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Postgraduate Medical Journal Sep 2005Unilateral and bilateral facial palsies are debilitating and depressing conditions for the patient. For the past 30 years attempts have been made to improve the... (Review)
Review
Unilateral and bilateral facial palsies are debilitating and depressing conditions for the patient. For the past 30 years attempts have been made to improve the reanimation of these patients. The ability to transfer axons over significant distances with nerve grafts and the transfer of muscle that can be revascularised by microvascular surgery greatly improves results of this surgery. The revascularisation of muscle has been the important step forward but the re-focusing of interest in this condition has brought about a number of peripheral advances.
Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Eye Diseases; Facial Paralysis; Female; Forehead; Graft Survival; Humans; Male; Middle Aged; Mobius Syndrome; Pectoralis Muscles; Surgical Flaps; Tissue and Organ Harvesting
PubMed: 16143684
DOI: 10.1136/pgmj.2004.020321 -
Anaesthesia Dec 1996Two cases are reported of sciatic nerve palsy after delivery by Caesarean section in primigravidae. One mother was slender and had an emergency Caesarean section for... (Review)
Review
Two cases are reported of sciatic nerve palsy after delivery by Caesarean section in primigravidae. One mother was slender and had an emergency Caesarean section for failure to progress with a breech presentation. Epidural analgesia during labour was extended for operative delivery. The other mother was obese, mildly hypertensive, had a large baby with a high head and was delivered by elective Caesarean section under epidural anaesthesia. She experienced severe intrapartum hypotension. Both patients suffered right sided sciatic nerve palsy. The aetiologies of obstetric palsies and those following regional block are reviewed and the importance of careful diagnosis and of avoiding peripheral nerve compression during regional block are emphasised.
Topics: Adult; Anesthesia, Epidural; Anesthesia, Obstetrical; Cesarean Section; Female; Humans; Paralysis; Peripheral Nervous System Diseases; Pregnancy; Sciatic Nerve
PubMed: 9038451
DOI: 10.1111/j.1365-2044.1996.tb15052.x -
The Canadian Veterinary Journal = La... May 1994The purpose of this review is to present an up-to-date summary of the signs, diagnosis, treatment, and implications of equine hyperkalemic periodic paralysis. The review... (Review)
Review
The purpose of this review is to present an up-to-date summary of the signs, diagnosis, treatment, and implications of equine hyperkalemic periodic paralysis. The review encompasses all original articles published between 1986 and early 1993. Hyperkalemic periodic paralysis is the result of a genetic mutation in the skeletal muscle sodium channel gene. It is inherited as an autosomal dominant trait; most affected horses are heterozygotes. The classical signs are muscle fasciculation, spasm, and weakness associated with hyperkalemia. However, these signs are only rarely observed in affected horses. Potential sequelae to attacks are abrasions and involuntary recumbency; these problems are not specific for hyperkalemic periodic paralysis, but they occur more frequently in hyperkalemic periodic paralysis-affected horses. It is also likely that hyperkalemic periodic paralysis results in greater muscle mass. There are suggestions that homozygotes may be more severely affected and show signs of upper respiratory obstruction as foals. The practitioner needs to be aware of the tests for hyperkalemic periodic paralysis, and their limitations, so that he can properly diagnose this condition. The industry has the difficult problem of deciding whether or not testing should be mandatory and the fate of positive horses.
Topics: Animals; Horse Diseases; Horses; Hyperkalemia; Male; Paralysis
PubMed: 8050073
DOI: No ID Found -
European Archives of... Jun 2021To evaluate the long-term (minimum of 2 years from the palsy onset) outcome of pediatric facial palsy by patient questionnaire and face-to-face assessment by the...
PURPOSE
To evaluate the long-term (minimum of 2 years from the palsy onset) outcome of pediatric facial palsy by patient questionnaire and face-to-face assessment by the Sunnybrook facial grading system, House-Brackmann grading system, and Facial Nerve Grading System 2.0. To compare the outcome results of self-assessment with the face-to-face assessment. To assess the applicability of the grading scales. To assess the palsy recurrence rate (minimum of a 10-year follow-up).
METHODS
46 consecutive pediatric facial palsy patients: 38 (83%) answered the questionnaire and 25 (54%) attended a follow-up visit. Chart review of 43 (93%) after a minimum of 10 years for the facial palsy recurrence rate assessment.
