapy (27 of 108). Surgical techniques included vocal fold augmentation (n = 43), thyroplasty (n = 20) and laryngeal re-innervation (n = 12). RESULTS: Overall 78 of 108 patients had restoration of near normal to normal voice with an additional 14 attaining a very good voice or better (voice outcome <2). CONCLUSIONS: Early intervention for symptomatic patients was found to be rewarding and safe. Vocal fold augmentation with autologous fat was particularly successful in achieving sustained improvement of voice.

Adult↗
PubMed2003

Vocal cord paralysis, synkinesis and vocal fold motion impairment.

Felix Semon's 'laws' of vocal cord paralysis were conceived over a century ago, based on the simple concept that abductor function of the recurrent laryngeal nerve was more vulnerable than adductor function. It is now clear that the neuromuscular pathology of laryngeal innervation is much more complex. Whether the nerve has been cut, crushed, stretched, cauterized or otherwise injured, it is seldom completely transected. There might be no detectable vocal cord movement at laryngoscopy, yet, electromyography usually shows at least some activity because of incomplete denervation and/or developing synkinesis. Electrical silence hardly ever persists forever. Disordered vocal fold movement following nerve injury appears to depend on laryngeal synkinesis with disorganized neuromuscular function caused by misdirected regeneration and aberrant reinnervation, sometimes by adjacent nerves. The severity of the injury, abnormal random reinnervation, scar tissue formation and nerve growth-stimulating and inhibiting factors influence the final position of the vocal fold. For a better understanding of neurolaryngological disorders it is no longer sufficient to think merely in terms of 'vocal cord paralysis'.

Electromyography↗
PubMed2003

Autologous fat injection laryngoplasty for unilateral vocal fold paralysis.

BACKGROUND: Fat injection laryngoplasty has been used at the Sydney Voice Clinic for selected cases of unilateral vocal fold paralysis since 1989. METHODS: Forty-five consecutive cases deemed suitable for treatment by this technique are presented in this paper. RESULTS: Mean follow up for this group of patients was 33 months. Over the period of follow up, 39 of the 45 patients achieved normal or near normal voice, with four patients requiring additional surgical intervention. CONCLUSION: Fat injection laryngoplasty is a quick, simple, inexpensive and reliable procedure, with few complications and good long-term results in suitable selected cases of unilateral vocal fold paralysis.

Adipose Tissue↗
PubMed2002

Vincristine-induced vocal cord paralysis in an infant.

We report the development of stridor and dysphagia in a 5-month-old-infant with acute lymphoblastic leukaemia after the administration of four weekly doses of vincristine during induction therapy. Because direct laryngoscopy revealed bilateral vocal cord paralysis, the patient underwent elective intubation. Extubation was performed 7 days later, after direct laryngoscopy confirmed recovery of vocal cord mobility. Vincristine-induced bilateral recurrent laryngeal nerve paralysis is a rare but potentially life-threatening complication. Therefore, it should be suspected when stridor is present, and clinicians should consider visualization of the airway to establish the cause of upper airway compromise in infants receiving vincristine.

Antineoplastic Agents, Phytogenic↗
PubMed1999

Diplophonia in unilateral vocal fold paralysis and intracordal cyst.

Diplophonia is the production by the voice of 2 separate tones through quasiperiodic variations in the vocal fold vibration (Ward PH, Moore GP. Ann Otol Rhinol Laryngol 1969;78:771-7). Clinically, diplophonia can be observed in patients with unilateral vocal fold paralysis with incomplete glottal closure and a mass lesion of the vocal fold, intracordal cyst, and granuloma (Kiritani S, et al. Ann Bull RILP 1991;25:55-62; Hirano M, et al. Ann Otol Rhinol Laryngol 1989;98:791-5). In this study we report 16 subjects with unilateral vocal cord paralysis or an intracordal cyst characterized perceptually by diplophonia. Diplophonia during tension imbalance may occur after surgery and is characterized by an improved perceptual score, a reduced number of vibratory cycles in each quasiperiodic waveform, and a reduced occurrence rate of the diplophonic waveform. During mass imbalance, no diplophonia occurred after surgery. Regarding the relationship of diplophonia with glottal condition at production of stops, in our study diplophonia varied significantly according to the different phonologic environments of stops during tension imbalance. We presume that there is a close relationship between the occurrence of diplophonia and the glottal conditions in tension imbalance, but not in mass imbalance.

Cysts↗
PubMed2003

Nontraumatic paralysis of the radial nerve with multiple constrictions.

