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PubMed2005

[A case report of ruptured internal carotid artery aneurysm with contralateral oculomotor nerve paresis].

We report a case of ruptured internal carotid artery aneurysm with contralateral oculomotor nerve paresis. A 69-year-old female experienced a sudden onset of severe headache. Left-sided mydriasis, absence of light reflex, disability of left ocular movement and ptosis were identified. Computed tomography scan revealed massive subarachnoid hemorrhage. Cerebral angiography showed a right internal carotid artery aneurysm. No abnormal finding was observed in the left internal carotid artery or basilar artery. Magnetic resonance imaging did not show thrombosed aneurysm. The oculomotor nerve paresis lasted for ten days. Ruptured right internal carotid artery aneurysm was surgically confirmed and repaired. We speculated that the contralateral oculomotor nerve paresis was the consequence of bloody jet flow from the ruptured aneurysm.

Aged↗
PubMed2005

Sherrington innervational surgery in the treatment of chronic sixth nerve paresis.

INTRODUCTION AND PURPOSE: To describe a new operation to treat unilateral chronic sixth nerve paresis based on Sherrington's innervational law. A recession of the medial rectus (MR) in the good eye, yoke to the paretic lateral rectus (LR), will have the reciprocal innervational effect of relaxing the contracture of the contralateral MR and by doing so will enhance the effect of a weakening procedure performed on this muscle. The goal of this study was to eliminate diplopia in primary position by improving the function of the paretic LR and reducing the contracture of its antagonist MR. METHODS: The records of 14 consecutive patients with unilateral chronic sixth nerve paresis so treated were reviewed. Nine had bilateral medial rectus muscle retroplacement and postop' adjustable sutures. A non-adjustable resection of the paretic lateral rectus muscle was added to the other five. Average time from onset to surgery was 60 months (minimum 9 months). Average post-surgical followup was 22 months. RESULTS: The function of the paretic LR and the contracture of the ipsilateral MR were improved in all 14 cases. Patients with bilateral medial rectus recessions and postop' adjustable sutures had an average correction of 32 prism diopters in primary position. Patients with the added resection of the paretic LR had an average correction in primary position of 46 prism diopters. Two of the 14 patients failed our goals; one had residual diplopia in primary position and the other one had diplopia within 30 degrees on gaze to one side; for an 86% success rate. CONCLUSIONS: The 86% success rate in this study (ultimately we also achieved a 100% satisfaction rate) indicates that innervational surgery in the form of a recession of the MR in the good eye added to that of the MR in the involved eye in patients with unilateral chronic sixth nerve paresis is a safe and effective surgical procedure.

Abducens Nerve Diseases↗
PubMed2005

General paresis with reversible mesial temporal T2-weighted hyperintensity on magnetic resonance image: a case report.

We report a patient with general paresis, whose magnetic resonance image (MRI) showed a T2 high-intensity lesion in bilateral mesial temporal regions. Serum rapid plasma reagin test showed reactive at 64 dilutions and serum Treponema pallidum haemagglutination test was 1:20480. Cerebrospinal fluid analysis showed: RBC 111/mm3, WBC 8/mm3, Venereal Disease Research Laboratory reactive at 1 dilution and protein 60 mg/dl. His neuropsychiatric symptoms recovered gradually after penicillin treatment two months later. Repeated MRI revealed resolution of the bilateral mesial temporal lesions. We demonstrated the first Taiwanese patient with general paresis whose clinical improvement was associated with the disappearance of the temporal lobe MRI abnormality. The diagnosis of neurosyphilis must be considered when MRI shows mesial temporal lesions. MRI may be used to predict prognosis in patients with general paresis.

Humans↗
PubMed1991

[Abducens paresis, a rare complication to spinal analgesia].

A case of paresis of the abducens nerve following spinal analgesia is described. Cranial nerve paresis is a rare complication of spinal analgesia although described for all cranial nerves except nos. 1, 9 and 10. It is very useful to know that cranial nerve paresis after spinal analgesia often occurs after a delay of several days, and that treatment is unnecessary because symptoms nearly always disappear spontaneously in about 2-4 months.

Abducens Nerve↗
PubMed1990

Cranial nerve paresis following epidural and spinal anesthesia.