RESULTS
Of the 25 patients assessed face-to-face, 68% had totally recovered but 35% of them additionally stated subjective sequelae in a self-assessment questionnaire. Good recovery was experienced by 80% of the patients. In a 10-year follow-up, 14% had experienced palsy recurrence, only one with a known cause. Sunnybrook was easy and logical to use, whereas House-Brackmann and the Facial Nerve Grading System 2.0 were incoherent.
CONCLUSIONS
Facial palsy in children does not heal as well as traditionally claimed if meticulously assessed face-to-face. Patients widely suffer from subjective sequelae affecting their quality of life. Palsy recurrence was high, much higher than previously reported even considering the whole lifetime. Of these three grading systems, Sunnybrook was the most applicable.
Topics: Bell Palsy; Child; Facial Nerve; Facial Paralysis; Follow-Up Studies; Humans; Quality of Life
PubMed: 33320295
DOI: 10.1007/s00405-020-06476-9 -
Medicine Nov 2018Laminectomy is an effective surgical treatment for multi-segment cervical spondylotic myelopathy (M-CSM) but usually results in C5 palsy. Some surgical techniques to... (Observational Study)
Observational Study
Limited laminectomy and foraminal decompression combined with internal fixation for treating multi-segment cervical spondylotic myelopathy: Does it effectively improve neurological function and prevent C5 palsy?
Laminectomy is an effective surgical treatment for multi-segment cervical spondylotic myelopathy (M-CSM) but usually results in C5 palsy. Some surgical techniques to restore the spinal sequence, increase the intervertebral foramen diameter, and limit the spinal cord drift distance have been proposed; however, it is unclear whether these procedures can avoid this complication.To investigate the clinical efficacy of limited laminectomy and foraminal decompression with fixation (LLFDF) for improving neurological recovery and preventing C5 palsy.A total of 71 patients with M-CSM were retrospectively analyzed. Thirty-nine of them were treated with LLFDF (group A) and 32 with normal laminectomy with fixation (NLF; group B) after 3 months of formal conservative treatment. Pre- and postoperative neurological function, spinal cord drift distance, cervical curvature index (CCI), and number of C5 palsy cases were recorded and analyzed.There was no significant intergroup difference in the surgical time or intraoperative blood loss (P >.05). The laminectomy widths in groups A and B were 16.7 ± 2.6 mm and 21.8 ± 2.9 mm, respectively (P <.01), while the spinal cord drift distances were 2.3 ± 0.4 mm and 3.6 ± 0.7 mm, respectively (P <.01). The mean Japanese Orthopedic Association score of both groups increased significantly after surgery (P <.01), and no significant difference was noted at any observation time points (P >.05). Both groups demonstrated significant CCI improvements after surgery compared with those before surgery (P <.01). There were 2 cases of C5 palsy in group A (5.1%) and 8 cases in group B (25.0%), and the difference was significant (P <.05).LLFDF can relieve spinal compression and considerably promote neurological recovery. Moreover, it restricts excessive spinal cord back drifting and decreases the incidence of C5 palsy.
Topics: Adult; Aged; Cervical Vertebrae; Decompression, Surgical; Female; Follow-Up Studies; Fracture Fixation, Internal; Humans; Laminectomy; Male; Middle Aged; Paralysis; Postoperative Complications; Recovery of Function; Retrospective Studies; Spinal Cord Compression; Spinal Cord Diseases; Spondylosis; Treatment Outcome
PubMed: 30461648
DOI: 10.1097/MD.0000000000013327 -
Neurologia May 2022Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant disorder, typically presenting with recurrent episodes of mononeuropathy in nerves...
INTRODUCTION
Hereditary neuropathy with liability to pressure palsy (HNPP) is an autosomal dominant disorder, typically presenting with recurrent episodes of mononeuropathy in nerves susceptible to compression, with similar neurophysiological characteristics. However, other clinical and neurophysiological presentations have been reported.
METHODS
We retrospectively analysed the clinical and neurophysiological characteristics of 20 patients with genetically confirmed HNPP. Sixteen patients were studied in our department between 1996 and 2016.
RESULTS
In addition to the typical characteristics of HNPP, we found atypical forms including recurrent positional sensory symptoms in 3 patients, chronic sensorimotor polyneuropathy in one, and non-progressive mononeuropathy in one. Onset was early in 2 patients: one at the age of 7 years, with common peroneal nerve injury, and another at birth, with brachial plexus involvement. By frequency, the main pathological findings in the nerve conduction study were: decreased sensory nerve conduction velocity in the sural (84%) and the median and superficial peroneal nerves (94%); decreased motor nerve conduction velocity in the ulnar nerve through the elbow (97%), and increased motor distal latency of the median and deep peroneal nerves (74%).
