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Isolated sleep paralysis, vivid dreams and geomagnetic influences: II.

This report describes a test of the hypothesis that significant changes in the ambient geomagnetic field are associated with altered normal nighttime dream patterns. Specifically, it was predicted that there would be a greater incidence of isolated sleep, paralysis or vivid dreams with abrupt rises and falls of geomagnetic activity. The author's (JC) and a second subject's (KC) daily reports of dream-recall were analyzed in the context of daily fluctuations of geomagnetic activity (K indices). Two analyses of variance indicated (i) significantly higher geomagnetic activity three days before a recorded isolated sleep paralysis event and (ii) significantly lower geomagnetic activity three days before an unusually vivid dream took place. Conversely, geomagnetic activity did not fluctuate significantly for randomly selected days. Testing a large sample over time is required for confirmation and extension of this work.

Dreams↗

Comparative prevalence of isolated sleep paralysis in Kuwaiti, Sudanese, and American college students.

A questionnaire measuring the incidence of isolated sleep paralysis was administered to 527 Kuwaiti, 762 Sudanese, and 649 American college students in what was the first study assessing the prevalence of isolated sleep paralysis in two Middle Eastern countries. Using the item "unable to move," 28.8% of Kuwaiti, 29.9% of Sudanese, and 24.5% of American participants reported experiencing the disorder at least once. When a second item, "pressure to the chest," was also used, the respective percentages were 19.2%, 20.7%, and 11.4%. With both criteria, the Kuwaiti and Sudanese had a significantly greater prevalence than did the American students. The Kuwaiti and Sudanese students did not differ significantly from each other in the percentage who reported the symptoms.

Adolescent↗

Thyroplasty type I (lateral compression) for dysphonia due to vocal cord paralysis or atrophy.

Based on the experimental results of thyroplasty, thyroplasty type I which aims at medical shifting the vocal cord was performed on 8 patients with dysphonia, 6 with vocal cord paralysis and 2 with vocal cord atrophy. The surgery was conducted on either in- or out-patient basis and local anesthesia was used. Usually, a rectangular incision was made on the thyroid cartilage at the level of the vocal cord, and the fragmemt was depressed inward. A cartilage piece taken from the opposite side was used as a wedge, if necessary, to enhance the effect of lateral compression of the vocal cord. The voice after surgery was generally satisfactory, except in one case of traumatic vocal cord paralysis. Complications such as stridor or dyspnea were nil. As surgical intervention inside the thyroid cartilage is minimal, fine and reliable adjustment of depression is possible during the surgery.

Adolescent↗

Auditory fatigue in patients with stapedius muscle paralysis.

Experiments were performed in 18 patients with peripheral facial palsy (Bell's palsy) including unilateral stapedius muscle paralysis. After exposure to narrow band noise centered at 0.5 kHz temporary threshold shift at 0.75 kHz was significantly higher in the ear with paralysis than in the normal ear. After exposure to 2.0 kHz narrow band noise there was no difference in TTS at 3.0 kHz between affected and non-affected ear. It was concluded that the stapedius reflex has a protective function against low frequency sound exposure and suggested that this protection might be extended to higher frequencies only when high frequency noise also contains low frequency components.

Acoustic Stimulation↗

Topographic diagnosis of facial paralysis by the assay of lysozyme concentration in tears.

Lysozyme in tears is secreted from the main lacrimal gland innervated by a parasympathetic nerve via the greater petrosal nerve. Lysozyme activity in tears was analysed in 10 cases of unilateral facial paralysis due to the cerebellopontine angle (CPA) tumor and 10 normal cases. The lysozyme concentration in tears on the paralysed side collected by Schirmer No. 2 test was significantly lower than that on the healthy side, or bilateral sides of normal subjects. This decreased concentration on the paralysed side is due to the interruption of the reflex are at the level of CPA. It is concluded that our new method is more useful for topographical diagnosis of facial paralysis than is the conventional Schirmer's filter paper test.

Adult↗

Relationship between idiopathic peripheral facial paralysis and climate.

We attempted to analyse a relationship between idiopathic peripheral facial paralysis and climate. One hundred and thirty-seven patients, 76 female and 61 male, were studied. The occurrence was not correlated with the mean temperature, mean humidity or mean atmospheric pressure. It can be assumed that unfavorable weather conditions, i.e. a wide temperature range, a lower percentage of sunshine and cloudy days, may bring on idiopathic peripheral facial paralysis.

