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International Ophthalmology Oct 2022To describe etiology, clinical characteristics, radiological features and management of isolated inferior oblique pareses.
PURPOSE
To describe etiology, clinical characteristics, radiological features and management of isolated inferior oblique pareses.
METHODS
A diagnosis of inferior oblique paresis was made after a thorough strabismus examination and neuroimaging. The patients were managed surgically with adjustable strabismus surgery, or conservatively. Surgical success was defined as average horizontal deviation within ≤ 10 prism diopters [PD] post-operatively and for vertical deviation, it was ≤ 5 PD, at last follow-up.
RESULTS
Seven cases were congenital, 6 cases were bilateral, with esotropia in 6 cases; 'A' pattern in 7 cases and hypotropia in 3 cases. The mean preoperative horizontal deviation was 52.5 PD, and the mean postoperative horizontal deviation was 2.37 PD (p = 0.028). The pre-operative vertical deviation was 18 PD and post-operative vertical deviation was 5 PD. MRI showed reduced IO muscle size; average area being 11.27 mm in the affected eyes, with normal sized inferior recti (average: 24.63 mm) and medial recti muscles (average: 30.08 mm). Surgical success was seen in all six cases. Average follow-up was 265 days. The Parks' three step test was not valid, except for one acquired unilateral case.
CONCLUSION
Isolated pareses of inferior oblique muscle exhibit defective elevation in adduction of the affected eye, 'A' pattern and fundus intorsion, and is confirmed by neuroimaging. These can be successfully managed surgically to correct the deviation.
Topics: Fundus Oculi; Humans; Oculomotor Muscles; Ophthalmologic Surgical Procedures; Orbital Diseases; Paresis; Retrospective Studies; Strabismus; Treatment Outcome; Vision, Binocular
PubMed: 35583684
DOI: 10.1007/s10792-022-02316-3 -
Revue Medicale Suisse Sep 2020Diaphragmatic paresis/paralysis can be unilateral or bilateral. Its manifestations range from completely asymptomatically to global respiratory failure. Respiratory... (Review)
Review
Diaphragmatic paresis/paralysis can be unilateral or bilateral. Its manifestations range from completely asymptomatically to global respiratory failure. Respiratory functional tests will reveal lowered respiratory pressures with a restrictive syndrome, and a decrease in vital capacity when lying in the supine position compared to sitting. Unilateral paresis is most often self-limited and mainly post-surgical. The bilateral dysfunction, observed in neuromuscular diseases, is often permanent. The treatment consists in the management of specific causes, the optimization of the treatment of comorbidities, and in some cases, diaphragmatic plication, ventilatory support or pacing of phrenic nerves.
Topics: Diaphragm; Humans; Paresis; Phrenic Nerve; Respiratory Insufficiency; Respiratory Paralysis
PubMed: 32914596
DOI: No ID Found -
Langenbeck's Archives of Surgery Dec 2023Hemithyroidectomies are mainly performed for two indications, either therapeutically to relieve compression symptoms or diagnostically for suspicious nodule(s). In case... (Observational Study)
Observational Study
PURPOSE
Hemithyroidectomies are mainly performed for two indications, either therapeutically to relieve compression symptoms or diagnostically for suspicious nodule(s). In case of the latter, one could consider the approach to be rather extensive since the majority of patients have no symptoms and will have benign disease. The aim of this study is to investigate the complication rates of diagnostic hemithyroidectomy and to compare it with the complication rates of compressive symptoms hemithyroidectomy.
METHODS
Data from patients who had undergone hemithyroidectomy either for compression symptoms or for excluding malignancy were extracted from a well-established Scandinavian quality register (SQRTPA). The following complications were analyzed: bleedings, wound infections, and paresis of the recurrent laryngeal nerve (RLN). Risk factors for these complications were examined by univariable and multivariable logistic regression.
RESULTS
A total of 9677 patients were included, 3871 (40%) underwent surgery to exclude malignancy and 5806 (60%) due to compression symptoms. In the multivariable analysis, the totally excised thyroid weight was an independent risk factor for bleeding. Permanent (6-12 months after the operation) RLN paresis were less common in the excluding malignancy group (p = 0.03).
CONCLUSION
A range of factors interfere and contribute to bleeding, wound infections, and RLN paresis after hemithyroidectomy. In this observational study based on a Scandinavian quality register, the indication "excluding malignancy" for hemithyroidectomy is associated with less permanent RLN paresis than the indication "compression symptoms." Thus, patients undergoing diagnostic hemithyroidectomy can be reassured that this procedure is a safe surgical procedure and does not entail an unjustified risk.