CONCLUSION
Our results confirm the clinical variability of HNPP, with the most frequent nerve conduction study findings being the generalised decrease in sensory nerve conduction velocity, in addition to motor involvement, mainly in locations susceptible to nerve compression. The nerve conduction study can detect typical, atypical, and asymptomatic cases of HNPP.
Topics: Arthrogryposis; Child; Chromosome Deletion; Chromosomes; Hereditary Sensory and Motor Neuropathy; Humans; Infant, Newborn; Paralysis; Retrospective Studies
PubMed: 35595399
DOI: 10.1016/j.nrleng.2019.02.012 -
JAMA Facial Plastic Surgery Jan 2019Study of the association of regional facial dysfunction with quality of life will lead to a better understanding of quality of life in facial palsy.
IMPORTANCE
Study of the association of regional facial dysfunction with quality of life will lead to a better understanding of quality of life in facial palsy.
OBJECTIVE
To determine the association of regional facial dysfunction with facial palsy-related quality of life.
DESIGN, SETTING, AND PARTICIPANTS
This retrospective cohort analysis included patients with flaccid and nonflaccid (synkinetic) facial palsy treated at a tertiary care facial nerve center; the flaccid facial palsy group included 529 patients, and the nonflaccid facial palsy group included 391 patients. Data were included from all patients with facial palsy who had an eFACE score and Facial Clinimetric Evaluation (FaCE) scale total score acquired at the same time from February 1, 2014, through October 31, 2017. Linear regression analysis was performed to calculate the amount of variance in quality of life explained by the severity of facial palsy (eFACE). A relative weight analysis was performed for the contribution of each individual eFACE item in estimating quality of life.
MAIN OUTCOMES AND MEASURES
Facial palsy severity was measured using all 15 individual eFACE items (rated on a scale of 0 to 200, where 0 represents complete flaccidity, 100 represents a balanced aesthetic appearance, and 200 represents the worst imaginable hypertonia of a patient with synkinesis, with a transformation used for values from 101 to 200), and facial palsy-related quality of life was measured using the FaCE scale total score (range, 0 [worst] to 100 [best]).
RESULTS
Data of 920 individual patients (59.5% female; mean [SD] age, 48.6 [16.6] years) were available. The eFACE composite score accounted for 21.2% of the quality-of-life variance in the flaccid group and 13.9% in the nonflaccid group. With the use of all 15 individual eFACE items, these proportions increased to 29.7% and 16.8%, respectively. In both groups, oral commissure movement with smile was found to be the most important contributing item (relative weight, 0.108 [95% CI, 0.075-0.148] for the flaccid group and 0.025 [95% CI, 0.005-0.052] for the nonflaccid group). Items related to the function of periocular muscles were found to be of low importance.
CONCLUSIONS AND RELEVANCE
The present study suggests that the function of individual facial regions is not equally important for estimating facial palsy-related quality of life. The ability to smile is of greatest importance among patients with flaccid and nonflaccid facial palsy. The true importance of periocular function in the estimation of quality of life should be studied further in future research.
LEVEL OF EVIDENCE
NA.
Topics: Disability Evaluation; Facial Paralysis; Female; Humans; Male; Middle Aged; Quality of Life; Retrospective Studies; Severity of Illness Index; Smiling
PubMed: 30073264
DOI: 10.1001/jamafacial.2018.0804 -
Journal of Ayub Medical College,... 2023Causes of vocal cord palsy (VCP) can be identified even before its clinical presentation if a radiologist has knowledge about signs of vocal cord palsy, its various...
When The Silence Prevails, Images Talk: The Characteristic Ct Features Of Vocal Cord Paralysis, Causes Of Missed Palsy By Radiologists And Mimics Of Vocal Cord Palsy Unveiled.
BACKGROUND
Causes of vocal cord palsy (VCP) can be identified even before its clinical presentation if a radiologist has knowledge about signs of vocal cord palsy, its various mimics and the anatomy of recurrent laryngeal nerve. Objectives are to know the signs and underlying causes leading to VCP and various mimics which may lead to the false positive diagnosis of VCP.