PURPOSE: To present an uncommon lesion of radial nerve paralysis with multiple constrictions. METHOD: Eight patients were treated in our department between January 1994 and August 2000. There were 4 men and 4 women with a mean age of 26 years (10-43 y). The radial nerves of all patients were explored. There were 1 to 5 segmental constrictive lesions at the main trunks of the radial nerves or the posterior interosseous nerves; no obvious extrinsic compression was noted. Epineurolysis was performed in 3 patients, in the other 5 patients the constricted portions of the nerves were resected, and neurorrhaphy was performed in 2 patients, nerve-grafting in 3. Histologic examination of the resected portions showed concentration of inflammatory cells around the vessels in the perineurium. RESULTS: The patients were followed-up for 6 months to 4 years after surgery. Seven patients had at least grade 4 muscle strength in the involved muscles. One patient who was treated by external neurolysis 15 months after onset had no signs of recovery 10 months after surgery. CONCLUSIONS: Nontraumatic paralysis of the radial nerve with multiple constrictions is very uncommon. The etiology may be a focal inflammatory response around the feeding arteries in the perineurium.

Adolescent↗
PubMed1977

[Paralysis, organic brain syndrome, and cardiac dysrhythmias caused by chronic laxative abuse (author's transl)].

A 39-year-old woman developed generalised paralysis, reversible organic brain syndrome, and cardiac dysrhythmias after 15 years of laxative abuse. Under continuous and cautious administration of potassium the cardiac rhythm became normal within four days and two days later the paralysis and organic brain syndrome almost disappeared. The cause of the psychiatric symptoms is thought to be cerebral potassium deficiency and an abnormal sodium/potassium equilibrium. Other clinical signs and symptoms due to extreme potassium depletion are presented. The importance of Na+/K+-activated membrane ATP-ase in myocardium and CNS is discussed.

Adult↗
PubMed2000

Restoration of lower eyelid support in facial paralysis.

Lower eyelid dysfunction in the patient with facial paralysis is frequently the result of several deleterious factors, including the loss of orbicularis tone, involutional changes in the canthal ligaments, the effect of aging on the midfacial soft tissue structures, and malposition of the lower eyelid punctum. This dysfunction is manifested as lagophthalmos, ectropion, and epiphora. Fortunately, there are several surgical methods by which the various abnormalities can be corrected or compensated for. This article addresses the management of the lower eyelid and several of the current methods available to the surgeon for management of the lower eyelid in facial paralysis.

Ear Cartilage↗
PubMed2001

[Unilateral and bilateral recurrence of inferior laryngeal nerve paralysis].

Unilateral recurrent nerve paralysis leads to glottic insufficiency, causing a significant lack of vocal ability. In contrast, bilateral palsies present with stridor on inspiration due to glottic stenosis. Most of the underlying lesions are iatrogenic, with thyroid surgery being the single most important causative factor. However, a variety of different reasons can lead to such a condition. Whenever aetiology is uncertain a complete diagnostic work-up is mandatory. Indirect laryngoscopy confirms the diagnosis. Laryngeal electromyography is of great value because it differentiates between paralysis and ankylosis of the cricoarytaenoid joint. Moreover, in many cases laryngeal electromyography provides a reliable prognosis of clinical outcome. While unfavorable results can be predicted with high accuracy, correct prognosis of complete recovery is more difficult. Speech therapy is the treatment of choice in case of unilateral recurrent nerve palsy. Only if a significant glottal gap persists medialization procedures may become useful for voice improvement. Endoscopic as well as open approaches are available for this purpose. Bilateral recurrent nerve palsies need to be addressed surgically in the vast majority of cases. Today, a variety of endoscopic techniques for widening the glottic airway are available. Compared to permanent tracheostomy these procedures have much less impact on the patient's quality of life and should be preferred whenever possible. Inevitably, voice quality is traded for airway normalisation. However, modern surgical techniques accomplish very tolerable phonatory results.

Functional Laterality↗
PubMed2004

Tick paralysis.

Tick paralysis results from inoculation of a toxin from tick salivary glands during a blood meal. It is a relatively uncommon neuromuscular disease with a higher prevalence among young girls, although older men who get exposed to ticks may also be affected. It typically presents as an acute ascending paralysis occurring a few days after tick attachment and may result in respiratory failure and death. Patients may report minor sensory symptoms but constitutional signs are usually absent. Deep tendon reflexes are usually hypoactive or absent and ophthalmoplegia and bulbar palsy can occur. Children may be ataxic. Electromyographic studies usually show a variable reduction in the amplitude of compound muscle action potentials but no abnormalities of repetitive nerve stimulation studies. These appear to result from a failure of acetylcholine release at the motor nerve terminal level. There may be subtle abnormalities of motor nerve conduction velocity and sensory action potentials. Removal of the tick results in the very rapid reversal of clinical and physiologic deficits, quicker with North American ticks than with the Ixodes species seen in Australia.