Topics: Humans; Thyroidectomy; Thyroid Neoplasms; Paresis; Wound Infection; Retrospective Studies
PubMed: 38062331
DOI: 10.1007/s00423-023-03168-w -
Annals of Physical and Rehabilitation... Nov 2019This paper revisits the taxonomy of the neurophysiological consequences of a persistent impairment of motor command execution in the classic environment of sensorimotor... (Review)
Review
This paper revisits the taxonomy of the neurophysiological consequences of a persistent impairment of motor command execution in the classic environment of sensorimotor restriction and muscle hypo-mobilization in short position. Around each joint, the syndrome involves 2 disorders, muscular and neurologic. The muscular disorder is promoted by muscle hypo-mobilization in short position in the context of paresis, in the hours and days after paresis onset: this genetically mediated, evolving myopathy, is called spastic myopathy. The clinician may suspect it by feeling extensibility loss in a resting muscle, although long after the actual onset of the disease. The neurologic disorder, promoted by sensorimotor restriction in the context of paresis and by the muscle disorder itself, comprises 4 main components, mostly affecting antagonists to desired movements: the first is spastic dystonia, an unwanted, involuntary muscle activation at rest, in the absence of stretch or voluntary effort; spastic dystonia superimposes on spastic myopathy to cause visible, gradually increasing body deformities; the second is spastic cocontraction, an unwanted, involuntary antagonist muscle activation during voluntary effort directed to the agonist, aggravated by antagonist stretch; it is primarily due to misdirection of the supraspinal descending drive and contributes to reducing movement amplitude; and the third is spasticity, one form of hyperreflexia, defined by an enhancement of the velocity-dependent responses to phasic stretch, detected and measured at rest (another form of hyperreflexia is "nociceptive spasms", following flexor reflex afferent stimulation, particularly after spinal cord lesions). The 3 main forms of overactivity, spastic dystonia, spastic cocontraction and spasticity, share the same motor neuron hyperexcitability as a contributing factor, all being predominant in the muscles that are more affected by spastic myopathy. The fourth component of the neurologic disorder affects the agonist: it is stretch-sensitive paresis, which is a decreased access of the central command to the agonist, aggravated by antagonist stretch. Improved understanding of the pathophysiology of deforming spastic paresis should help clinicians select meaningful assessments and refined treatments, including the utmost need to preserve muscle tissue integrity as soon as paresis sets in.
Topics: Humans; Motor Neurons; Muscle Contraction; Muscle Spasticity; Muscle, Skeletal; Paresis
PubMed: 30500361
DOI: 10.1016/j.rehab.2018.10.004 -
Laryngo- Rhino- Otologie Nov 2019
Topics: Humans; Paresis; Recurrence; Recurrent Laryngeal Nerve
PubMed: 31739352
DOI: 10.1055/a-0954-7785 -
Trends in Neurosciences Aug 2022Despite advances in understanding of corticospinal motor control and stroke pathophysiology, current rehabilitation therapies for poststroke upper limb paresis have... (Review)
Review
Despite advances in understanding of corticospinal motor control and stroke pathophysiology, current rehabilitation therapies for poststroke upper limb paresis have limited efficacy at the level of impairment. To address this problem, we make the conceptual case for a new treatment approach. We first summarize current understanding of motor control deficits in the arm and hand after stroke and their shared physiological mechanisms with spinal cord injury (SCI). We then review studies of spinal cord stimulation (SCS) for recovery of locomotion after SCI, which provide convincing evidence for enhancement of residual corticospinal function. By extrapolation, we argue for using cervical SCS to restore upper limb motor control after stroke.
Topics: Arm; Cervical Cord; Humans; Motor Cortex; Paresis; Recovery of Function; Spinal Cord; Spinal Cord Injuries; Stroke
PubMed: 35659414
DOI: 10.1016/j.tins.2022.05.002 -
The Medical Journal of Australia Aug 2022
Topics: Emergency Medical Services; Hospitals; Humans; Paresis; Stroke
PubMed: 35820662
DOI: 10.5694/mja2.51654 -
The Annals of Otology, Rhinology, and... Sep 2022Evidence demonstrates neurotropism is a common feature of coronaviruses. In our laryngology clinics we have noted an increase in cases of "idiopathic" vocal fold...
OBJECTIVE
Evidence demonstrates neurotropism is a common feature of coronaviruses. In our laryngology clinics we have noted an increase in cases of "idiopathic" vocal fold paralysis and paresis in patients with no history of intubation who are recovering from the novel SARS-Cov-2 coronavirus (COVID-19). This finding is concerning for a post-viral vagal neuropathy (PVVN) as a result of infection with COVID-19. Our objective is to raise the possibility that vocal fold paresis may be an additional neuropathic sequela of infection with COVID-19.