Adolescent↗

Long-term modifications of vertical and horizontal vestibulo-ocular reflex dynamics in man. I. After acute unilateral peripheral vestibular paralysis.

Horizontal (HOR) and vertical (VERT) vestibulo-ocular reflex (VOR) responses to whole-body triangular velocity profiles with constant accelerations of 10, 15 and 20 deg/s2 were studied in two populations: normals, and patients with acute unilateral peripheral vestibular paralysis. The effect of this type of unilateral deficit on VOR gain and long time constant were determined as well as the time course of the compensation processes for HOR and VERT VOR dynamics. In the patient population, HOR VOR gain was asymmetric post deficit, being, on average, 50% and 75% of normal for rotations toward and away from the deficit, respectively. For the VERT VOR, on average, a symmetric 66% reduction occurred. The VERT VOR time constant was marginally affected by the deficit. HOR time constants were reduced for both directions of rotation. HOR and VERT VOR gain was within normal limits 1-3 months following an acute paralysis; time constants required a longer recovery period. Our results indicate that a unilateral deficit causes a markedly different alteration for HOR VOR dynamics compared to the effect on VERT VOR.

Adolescent↗

Result of decompression surgery in late-stage severe facial paralysis.

We investigated the usefulness of decompression surgery in the treatment of the facial nerve in 23 patients with severe complete facial paralysis regardless of etiology. All patients were followed up for at least one year after onset. Nine patients underwent decompression surgery within a month of onset (Group A), 10 underwent surgery at a later time (Group B), and 4 did not receive surgery (Group C). In Group A, 2 patients showed satisfactory recovery and 2 fair recovery. In Group B, 4 patients showed satisfactory outcome, and one patient who underwent surgery 131 days after onset showed fair outcome. No patient in Group C showed satisfactory or fair recovery. There were no significant differences among the three groups in the percentage showing sequelae after treatment. We conclude that decompression surgery is indicated even for patients with severe facial paralysis who have a history of palsy of 2 months' or more duration.

Facial Muscles↗

Renal tubular acidosis, hypokalemic paralysis, rhabdomyolysis, and acute renal failure--a rare presentation of Chinese herbal nephropathy.

We encountered a 66-year-old Chinese man presented with hypokalemic paralysis, rhabdomyolysis and acute renal failure after administration of mixed Chinese herbs. Proximal renal tubular acidosis and selective glucosuria were the main tubular dysfunctions. The renal failure recovered smoothly and rapidly after resuscitation and the tubular function abnormalities regained spontaneously after medicine withdrawal. It should be recognized that renal tubular acidosis with hypokalemic paralysis, rhabdomyolysis and subsequent acute renal failure may develop after taking Chinese mixed herbal medicine.

Acidosis, Renal Tubular↗

Vocal cord paralysis associated with anterior cervical fusion: considerations for prevention and treatment.

In a series of 375 patients with anterior cervical fusions, long-term follow-up results complete with laryngeal examination were obtained in 102 patients. One patient was found to have an inferior laryngeal nerve palsy, and one had a superior laryngeal nerve palsy. Both deficits were thought to be the result of surgical trauma. Measures to minimize the incidence of vocal cord paralysis include careful surgical technique and knowledge of the surgical anatomy of the laryngeal nerves. Suggestions are given for the assessment of postoperative hoarseness, and for the management of vocal cord paralysis.

Cervical Vertebrae↗

Cruciate paralysis: a clinical and radiographic analysis of injuries to the cervicomedullary junction.

Fourteen patients with superior cervical spinal cord injuries and the clinical signs and symptoms of cruciate paralysis are presented. This rare injury pattern is characterized by weakness of the upper extremities with little or no compromise of lower-extremity function following trauma to the superior spinal cord. Anatomically, cruciate paralysis is thought to represent selective injury to descending corticospinal tracts as they decussate at the cervicomedullary junction. The clinical and radiographic findings of each patient are outlined and the incidence and natural history of the injury syndrome, including a review of the literature, are presented.

Adolescent↗

Self-inflicted vocal cord paralysis in patients with vagus nerve stimulators. Report of two cases.

