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PubMed1997

Bilateral diaphragmatic paralysis--a rare cause of acute respiratory failure managed with nasal mask bilevel positive airway pressure (BiPAP) ventilation.

A 68 yr old woman presented with acute respiratory failure. She was suspected of having a phrenic-diaphragmatic impairment, without evidence of an intrinsic lung disease or generalized neuromuscular disorder, after 3 weeks of prolonged mechanical ventilation. A series of studies, including fluoroscopy, phrenic nerve stimulation test and diaphragmatic electromyography, was performed before the diagnosis of bilateral diaphragmatic paralysis (BDP) was confirmed. The patient was successfully weaned from the conventional mechanical ventilator, and was placed on nasal mask bi-level positive airway pressure (BiPAP) ventilation. A high degree of clinical suspicion of bilateral diaphragmatic paralysis should always be raised in patients suffering respiratory failure without definite predisposing factors. Weaning with noninvasive nasal mask ventilation should be tried first instead of direct tracheostomy.

Acute Disease↗

PubMed1999

Diaphragmatic paralysis due to Lyme disease.

Lyme disease is a tick-borne spirochaete infection which, in a proportion of patients, can lead to neuropathy. This article describes a case of diaphragmatic paralysis due to Lyme disease. A 39-yr-old male presented to the hospital because of an acute left facial palsy. Six weeks prior to admission he had developed a circular rash on his left flank during a camping holiday. He also complained of shortness of breath and arthralgia for 1 week. His chest radiograph demonstrated a raised right hemi-diaphragm. Diaphragmatic paralysis was confirmed by fluoroscopy (a positive sniff test). Serology revealed evidence of recent infection by Borrelia burgdorferi. On the basis of the patient's clinical presentation, a recent history of erythema migrans, and positive Lyme serology, a diagnosis of neuroborreliosis was made. He received oral doxycycline therapy (200 mg x day(-1)) for three weeks. Facial and diaphragmatic palsies resolved within eight weeks. On the basis of this case, a diagnosis of Lyme disease should be considered in patients from endemic regions with otherwise unexplained phrenic nerve palsy.

Adult↗

PubMed1987

HLA and thyrotoxic periodic paralysis in Japanese patients.

Periodic paralysis (PP) is a well recognized although rare and peculiar complication of thyrotoxicosis, especially among Chinese and Japanese patients. The susceptibility to autoimmune thyroid disease has recently been reported to be strongly linked to certain immunogenetic factors, and increased frequency of certain HLA antigens has been found in patients with Graves' disease. This study was, therefore, undertaken to determine HLA haplotypes in Japanese men with thyrotoxic periodic paralysis (TPP). HLA typing in 35 TPP patients and 263 normal men and women demonstrated highly significant increases (P less than 0.01) in HLA-A2, Cw3, and DRw8 in the TPP patients. In comparing TPP patients with thyrotoxic men who did not have PP, the frequency of DRw8 antigen was 2.5-fold greater in patients with PP than in those without it (62.8% vs. 28.6%). The data suggest that the HLA-DRw8 gene itself may play a significant role in the susceptibility to TPP among Japanese men.

Adult↗

PubMed1981

Acute effects of acetazolamide in hyperkalemic periodic paralysis.

We studied the effect of acetazolamide on plasma potassium in normals and in two patients with hyperkalemic periodic paralysis. Administration of acetazolamide for 48 hours lowered mean plasma potassium in normals from 4.01 to 3.56 mEq per liter (p less than 0.001) and in the patients from 4.55 to 4.00 mEq per liter (p less than 0.001). This kaliopenic effect of acetazolamide may account for its therapeutic action in hyperkalemic periodic paralysis.

Acetazolamide↗

PubMed1982

Vincristine-induced laryngeal nerve paralysis.

The neurotoxicity of the Vinca alkaloids vincristine and vinblastine is well recognized. Less recognized is laryngeal nerve paralysis induced by these chemotherapeutic agents. This potentially dangerous paralysis is usually reversible when the drug is withdrawn, but other causes of hoarseness in a cancer patient must be considered. I add two cases to 19 previously documented.

Acute Disease↗

PubMed1984

Motor paralysis increases brain uptake of lidocaine during status epilepticus.

The effect of pH on brain uptake of lidocaine during status epilepticus was studied by comparing blood and brain lidocaine concentrations and pH in paralyzed and nonparalyzed rats during pentylenetetrazol-induced status. Status produced both brain and blood acidosis; paralysis prevented the blood acidosis. Both brain and blood lidocaine concentrations were increased in the status animals. The increase in brain lidocaine was greatest (10-fold over control) in animals paralyzed during status. These findings probably reflect the fall in brain and blood pH during status affecting the partitioning of the weak base lidocaine (pKa 7.86). Paralysis prevents blood, but not brain, acidosis, thereby maximizing the pH gradient and partitioning of lidocaine into the brain.