Three cases of cranial nerve paresis following epidural and spinal anesthesia are presented. One patient had combined oculomotor and abducens nerve paresis, while the other two patients had solitary abducens nerve pareses. The authors postulate that mechanical traction is the cause of cranial nerve paresis following epidural and spinal anesthesia.

Abducens Nerve↗
PubMed1988

Dural carotid-cavernous sinus vascular malformation with facial nerve paresis.

Facial nerve paresis is rarely seen in dural cavernous sinus arteriovenous malformations or carotid-cavernous sinus fistulae. A patient with an otherwise typical presentation of a spontaneous carotid-cavernous sinus malformation was found to have ipsilateral infranuclear facial nerve paresis. Angiography revealed a dural arteriovenous malformation with early petrosal sinus filling. Possible mechanisms for the paresis include compression of the facial nerve by increased venous pressure and "stealing" of the arterial supply by the malformation.

Aged↗
PubMed1987

Improvement of vocal cord paresis after thyroidectomy.

Iatrogenic vocal cord paralysis is a well-publicized complication of thyroid and parathyroid operations. Less appreciated is the improvement of vocal cord function after resection of a thyroid or parathyroid tumor. Over the last 22 years, 14 patients presented with vocal cord paresis in the presence of thyroid or parathyroid tumors. Of these 14 patients, nine had complete resolution of paresis following resection of the thyroid or parathyroid tumors: three had a thyroid carcinoma impinging upon the nerve, three had large colloid goiters, two had a follicular adenoma and one had a parathyroid adenoma displacing the nerve. In five of the 14 patients the vocal cord paralysis persisted after operation. In three, the pathology accounted for the vocal cord paralysis and was not amenable to operative improvement: one patient had an unresectable anaplastic thyroid carcinoma, one patient had long-standing idiopathic unilateral vocal cord paralysis, and one patient had laryngeal adenoid cystic carcinoma with thyroid invasion. The fourth patient had an extensive thyroid hemangioma. The paralysis persisted after resection. The fifth patient had long-standing idiopathic vocal cord palsy. A preoperative vocal cord paresis in a patient with thyroid or parathyroid disease does not indicate permanent loss of recurrent nerve function, even in the presence of carcinoma. In this series, vocal cord function was restored in 9 of 10 patients with resectable thyroid or parathyroid tumors.

Adult↗
PubMed1977

Delayed paresis following spinal fusion with Harrington instrumentation.

Immediate postoperative paresis following spinal fusion for scoliosis is uncommon. This neurological disaster can occur either within hours or days after surgical correction of the curvature. Paresis of the right lower extremity occurred on the third postoperative day in a 15-year-old boy who underwent spinal fusion for a pseudarthrosis of a previous fusion and in whom a Harrington rod was inserted for stability but not correction. The rod was removed within four hours of recognition of the paresis; within 18 months the child made an almost complete recovery of all motor function; slight residual weakness of the anterior dorsiflexors of the foot still remain.

Adolescent↗
PubMed1997

Acquired supranuclear ocular motor paresis following cardiovascular surgery.

Acquired supranuclear ocular motor paresis is a rare disorder characterized by impaired saccadic and smooth pursuit eye movements in one or more directions of gaze. Vestibularly induced eye movements, however, are preserved. Six adult patients developed an acquired supranuclear ocular motor paresis following cardiopulmonary bypass surgery. Neuroimaging studies were normal in two patients and were consistent with small vessel ischemia in four patients. The mean cardiopulmonary bypass time was 132.3 min, and mean circulatory arrest time was 38.7 min; these were not outside established norms for this type of surgery. Patients undergoing cardiopulmonary bypass procedures with deep hypothermia are at risk for acquired supranuclear ocular motor paresis, but the development of this syndrome may not be predictable by duration of circulatory arrest or cardiopulmonary bypass times.

Aged↗
PubMed1976

Electromyographic studies in calves with spastic paresis.

As part of the investigation into the cause of spastic paresis in cattle, electromyographic studies were done in a number of calves with spastic paresis of one limb and in a number of normal calves. The calves with spastic paresis were also studied at various intervals after total neurectomy of the tibial nerve or tenotomy of the Achilles tendon structure. A marked increase in activity was perceptible in a number of muscles but characteristic changes in the EMG were not observed.

Achilles Tendon↗
PubMed1997

[A case of partial fascicular oculomotor paresis].