Vagus nerve stimulation for treatment of epilepsy is considered safe; reports of severe complications are rare. The authors report on two developmentally disabled patients who experienced vocal cord paralysis weeks after placement of a vagus nerve stimulator. In both cases, traction injury to the vagus nerve resulting in vocal cord paralysis was caused by rotation of the pulse generator at the subclavicular pocket by the patient. Traumatic vagus nerve injury caused by patients tampering with their device has never been reported and may be analogous to a similar phenomenon reported for cardiac pacemakers in the literature. As the use of vagus nerve stimulation becomes widespread it is important to consider the potential for this adverse event.

Adult↗

Observations on hexachlorophene-induced paralysis in the cat and its antagonism by hypertonic urea.

Cats given HCP (20 mg/kg) orally each day developed hindlimb paralysis and greatly elevated CSFP (174 mm saline; 19 mm in controls) in 3 to 5 days. "Status spongiosis" was seen in white matter only in sections of brain and cord. There was no dilation of cerebral ventricles, or damage to their ependymal linings or to the arachnoid villi. The neurological picture excluded any but a terminal effect upon cranial nerve function. There appeared to be no damage to neurons, and recovery of survivors was complete within 6 weeks after cessation of HCP administration. Elevated CSFP in paralyzed anesthetized cats was quickly lowered by an average of 256 mm by slow iv administration of 30% urea (2 g/kg in 10% invert sugar). Unanesthetized cats similarly paralyzed were able to stand and walk for up to 4 hr after this treatment. Neither acetazolamide nor prednisolone alone had any effect, nor did coadministration with urea enhance the effect of urea. The HCP lesion does not appear to be inflammatory in origin, nor does it seem to involve ventricular obstruction or overproduction of cerebrospinal fluid. The reappearance of paralysis about 4 hr after osmotic diuresis, which corresponds with the elimination of urea, suggests that prolonged iv infusion with urea or a similar osmotically active substance may have significant clinical value in the management of HCP poisoning.

Animals↗

[Laser arytenoidectomy for bilateral vocal fold paralysis].

Laser arytenoidectomy can be performed via an intralaryngeal approach which preserves airway and voice quality without aspiration. Laser arytenoidectomy is minimally invasive surgery, and a useful surgical procedure for bilateral vocal fold paralysis. CO2 laser arytenoidectomy was performed for 12 cases of bilateral vocal fold paralysis. Recommended methods for this surgical procedure are: 1) Submucous laser arytenoidectomy should be done. 2) To widen the posterior glottis, not only the arytenoid cartilage but also the posterior part of the thyroarytenoid muscle should be removed. 3) Membranous portions of the vocal folds should not be vaporized. 4) The wound should be covered with mucosa with fibrin glue.

Aged↗

[Intracordal injection therapy using atelocollagen for unilateral laryngeal paralysis under local anesthesia].

Intracordal injection therapy is a surgical therapeutic modality for glottic incompetence caused by unilateral laryngeal paralysis. Atelocollagen, which has recently been attracting attention as a material for use in intracordal injection therapy that supplants silicon, was initially claimed and expected, by virtue of its salient biophysical properties, not to cause impaired wave-motion of the vocal mucosa when injected into the submucosa. Unfortunately, however, our attempt to use this material for the same purpose proved disappointingly unsuccessful, with vocal sounds produced thereafter being metallic, vocal folds becoming tense and consequently transforming the site into a muscular coat of vocal muscles. During the past 3 years, we at the Department of Otolaryngology of the Jikei University School of Medicine, have performed intracordal injection therapy with atelocollagen on 20 patients diagnosed as having unilateral laryngeal paralysis under local anesthesia using a flexible fiberscope and a stroboscope under a video monitoring system. Comparisons were made of the voice before and after injection in 6 patients receiving submucosal injection and 14 given intramuscular injection of the material. In some autopsied patients, histological findings of the treated vocal cords were scrutinized and problems regarding atelocollagen injection were investigated. Judging from pathological findings of the vocal cords after atelocollagen injection and the clinical results of this therapeutic procedure, it seems most appropriate to inject this plastic material into the vocal muscles. This will prevent atelocollagen diffusion and maintain unimpaired wave-motion of the vocal mucosa, thus resulting in an acceptable voice quality.

