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PubMed1983

Steroids and idiopathic facial paralysis.

The face proclaims to the world an individual's identity and as such is the most conspicuous part of his anatomy. No wonder, then, that idiopathic facial paralysis is a frightening experience for the patient. Ever since it was first noted, all manners of measures have been used to bring about early and full recovery. Unfortunately, none of these treatments is effective. Following Rothendler's case description in 1951, a multitude of papers have appeared, evaluating the effectiveness of steroids in idiopathic facial paralysis. This article evaluates 92 of these papers. Only a few properly controlled, randomized prospective studies were available. Their main conclusion was that steroid treatment was not more beneficial than conventional treatment. But several less valid prospective and retrospective studies have suggested that steroid treatment is beneficial. The definitive, statistically valid study of the benefits of steroids in treating has yet to be performed. Until then steroid treatment of this condition will continue to be controversial.

Adrenocorticotropic Hormone↗
PubMed1983

Evoked electromyography and idiopathic facial paralysis.

The purpose of this study was to standardize and evaluate the results of evoked electromyography (EEMG) in normal patients and in patients with acute idiopathic facial paralysis. A comparison of the amplitude of response to EEMG from one side of the face to the other in 288 normal patients yielded a great variability in results. The amplitude difference was not greater than 50%, and therefore a difference of less than 50% was considered normal. Test-retest variability of the percentage difference in amplitude in 10 subjects showed a 10% variation in seven patients and up to a 20% variation in the remaining three patients. Fifty patients with acute idiopathic facial paralysis were seen within 14 days of onset. A favorable prognosis was based on an EEMG amplitude of more than 25% of the normal side. With this criterion EEMG was accurate in predicting complete recovery in 36 (92%) of 39 patients. When EEMG was 25% of normal or less, incomplete recovery occurred in 9 (82%) of 11 patients. The response was 0% to 10% in six patients; four had a poor recovery and the remaining two had a fair recovery. The technique, interpretation of results, avoidance of pitfalls, and shortcomings of this test are discussed.

Electromyography↗
PubMed1986

Abducens nerve paralysis: a potential presentation of sphenoid sinus cancer.

The sphenoid sinus is the paranasal sinus most commonly implicated when cranial neuropathies are present. Two patients presenting with sixth nerve paralysis secondary to sphenoid sinus involvement are presented. One patient had a primary sphenoid sinus tumor, and the other a metastasis from a bronchogenic carcinoma. Of the two patients, one carried the diagnosis of idiopathic sixth nerve paresis and had had a normal sinus x-ray film and CAT scan done previously. Even in the absence of positive radiographic findings, the high clinical suspicion of sinus malignancy must be maintained in patients manifesting abducens nerve paralysis. In these patients, the petrous apex and cavernous sinus "silent area" must be diligently evaluated. For the patient to have any chance for palliation or potential cure, the tumor must be diagnosed as soon as possible.

Abducens Nerve↗
PubMed1986

Functional electrical stimulation for the treatment of bilateral recurrent laryngeal nerve paralysis.

We have previously presented the concept of electrophysiologic pacing of bilaterally paralyzed vocal cord abductors as a solution to the difficult problem incurred in this clinical situation. Initially, we demonstrated that it was indeed feasible to electrophysiologically pace abduction of the vocal cords synchronously with respiration, employing the EMG activity of the diaphragm as a trigger stimulus. Further research has led us to evaluate other possible physiologic trigger stimuli to ascertain which of these will prove most suitable in long-term pacing studies. In this article, we will report our preliminary results, employing negative intrathoracic pressure occurring with respiration--as detected by an implanted pressure transducer as a trigger stimulus. This device was interfaced with a muscle stimulator attached to electrodes placed in the cricoarytenoid muscles in five canines whose recurrent laryngeal nerves had been sectioned bilaterally. In all animals, obvious physiologic synchrony of vocal cord abduction and a reduction of negative inspiratory intratracheal pressure was achieved during electrical pacing. This reinforces our initial findings that it is indeed feasible to pace vocal cord abduction in bilateral recurrent laryngeal nerve paralysis with resultant return of physiologic normality to the glottis. Thus, functional electrical stimulation offers an alternative approach to the difficult problems incurred in the patient with bilateral recurrent laryngeal nerve paralysis. It also demonstrates that physiologic negative intrathoracic pressure activity occurring with inspiration can be a trigger source.