Acidosis↗

PubMed1992

Diagnosis of familial hypokalemic periodic paralysis: role of the potassium exercise test.

Familial hypokalemic periodic paralysis (FHOPP) is a rare, dominantly inherited disease, the diagnosis of which may require the induction of paralysis. We studied whether the increase in plasma potassium concentration during exercise can be used in the diagnosis of FHOPP. Potassium concentration increased 0.3 +/- 0.1 mEq/l in patients with FHOPP and 0.6 +/- 0.1 mEq/l in healthy controls (p < 0.001) during a 10-minute bicycle exercise test, and 0.3 +/- 0.1 mEq/l in patients with FHOPP and 0.8 +/- 0.2 mEq/l in healthy controls (p < 0.001) during a 30-minute bicycle exercise test. We conclude that the potassium exercise test may be useful in the diagnosis of FHOPP.

Adolescent↗

PubMed1997

A prospective clinical and electrophysiologic survey of acute flaccid paralysis in Chinese children.

We studied 29 children admitted to Beijing Children's Hospital (BCH) with acute flaccid paralysis between June 1991 and June 1993. Twenty-seven patients had Guillain-Barré syndrome--7 with acute inflammatory demyelinating polyneuropathy and 20 with acute motor axonal neuropathy (AMAN). Two had poliomyelitis. The most common cause of acute flaccid paralysis at BCH is the AMAN pattern of GBS.

Acute Disease↗

PubMed2002

Tick paralysis in children: electrophysiology and possibility of misdiagnosis.

The authors report six patients with tick paralysis seen over 5 years. Clinical and electrodiagnostic findings failed to adequately distinguish tick paralysis from Guillain-Barré syndrome in these patients. Finding a tick attached to the scalp or the nape of the neck and removing it resulted in rapid clinical improvement.

Child, Preschool↗

PubMed2006

Thyrotoxicosis presenting as hypokalaemic paralysis and hyperlactataemia in an oriental man.

A 35-year-old Malaysian man presented with rapid onset of flaccid quadriparesis associated with nausea and vomiting. General blood tests revealed severe hypokalaemia (serum potassium 1.5 mmol/L) and hypophosphataemia (serum phosphate 0.29 mmol/L) as a potential cause of the flaccid paralysis. Arterial blood gases showed mixed acid base disturbance of respiratory alkalosis and metabolic acidosis with hyperlactataemia. Thyrotoxic periodic paralysis (TPP) was suspected as the underlying cause of this presentation and thyroid function tests showed severe hyperthyroid results (free T4 > 77.2 pmol/L, free T3 19.3 pmol/L, thyroid-stimulating hormone [TSH] < 0.05 mIU/L). Treatment with intravenous potassium and phosphate infusion and oral propranolol resulted in rapid resolution of his symptoms. A discussion of the clinical and pathophysiological features and treatment of TPP (a very rare encounter in UK clinical practice) is presented, and to our knowledge associated hyperlactataemia has not been previously described.

Administration, Oral↗

PubMed2001

Cervical osteophytes presenting as unilateral vocal fold paralysis and dysphagia.

Any process involving either the vagus nerve, its recurrent laryngeal branch or the external branch of the superior laryngeal nerve may cause paralysis of the vocal fold. The most common cause is neoplasm. Clinically, the patients often present with a hoarse, breathy voice as well as symptoms of aspiration. The following represents a unique case of unilateral vocal fold paralysis and dysphagia caused by a degenerative disease of the cervical spine, resluting in extrinsic compression of the recurrent laryngeal nerve.

Aged↗

PubMed2002

Hypoglossal nerve paralysis following tonsillectomy.

While tonsillectomy is the commonest operation performed by otolaryngologists, paralysis of the hypoglossal nerve following tonsillectomy is not well recognized in the otolaryngology text or literature. We report a case of hypoglossal nerve paralysis following tonsillectomy and discuss the theories on the pathoaetiology as described in the predominantly anaesthetics literature. The likely causes of nerve injury are described and precautions are suggested to help avoid this problem.

Adult↗

PubMed2002

Familial vocal fold paralysis.