Action Potentials↗
PubMed1998

Use of the disposable stapler to insure proper fixation of a transferred muscle in treatment of facial paralysis.

The authors introduce the use of a disposable stapler to create a stable muscle end in transferring a free neurovascular muscle segment for the treatment of facial paralysis. This procedure allows the firm fixation of the fragile soft end of a muscle transferred to the nasolabial region of a paralyzed face, and avoids adhesion and tethering of the muscle end to the skin, which may result in inaccurate positioning of a newly-created nasolabial fold and an asymmetrical smile. Transection and hemostasis at both ends of the harvested muscle segment also can be achieved simultaneously. Although the disposable stapler incurs additional cost, it can greatly improve the result of a free neurovascular muscle transfer for the treatment of facial paralysis, as well as simplify harvesting of the muscle segment. No complications and problems have been encountered in stapling the muscle.

Disposable Equipment↗
PubMed1997

A double-muscle transfer using a divided rectus femoris muscle for facial-paralysis reconstruction.

There are two types of smiling: without exposure of the teeth (usual smile), and with their exposure (square smile). Performance of the former involves use of the major zygomatic muscle, while the latter is created by the major zygomatic and the depressor labii inferior muscles. The function of the depressor labii inferioris muscle cannot be ignored in facial paralysis reconstruction. A double-muscle transfer using a divided rectus femoris muscle for one-stage reconstruction of both the major zygomatic muscle and the depressor labii inferior muscle is described. The patient suffered facial paralysis caused by an extracranial schwannoma originating from the facial nerve. After the tumor was removed, divided rectus femoris muscle segments were transferred to reconstruct the major zygomatic muscle and the depressor labii inferior muscle. After the pedicle vessel of the muscles was anastomosed to the recipient facial vessel, the long motor nerve of the proximal divided muscle was cross-faced and coapted directly to the prepared contralateral buccal branch. The short motor nerve of the distal muscle segment was sutured to the ipsilateral masseteric nerve. The advantages of divided rectus femoris muscle transfers are that (1) independent muscle contraction can be reconstructed; (2) no tongue or trapezius muscle atrophy occurs because the masseteric nerve is used as the motor source of the labial depressor; (3) only one muscle is sacrificed for muscle grafts; and (4) it is a one-stage reconstruction.

Adult↗
PubMed1998

[Modified posterior Dennis and Kashima cordectomy in treatment of bilateral recurrent nerve paralysis].

BACKGROUND: A number of different surgical methods are described in the literature to enlarge the glottic gap in patients with bilateral recurrent nerve paralysis with an excessively small glottic gap. The latest method is the posterior chordectomy described by Dennis and Kashima. PATIENTS AND METHODS: Twenty-three patients with bilateral recurrent nerve paralysis were treated between 1993 and 1997. In the first 5 patients, a muscular triangle as described by Dennis and Kashima from the posterior part of the muscular portion of the vocal fold was resected. Later on, the surgical procedure was extended by additional resection of muscular tissue from the anterior two-thirds of the vocal fold. Preoperative and postoperative data were carefully assessed in a prospective setting. Subjective data such as limitation of physical exertion and ability to communicate were documented. There was objective documentation by spirometry and phoniatric-logopedic assessment of voice quality parameters. Generally, it takes a number of months until the final permanent state is reached. The minimum follow-up was therefore at least 6 months with a mean of 16 months. RESULTS: The follow-up of the 23 patients showed that the surgical technique as originally described by Dennis and Kashima does not always improve breathing sufficiently in the long run. A repeat chordectomy was required in three out of five patients with this technique. The modified technique with additional muscle resection of the anterior two-thirds of the vocal fold resulted in the desired long-term enlargement of the glottic gap in 16 out of 18 patients. Spirometric controls showed a significant improvement of respiration. However, some voice quality parameters showed a significant reduction as expected. Despite this, the overall communication ability was described as only slightly reduced by the patients themselves. CONCLUSIONS: By the modified posterior laser chordectomy, the glottic gap is widened on a long term, though less than after an arytenoidectomy. The compromise between reduction of voice quality and dyspnoea is better than after arytenoidectomy. The preservation of the laryngeal sphincter is important in that it prevents the latent aspirations that are occasionally observed and achieves a certain adduction of the vocal folds with phonation. The surgical procedure is technically simple, may be repeated, and never needs a tracheostomy.

Adult↗