Adult↗

[Evaluation of the plasma endothelin levels in facial nerve paralysis].

The etiology of so-called Bell's palsy is still unknown. Based on the hypothesis that endothelin, with its potent vasoconstricting action, is in some way involved in the etiological mechanism of facial nerve paralysis, we measured the blood endothelin levels of 62 patients with Bell's palsy in the acute stage (within one week following onset). The measurements were extended to include 10 patients with Ramsay Hunt syndrome and 14 patients with zoster sine herpete. To determine endothelin content, blood samples were drawn into blood collecting tubes, containing EDTA-2Na+aprotinin at any time desired during the day. The samples were immediately chilled and centrifuged to separate the plasma portion, and 2ml of this plasma sample was preserved by freezing. ET-1 was extracted using silica-ODS and analyzed by RIA using anti-ET 1 antibody. An age-matched comparison between the Bell's palsy patients and 36 normal individuals using the Mann-Whitney U test showed a significant difference (p < 0.01). The patients with Ramsay Hunt syndrome and zoster sine herpete also tended to have elevated endothelin levels. This finding suggests that disorders of the microcirculatory system in which endothelin is in some way involved may play a role in the pathogenesis of facial nerve paralysis.

Adolescent↗

[Effects of transcutaneous silicon injection for aspiration caused by unilateral vocal cord paralysis].

The purpose of this study was to determine the effects of transcutaneous silicon injection on swallowing function in unilateral vocal cord paralysis with aspiration. The preoperative and postoperative swallowing function were evaluated by means of videofluoroscopy and pharyngeal manometry in eight patients who received injection of silicon into the laryngeal vestibule, ventricle and vocal cord. Data analysis compared 1) types of aspiration and pharyngeal clearance, 2) timing of laryngeal closure (complete closure between arytenoid and epiglottic base) that was correlated with the onset of cricopharyngeal (CP) opening as time zero, and 3) swallowing pressure in the pyriform sinus on the side of the paralyzed vocal cord. In seven of the 8 patients, a favorable clinical response was achieved and aspiration and/or penetration were not observed on the fluoroscopic images after the silicon injection. Timing of laryngeal closure could be quantified in six patients, and mean values of the times preceding the onset of CP opening were significantly earlier on the postoperative examinations than preoperative examinations. Pharyngeal clearance on the affected vocal cord side was improved in six of the 8 patients, and swallowing pressure in the pyriform sinus was significantly elevated in four patients following surgery. These results suggested that silicon injection therapy produced earlier laryngeal closure during the swallow and improvement of pharyngeal clearance on the affected side after the swallow, so that aspiration and/or penetration with vocal cord paralysis might be prevented.

Aged↗

Thyrotoxic periodic paralysis in a Hispanic man after the administration of prednisone.

OBJECTIVE: To present a case of thyrotoxic periodic paralysis (TPP) in a Hispanic man and to discuss the potential precipitating mechanisms. METHODS: We review the clinical and laboratory findings relative to the occurrence of TPP in a 34-year-old Hispanic man, who had been diagnosed as having Graves' disease. RESULTS: TPP is a rare complication of thyrotoxicosis. The two known triggers of TPP are high carbohydrate intake and rest after strenuous physical activity. Other precipitating factors include ingestion of alcohol, infection, trauma, emotional stress, and exposure to cold. Nonselective beta-adrenergic blocking agents are used as prophylaxis for the paralytic attacks. Glucocorticoids have been used to treat nonresponsive and recurrent episodes. Nevertheless, our patient, a 34-year-old Hispanic man, had received propranolol for 7 days and one single dose of prednisone 2 hours before the onset of the paralysis. In patients with TPP, the Na+/K+-adenosinetriphosphatase (ATPase) pump activity is considerably increased by excess thyroid hormones, resulting in an increased intracellular potassium shift. Insulin activates the Na+/K+-ATPase pump as well; thus, the precipitating effect of a high carbohydrate diet is explained. Glucocorticoids have been shown to increase the number of Na+/K+-ATPase molecules in skeletal muscle. They also increase insulin secretion in the basal state and the first-phase insulin release after a glucose load. CONCLUSION: In our patient with TPP, the onset of the attack was not prevented by the use of propranolol and was likely triggered by the administration of prednisone.

Adult↗