We report a case of partial fascicular oculomotor paresis in a 22-year-old woman. The patient noticed sudden onset diplopia which had transiently occurred twice in the past two months for several hours. She also had left blepharoptosis. Neurological examination revealed left blepharoptosis and diplopia caused by paresis of the left inferior oblique and superior rectus muscles. No other focal neurological signs were detected. Laboratory data, CSF examinations, ABR, SEP and VEP studies were all normal. Brain MRI revealed a high-signal-intensity lesion of about 7 mm in diameter in the left paramedian area of the midbrain at superior colliculus level on T2-weighted images. Cerebral angiography showed no significant findings. The lesion was limited to the left oculomotor fascicles. Either demyelinating or vascular lesion might be responsible for her oculomotor paresis. The symptomatic differences between this and previously reported cases suggest that the topographical organization of the oculomotor fascicles for the superior rectus, levator palpebrae superioris, inferior oblique, medial rectus, and inferior rectus muscles and the sphincter muscles of the pupils consists of fibers that lie in a lateromedial order.

Adult↗
PubMed2004

Wegener granulomatosis presenting as an infiltrative retropharyngeal mass with syncope and hypoglossal paresis.

We describe a woman who presented with syncopal episodes and unilateral hypoglossal paresis in association with a highly infiltrative retropharyngeal mass. After an extensive malignancy workup, the patient was found to have Wegener granulomatosis (WG), an autoimmune necrotizing vasculitis that presents with inflammatory lesions anywhere in the respiratory tract and variable renal involvement. The archetypal presentation in the head and neck is erosive sinonasal crusting, though otologic, pharyngeal, and laryngeal findings are common. Highly uncharacteristic lesions are occasionally encountered and may contribute to significant diagnostic dilemmas. Neurologic involvement is not uncommon, but few reports of hypoglossal paresis and no reports of syncope as a result of WG are found in a review of the literature. Given the variability of presentation of WG in the head and neck, the otolaryngologist must maintain a high degree of suspicion for this disease in the evaluation of airway lesions.

Adult↗
PubMed1986

Investigations into the cause of canal paresis in Menière's disease.

Since the literature has a paucity of documented lesions of the vestibular hair cells and neurons in Menière's disease, the cause of canal paresis remains unexplained. A clinicopathological correlation was sought and demonstrated between ampullary distortion of lateral canal and reduced caloric response. The findings in this investigation make a strong case for ampullary distortion disrupting the tenuous but vital cupulary attachment resulting in canal paresis. This concept is attractive because it explains an important clinical event in Menière's disease on the basis of the only consistent histopathological finding, namely, membrane distension.

Adolescent↗
PubMed1987

Studies on the neuromuscular junction with a special preference to nicotinic receptors in normal delivering cows and cows suffering from parturient paresis.

Acetylcholine synthesizing (ACh-s) activity, and binding of 3H-alpha-bungarotoxin (3H-Btx) and 3H-d-tubocurarine (3H-TC) were analysed in gluteus media muscle from normal cows and from cows suffering from parturient paresis, both at parturition and 3 months later. At parturition, the ACh-s activity was 50% lower in the muscle of paretic cows than in non-paretic cows. No difference was found in the number of 3H-Btx and 3H-TC binding sites at parturition, while 3 months after parturition the numbers of 3H-TC and 3H-Btx binding sites were significantly higher in normal than in paretic cows. These significant differences in the number of receptors and a possible underlying receptor regulation defect might be a plausible etiological factor for the disease parturient paresis.

Acetylcholine↗
PubMed1994

General paresis: neuropsychological and SPECT study of five cases.

Although much less common than before the advent of the antibiotics, cognitive impairment due to general paresis can still be found in clinical practice. Five patients with general paresis underwent longitudinal neuropsychological assessment; on the occasion of the final evaluation, Single Photon Emission Tomography (SPECT) was also performed in four cases. The most frequent cognitive deficit at admission was long term spatial memory impairment, which was present in four patients. Only the two patients who received the highest dosage of intravenous penicillin therapy showed significant improvement at neuropsychological tests after treatment. SPECT findings included areas of cortical hypoperfusion and/or perfusion asymmetry in three out of four patients.

Brain↗
PubMed1982

Calcium and 24,25-dihydroxyvitamin D: inverse relation in cows with parturient paresis.