Animals↗
PubMed1988

Facial paralysis: traumatic neuromas vs. facial nerve neoplasms.

Traumatic neuromas (TN) are benign proliferations of neural tissue that may occur without disruption of the facial nerve. The clinical presentation, as well as the radiographic appearance, may suggest neoplastic involvement of the facial nerve. Histologically, they may closely resemble neurilemomas (Schwannomas) or neurofibromas. Three cases of TN of the facial nerve associated with facial paralysis are presented here. Unlike previously reported cases, these tumors were not associated with chronic inflammatory middle ear disease. TN must be considered in the differential diagnosis and treatment of facial paralysis.

Adolescent↗
PubMed1989

Glomus vagale tumor: the significance of early vocal cord paralysis.

Glomus body tumors most frequently originate in the middle ear (tympanicum) or on the jugular bulb (jugulare). Tumors that arise from the vagal body account for less than 2.5% of these unique paraganglionic neoplasms. Otologic manifestations of tympanicum and jugulare tumors usually precede or accompany neurologic findings. In reviewing five cases of glomus vagale tumors, the initial symptom of voice change, caused by vocal cord paralysis, preceded the presenting symptoms of hearing loss and tinnitus by an average of 2.5 years. The concept of early cranial nerve involvement by glomus vagale tumors is supported in a literature review. The evaluation of "idiopathic" vocal cord paralysis must include radiographic inspection of the skull base, whereas an accurate, temporal account of presenting symptoms may help distinguish vagal body tumors from other vascular neoplasms of this region.

Adult↗
PubMed1989

Total facial nerve decompression for recurrent facial paralysis: an update.

Recurrent facial paralysis (RFP) is a rare disorder that in some individuals may lead to worsening sequelae. Melkersson-Rosenthal syndrome is a variant of RFP that is associated with recurrent facial edema. In the past, decompression of the mastoid segment of the facial nerve has not been successful in preventing recurrences. In 1981 we began performing total facial nerve decompression for RFP and in 1986 reported its efficacy in one patient with Melkersson-Rosenthal syndrome and in another in whom both nerves were decompressed for alternating bilateral paralysis. An additional four cases with 3 to 8 years of followup demonstrate no recurrences in any patient. Total facial nerve decompression for RFP in selected patients appears efficacious in preventing recurrences. Decompression will remain investigational until further followup is obtained. Furthermore, its salutary effect should not be extrapolated to Bell's palsy without further study.

Adolescent↗
PubMed1989

MRI findings in two cases of acute facial paralysis.

This article describes the use of magnetic resonance imaging (MRI) in the evaluation of the facial nerve paralysis of Bell's palsy and herpes zoster oticus. Identification of the nature of inflammatory facial nerve paralysis often presents a diagnostic dilemma. The site of involvement along the course of the nerve may have importance when treatment options are being considered. We have found MRI to be a unique method for localizing the site of nerve injury in both Bell's palsy and Ramsay Hunt syndrome.

Adult↗
PubMed1991

MRI of the facial nerve during paralysis.

Gadolinium-enhanced MRI was used to evaluate 10 patients with Bell's palsy and one patient with facial paralysis secondary to Lyme disease. Nine of the eleven patients showed increased signal intensity of their facial nerve with gadolinium-enhanced MRI. In all nine patients, the facial nerve was involved at the labyrinthine, geniculate ganglion and proximal tympanic portions of the facial nerve, while two of the nine patients also had involvement of the mastoid segment of the facial nerve. Patients whose facial nerve enhancement was limited to the labyrinthine, geniculate ganglion and proximal tympanic facial nerve ultimately had complete return of facial function. Patients whose facial nerve enhanced in the mastoid segment experienced incomplete return of facial function. Gadolinium is effective in localizing the site of inflammation during facial paralysis. Those patients with enhancement localized to the labyrinthine, geniculate ganglion and proximal tympanic segments were more likely to regain complete facial function. In contrast, patients who had enhancement of the mastoid segment of the facial nerve had poorer prognoses for complete return of facial function.

Adolescent↗
PubMed1991

A functional evaluation of ansa cervicalis nerve transfer for unilateral vocal cord paralysis: future directions for laryngeal reinnervation.