METHODS
Retrospective review of patients who tested positive for COVID-19, had no history of intubation as a result of their infection, and subsequently presented with vocal fold paresis between May 2020 and January 2021. Charts were reviewed for demographic information, confirmation of COVID-19 infection, presenting symptoms, laryngoscopy and stroboscopy exam findings, and laryngeal electromyography (LEMG) results.
RESULTS
Sixteen patients presented with new-onset dysphonia during and after recovering from a COVID-19 infection and were found to have unilateral or bilateral vocal fold paresis or paralysis. LEMG was performed in 25% of patients and confirmed the diagnosis of neuropathy in these cases.
CONCLUSIONS
We believe that COVID-19 can cause a PVVN resulting in abnormal vocal fold mobility. This diagnosis should be included in the constellation of morbidities that can result from COVID-19 as the otolaryngologist can identify this entity through careful history and examination.
Topics: COVID-19; Electromyography; Humans; Paresis; SARS-CoV-2; Vocal Cord Paralysis; Vocal Cords
PubMed: 34643462
DOI: 10.1177/00034894211047829 -
Nederlands Tijdschrift Voor Geneeskunde Jul 2022Three patients with acute severe neck pain, presented with and without neurological deficits. One patient had severe neck pain followed by autonomic dysfunction, aphagia...
Three patients with acute severe neck pain, presented with and without neurological deficits. One patient had severe neck pain followed by autonomic dysfunction, aphagia and dysarthria. She had an vertebrobasilar infarction due to the etiology of a dissection of both vertebral arteries. In one patient with a subarachnoidal bleeding, were the complaints mainly started with severe neck pain. There was no aneurysma found. One patient presented with severe pain in the right side of the neck, shoulders and her right arm. She had a hemiparesis. Because of the suspicion of a cerebral infarction, additional anticoagulation was started. She developed a paraparalysis. Her diagnosis was an acute spontaneous cervical epidural hematoma In a few cases, the presence of solely per-acute neck pain is found as symptom of a subarachnoid hemorrhage. In cases of acute neck pain with alarm symptoms, the patient should be referred to the emergency department.
Topics: Diagnosis, Differential; Female; Hematoma, Epidural, Spinal; Humans; Magnetic Resonance Imaging; Neck Pain; Paresis
PubMed: 35899719
DOI: No ID Found -
Restorative Neurology and Neuroscience 2022Standard mirror therapy (MT) is a well-established therapy regime for severe arm paresis after acquired brain injury. Bilateral robot-assisted mirror therapy (RMT) could... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Standard mirror therapy (MT) is a well-established therapy regime for severe arm paresis after acquired brain injury. Bilateral robot-assisted mirror therapy (RMT) could be a solution to provide visual and somatosensory feedback simultaneously.
OBJECTIVE
The study compares the treatment effects of MT with a version of robot-assisted MT where the affected arm movement was delivered through a robotic glove (RMT).
METHODS
This is a parallel, randomized trial, including patients with severe arm paresis after stroke or traumatic brain injury with a Fugl-Meyer subscore hand/finger < 4. Participants received either RMT or MT in individual 30 minute sessions (15 sessions within 5 weeks). Main outcome parameter was the improvement in the Fugl-Meyer Assessment upper extremity (FMA-UE) motor score. Additionally, the Motricity Index (MI) and the FMA-UE sensation test as well as a pain scale were recorded. Furthermore, patients' and therapists' experiences with RMT were captured through qualitative tools.
RESULTS
24 patients completed the study. Comparison of the FMA-UE motor score difference values between the two groups revealed a significantly greater therapy effect in the RMT group than the MT group (p = 0.006). There were no significant differences for the MI (p = 0.108), the FMA-UE surface sensibility subscore (p = 0.403) as well as the FMA-UE position sense subscore (p = 0.192). In both groups the levels of pain remained stable throughout the intervention. No other adverse effects were observed. The RMT training was well accepted by patients and therapists.
CONCLUSIONS
The study provides evidence that bilateral RMT achieves greater treatment benefit on motor function than conventional MT. The use of robotics seems to be a good method to implement passive co-movement in clinical practice. Our study further demonstrates that this form of training can feasibly and effectively be delivered in an inpatient setting.
Topics: Humans; Mirror Movement Therapy; Pain; Paresis; Recovery of Function; Robotics; Stroke; Stroke Rehabilitation; Treatment Outcome; Upper Extremity
PubMed: 35848045
DOI: 10.3233/RNN-221263