Recent work suggests a role for 24,25-dihydroxyvitamin D in inhibiting mobilization of bone. This study was undertaken to investigate its possible role in the etiology of parturient paresis, a hypocalcemic condition of dairy cows occurring at the onset of lactation. This metabolic disease was chosen to serve as a model of impaired mineral homeostasis. The animals examined were parturient Holstein cows with (N = 6) and without (N = 7) parturient paresis. Determinations of serum 1,25-dihydroxyvitamin D, serum 24,25-dihydroxyvitamin D, and serum calcium were used to evaluate the 2 groups. The hormones were isolated using methylene chloride:methanol extraction, Sephadex LH-20 chromatography, and high-pressure liquid chromatography (HPLC). Quantitation was by competitive protein binding assays. Serum 1,25-dihydroxyvitamin D levels of affected cows were not significantly different from those of normal cows. The 24,25-dihydroxyvitamin D levels of paretic cows (3.48 +/- 0.27 ng/ml) were significantly higher than in the normal cows (2.03 +/- 0.34 ng/ml) (p less than 0.01). Linear regression analysis of the data from the paretic cows revealed an inverse relationship between serum calcium and 24,25-dihydroxyvitamin D (r = -0.94). This negative correlation between serum 24,25-dihydroxyvitamin D and serum total calcium in a naturally occurring hypocalcemic disease of dairy cattle may provide evidence that this metabolite is of significance in the etiology and pathogenesis of this syndrome.

24,25-Dihydroxyvitamin D 3↗
PubMed2004

Does ICU-acquired paresis lengthen weaning from mechanical ventilation?

OBJECTIVE: To determine whether ICU-acquired paresis (ICUAP) is an independent risk factor of prolonged weaning. DESIGN: Second study of a prospective cohort of 95 patients who were enrolled in an incidence and risk factor study of ICUAP. SETTING: Three medical and two surgical ICUs in four hospitals. PATIENTS AND PARTICIPANTS: Ninety-five patients without pre-existing neuromuscular disease recovering from the acute phase of critical illness after > or =7 days of mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Duration of weaning from mechanical ventilation was defined as the duration of mechanical ventilation between awakening (day 1) and successful weaning. Muscle strength was evaluated at day 7 after awakening using the Medical Research Council (MRC) score. Patients with an MRC <48 were considered to have ICUAP. Among the 95 patients (mean age 62.0+/-15.3 years, SAPS 2 on admission 48.7+/-17.4) who regained satisfactory awakening after 7 or more days of mechanical ventilation, 67 (70.5%) were hospitalized in a medical ICU and 28 (29.5%) in a surgical ICU. Median duration (25th-75th percentiles) of weaning was longer in patients with ICUAP than in those without ICUAP: 6 days (1-22 days) vs 3 days (1-7 days); p=0.01; log-rank analysis. In multivariate analysis, the two independent predictors of prolonged weaning were ICUAP [hazard ratio (HR): 2.4; 95% confidence interval (CI): 1.4-4.2] and chronic obstructive pulmonary disease (HR: 2.7; 95% CI: 1.6-4.5) CONCLUSIONS: ICU-acquired paresis is an independent predictor of prolonged weaning. Prevention of ICU-acquired neuromuscular abnormalities in patients recovering from severe acute illness should result in shorter weaning duration.

Aged↗
PubMed1996

Lateralization of cutaneous inflammatory responses in patients with unilateral paresis after poliomyelitis.

Unilateral paresis remaining after poliomyelitis may affect the expression of inflammatory diseases by lateralization of the disease manifestations. The purpose of this study was to assess the impact of the unilateral paresis after poliomyelitis on lateralization of neurogenic inflammation and immune responsiveness. The delayed-type hypersensitivity (DTH) reaction to tuberculin was used as an in vivo measure of antigen-specific T lymphocyte reactivity. Assessment of axon reflex vasodilatation was simultaneously employed to test for neurogenic inflammation. Fourteen of the 16 polio patients displayed a positive DTH reaction to tuberculin. All but two showed weaker DTH reaction on the paretic- compared to the contralateral-side (P = 0.001). Magnitude of electrically evoked axon reflexes significantly correlated to asymmetries of DTH responses. We conclude that damage of lower motor neuron leads to ipsilateral down-regulation of T cell-mediated cutaneous inflammation. This lateralization of DTH responses is related to deficiencies in motor and sympathetic innervation of the paretic extremity.

Adult↗