There are a variety of methods for treating unilateral vocal cord paralysis, but to date there are few objective studies that evaluate the functional results of nerve transfer from the ansa cervicalis. Six dogs underwent unilateral recurrent laryngeal nerve section with immediate reanastamosis to the sternothyroid branch of the ansa cervicalis. After 5 to 6 months, measurements of vocal efficiency and acoustic parameters, videolaryngoscopy, videostroboscopy, and evoked electromyography were performed. Identical measurements were made in eight control dogs during normal electrically induced phonation and a simulated unilateral recurrent laryngeal nerve paralysis. Histologic analysis of both vocalis muscles, recurrent laryngeal nerves, ansa cervicalis, and the ansa-recurrent laryngeal nerve anastamosis site was performed. Evidence of reinnervation was found in all of the animals that underwent nerve transfer. The vocal efficiency and acoustic quality after ansa cervicalis nerve transfer were dependent on the degree of electrical stimulation from the transferred nerve to the reinnervated cord during phonation. In the absence of electrical stimulation to the nerve transfer, physiologic vocal cord motion could not be elicited from the reinnervated cord.

Anastomosis, Surgical↗
PubMed1991

Functional staging for vocal cord paralysis.

Phonatory function can be reliably tested after vocal paralysis. After a review of 116 cases, 55 patients underwent objective testing. The clinical history of vocal ability and aspiration were found to be significantly correlated with measurements of phonatory mean flow rate (MFR), maximum phonation time (MPT), and maximum decibel output (SPL). A four-stage classification system, based on clinical and objective measurements, has been formulated. In stage I, measures of vocal parameters approached those of normals with MFR = 155 cc/sec, MPT = 12 sec, and SPL = 92 dB. Patients with stage IV disability have high MFR (480 cc/sec), but low MPTs (less than 3 sec) and low SPL values (76 dB). Factors such as sex, age, weight loss, and the presence of malignancy affect the degree of vocal function deficit. Post-therapy recordings indicated an improvement in vocal function by an increase in MPT and SPL, with a decrease in MFR. Measurements of MFR, PT, and SPL are good objective indicators available to the clinician. Functional staging can be applied to assessment and treatment of vocal cord paralysis.

Adult↗
PubMed1993

Facial paralysis in a benign osseous parotid tumor: a case report.

This unique lesion has not been described in the literature so far. It appears to have originated from the base of the skull (i.e., styloid process of the temporal bone). Its pathology was extensively reviewed and it appeared to be a benign proliferative mass, but had produced a total facial nerve paralysis with invasion and destruction of the nerve. Although not palpable clinically, it had invaded the deep lobe of the parotid gland, thus reinforcing the importance of a work-up with CT scans and MR imaging to work-up a facial paralysis of unknown cause lasting more than 6 months.

Facial Paralysis↗
PubMed1994

A preliminary study of the prognostic role of electromyography in laryngeal paralysis.

Confidence in the reliability of laryngeal electromyography to predict recovery is critical if this tool is to be used to select the type and timing of surgical intervention. The characteristics of electromyography of 14 patients with unilateral vocal fold paralysis were assessed to determine which factor or combination of factors would be most useful in determining prognosis. We examined the duration, amplitude, waveform morphology, root-mean-square, and time interval from onset to electromyography recording. The results supported the concept that electromyography recordings are valuable in determining prognosis if performed before 6 months and preferably within 6 weeks of onset of laryngeal paralysis. A positive prognosis for laryngeal recovery was indicated when the following electromyography features were present in the immobile vocal fold: (1) normal motor unit waveform morphology, (2) overall electromyography activity characterized by a root-mean-square value greater than 40 microV in any one task, and (3) no electrical silence during voluntary tasks. On the basis of this criteria our overall correct prognostic rate was 89%.

Electromyography↗
PubMedDate not supplied

Seasonal variations in the incidence of cranial nerve paralysis.

The aim of the study was to verify whether there is a seasonal pattern in the occurrence of cranial nerve paralysis. All patients admitted to the Emergency Department of St Anna Hospital, Ferrara, Italy, from 1 January 1991 to 31 December 1997, were reviewed. Cranial nerve paralysis was diagnosed in 126 cases: the oculomotor nerve accounted for 46 cases, the trochlear nerve for 14, and the abducens nerve for 66. The frequencies of cases involving the oculomotor nerve and of all cases were significantly higher in winter than in the other seasons. Compared with other 2-month periods, the highest number of total cases occurred in November to December. Chronobiological analysis of the data for individual months showed a rhythmic 12-month pattern for the total population, with a weakly significant peak in January.