Familial clustering of congenital bilateral abductor vocal fold paralysis has been reported very rarely. So far, only a handful of cases have been reported, mostly with the autosomal dominant of X-linked recessive mode of inheritance. We describe the cases of a brother and sister, who presented with neonatal stridor due to bilateral abductor vocal fold paralysis. First-degree parental consanguinity suggests an autosomal recessive mode of inheritance. Karyotype analysis revealed a paracentric balanced inversion of chromosome 13 in both cases, that was also present in the unaffected mother. An updated review of the literature on this interesting but rare condition is also presented.

Chromosomes, Human, Pair 13↗

PubMed2003

Facial nerve paralysis secondary to Warthin's tumour of the parotid gland.

Facial nerve paralysis associated with a parotid gland tumour classically denotes malignancy. Only a few case reports have indicated benign parotid tumours as a cause of facial nerve palsy. We present a new case of facial nerve paralysis secondary to Warthin's tumour of the parotid gland. It is important for clinicians to be aware that, on rare occasions, facial nerve dysfunction may result from benign parotid disease.

Adenolymphoma↗

PubMed2004

Cervical necrotizing fasciitis with facial nerve paralysis.

Necrotizing fasciitis (NF) is a very aggressive infection with associated high mortality. Risk factors of acquiring this infection may include diabetes mellitus, surgery, trauma, and infection. This infection necessitates prompt recognition and aggressive management in order to avoid its unfavourable outcomes. Associated nerve paralysis may indicate the involvement of deeper tissue. The present report highlights a case of cervical NF that was complicated by facial nerve paralysis, a feature that has rarely been reported.

Facial Paralysis↗

PubMed2005

Bilateral traumatic facial paralysis associated with unilateral abducens palsy: a case report.

Bilateral traumatic facial paralysis is a very rare clinical condition. Abducens palsy, associated with bilateral traumatic paralysis, is even rarer and has not been well described in the literature. In this report, a 24-year-old male, who developed immediate bilateral facial and right abducens paralyses following a motor vehicle accident, is presented. The patient was referred for neurotologic evaluation 22 days after the injury. Electroneurography (ENoG) demonstrated 100 per cent degeneration at the first examination and, correspondingly, electromyography showed no regeneration potentials. Using high-resolution computed tomography (HRCT), a longitudinal fracture on the right and a mixed-type fracture on the left were identified. The patient had good cochlear reserve on both sides. The decision for surgery was based not on ENoG, because of the delayed referral of the patient, but on the HRCT, which showed clear fracture lines on both sides. The middle cranial fossa approach for decompression of the right facial nerve was performed on the 55th day following the trauma, and a combined procedure using the middle cranial fossa and transmastoid approaches was applied for decompression of the left facial nerve on the 75th day following the trauma. On the right, there was dense fibrosis surrounding the geniculate ganglion and the proximal tympanic segment whereas, on the left, bone fragments impinging on the geniculate ganglion, dense fibrosis surrounding the geniculate ganglion, and a less extensive fibrotic tissue surrounding the pyramidal segment were encountered. There were no complications or hearing deterioration. At the one-year follow up, the patient had House-Brackmann (HB) grade 1 recovery on the right, and HB grade 2 recovery on the left side, and the abducens palsy regressed spontaneously. The middle cranial fossa approach and its combinations can be performed safely in bilateral temporal bone fractures as labyrinthine sparing procedures if done on separate occasions.

Abducens Nerve Injury↗

PubMed1976

Surgical management of bilateral vocal cord paralysis.

Fifty-five patients with bilateral abductor paralysis of the vocal cords were managed surgically from 1957 to 1973. Initially, unilateral arytenoidectomy or arytenoidopexy was employed. If this was not satisfactory, a contralateral arytenoidectomy was performed 6 to 12 months later. If the patient's airway was still inadequate, then open unilateral submucous resection of the vocal cord was accomplished. Initial management was successful in 62 patient (34/55) of patients, and 50 to 55 patients (91 percent) were eventually decannulated. Failure of the arytenoidectomy appeared to be related to traumatic etiology of the bilateral paralysis presence of previous treatment, and technical problems of the procedure itself.

Adolescent↗

PubMed1976

Diagnostic value of tomography in unilateral vocal cord paralysis.

Tomographic studies were made on 56 patients with unilateral paralysis of the vocal cord. The findings were examined in relation to etiology, course, and laryngoscopic findings. In 74.1 percent of the cases, marked enlargement of the ventricle was noticed on the side of the paralysis, especially during inhalation. The paralyzed vocal cord was higher than the intact cord during phonation in 46.4 percent of the cases. The rest of the cases (53.6 percent) demonstrated no level difference between the vocal cords. The position of the paralyzed vocal cord, unilateral involvement of the cricothyroid muscle and other neck muscles were suggested as possible contributors to the findings.

Adolescent↗