Aged↗
PubMedDate not supplied

Paralysis of the serratus anterior in a world class marksman. A case study.

The medical literature has produced a wide array of descriptive articles concerning paralysis of the serratus anterior; however, there has been no work on the role of sports in producing this condition. The functional anatomy, pathophysiology, and clinical evaluation are presented. A case study demonstrates the symptoms and progression of a typical patient with paralysis of the serratus anterior.

Adult↗
PubMed2001

Under one roof: the Miami Project to Cure Paralysis model for spinal cord injury research.

Concentrating a wide range of spinal cord injury (SCI) research laboratories in a single location to accelerate progress and draw attention to the promise of SCI research has made The Miami Project to Cure Paralysis one of the most publicly recognized and often controversial research groups in the neurosciences. A "Center of Excellence" at the University of Miami School of Medicine, the Miami Project also serves as a model for SCI research programs being developed nationally and internationally. Founded in 1985, the Miami Project set out on an unprecedented path-to develop a research center dedicated to improving treatments for SCI by bridging basic and clinical science. In doing so, neurosurgeon Barth Green, M.D., enlisted not only a multidisciplinary team of scientists but also a devoted following of financial donors and volunteer research subjects, and support from the University of Miami and Florida legislature. Highly visible spokespersons, including cofounder ex-Miami Dolphin Nick Buoniconti and his son Marc, brought the issue of SCI paralysis and the promise of research before the public, the media, and sports communities. As progress in the neurosciences has raced ahead, public attention to medical research, and SCI research in particular, has grown exponentially. This review will assess the Miami Project as a model for disease-based research that unites academic, philanthropic, and patient communities in a common cause.

Academic Medical Centers↗
PubMed2005

Prevalence and illness beliefs of sleep paralysis among Chinese psychiatric patients in China and the United States.

To investigate the prevalence and illness beliefs of sleep paralysis (SP) among Chinese patients in a psychiatric out-patient clinic, consecutive Chinese/Chinese-American patients who attended psychiatric out-patient clinics in Boston and Shanghai were asked about their lifetime prevalence, personal experience and perceptions regarding the causes, precipitating factors, consequences, and help-seeking of SP. During the 4-month study period, 42 non-psychotic psychiatric out-patients from the Boston site and 150 patients from the Shanghai site were interviewed. The prevalence of SP was found to be 26.2% in Boston and 23.3% in Shanghai. Patients with post-traumatic stress disorder (PTSD) or panic disorder reported a higher prevalence of SP than did patients without these disorders. Patients attributed SP to fatigue, stress, and other psychosocial factors. Although the experience has traditionally been labeled 'ghost oppression' among the Chinese, only two patients, one from each site, endorsed supernatural causes of their SP. Sleep paralysis is common among Chinese psychiatric out-patients. The endorsement of supernatural explanations for SP is rare among contemporary Chinese patients.

China↗
PubMed2006

One-stage lateral rhachotomy and posterior spinal fusion with compression hooks for Pott's paralysis in the elderly.

PURPOSE: To evaluate the safety and effectiveness of one-stage lateral rhachotomy and posterior fusion with compression hooks, for the treatment of Pott's paralysis in the elderly. METHODS: 11 elderly patients underwent lateral rhachotomy (costotransversectomy and pediculectomy) to debride the tuberculosis focus extending into the epidural space and to decompress the spinal cord. After debridement, the interbody cavity was packed with autologous iliac bone chips. For stabilisation, posterior fusion was performed using a compression lamina hook system. Patients were followed up for at least 2 years for complications. Neurological status was assessed using the Frankel score. The kyphotic deformity was measured on lateral radiographs taken before surgery and at follow-up. RESULTS: During separation of the adhesion around the abscess, a dural tear occurred in one patient and a pleural tear in another. Both tears were successfully repaired. One patient had mild pneumonia after surgery. The Frankel scores of the 11 patients improved from C or D before surgery to D or E after surgery. No relapse of spinal tuberculosis was encountered. The mean deformity angle was 25.5 degrees before surgery and 23.2 degrees at the final follow-up. Spinal fusion was achieved in all patients. CONCLUSION: Without the need of thoracotomy, one-stage lateral rhachotomy with posterior spinal fusion using compression hooks was an effective option for treating Pott's paralysis in the elderly.

Aged↗