METHODS
A retrospective cross-sectional pilot study comprising 54 patients with vocal cord palsy proven by IDL was conducted. 3 groups were identified. The first group comprised missed VCP on cross-sectional imaging. The second group was, of missed cause of VCP in patients with clinical diagnoses. The third group was patients with mimics of the palsy.
RESULTS
Thirteen (76.5%) patients had missed diagnosis due to lack of knowledge of signs and 23.5% due to lack of time, overwork and tiredness. A vigilant search for the cause was not done in 31.6% of patients and in 68.4% of patients, the cause was identified but not correlated. A total of 8 patients had false positive diagnoses due to failure to differentiate from mimics.
CONCLUSIONS
There is an increasing trend of missed diagnosis of vocal cord palsy on cross-sectional imaging in patients with established clinical diagnosis due to a lack of knowledge of VCP signs and missed causes along the course of recurrent laryngeal nerve.
Topics: Humans; Vocal Cord Paralysis; Retrospective Studies; Pilot Projects; Recurrent Laryngeal Nerve; Radiologists; Thyroidectomy
PubMed: 38406936
DOI: 10.55519/JAMC-04-11853 -
Ocular motor nerve palsy in patients with diabetes: High-resolution MR imaging of nerve enhancement.Journal Francais D'ophtalmologie Sep 2023To evaluate the extent of signal abnormality in impaired ocular motor nerves using high signal and spatial resolution MRI sequences and to discuss the involvement of...
OBJECTIVE
To evaluate the extent of signal abnormality in impaired ocular motor nerves using high signal and spatial resolution MRI sequences and to discuss the involvement of inflammatory or microvascular impairment in patients with diabetic ophthalmoplegia.
METHODS
We conducted a retrospective study of 10 patients referred for acute ocular motor nerve palsy in the context of diabetes mellitus from September 15th, 2021 to April 24th, 2022. 3T MRI evaluation included diffusion, 3D TOF, FLAIR, coronal STIR and post-injection 3D T1 SPACE DANTE sequences.
RESULTS
Ten patients were included: 9 males and 1 female aged from 46 to 79 years. Five patients presented with cranial nerve (CN) III palsy, and 5 presented with CN VI palsy. Third nerve palsy was pupil-sparing in 4 patients and pupil-involved in 1 patient. Pain was associated in all patients with CN III deficiencies and in 2 patients CN VI deficiencies. In all patients, MRI sequences ruled out mass effect and vascular pathology, such as acute stroke or aneurysm. Eight patients presented with STIR hypersignals, some with enlargement of the involved nerve. The diagnosis was confirmed through a post-injection 3D T1 SPACE DANTE sequence, which showed extended enhancement along the abnormal portion of the nerve.
CONCLUSION
High-resolution MRI evaluation of diplopia in diabetic patients is used to rule out a diagnosis of acute stroke and contributes to the positive diagnosis of ocular motor nerve impairment, possibly combining the influences of inflammatory and microvascular phenomena. Dedicated MR imaging should be included in the initial diagnosis and longitudinal follow-up of patients with diabetic ophthalmoplegia.
Topics: Male; Humans; Female; Retrospective Studies; Diabetes Mellitus; Oculomotor Nerve Diseases; Paralysis; Ophthalmoplegia; Stroke; Magnetic Resonance Imaging
PubMed: 37210294
DOI: 10.1016/j.jfo.2023.01.009 -
Proceedings of the Royal Society of... Apr 1955Management of chronic ear infections dependent on recognition of the differences (pathological and clinical) between tympano-tubal lesions and attico-antral disease....
Management of chronic ear infections dependent on recognition of the differences (pathological and clinical) between tympano-tubal lesions and attico-antral disease. Chronic suppurative otitis media as a reason for rejection for military service. Statistics obtained from the Ministry of Labour and National Service. Relative incidence of tympanic and attico-antral disease in a series of 500 hospital patients at the present time. Resistant chronic tympanic disease still a problem. Relation to acute suppurative otitis media. Recurrent and relapsing attacks of acute otitis media. Does early chemotherapy interfere with development of immunity?Problems presented by acute otitis media likely to be elucidated by the general practitioner rather than by the otologist. The general practitioner's opportunities for research in this clinical problem. Incidence of ear diseases in average general practice.Training of medical students in diseases of the ear, nose and throat. Methods of instruction followed in the teaching schools of Great Britain and Northern Ireland and attitude of the Examining Bodies to this subject. The contribution of otologists to the education of doctors.Some observations on facial paralysis. Importance of prognosis. Different criteria in early and late stages of paralysis. Reasons for abandoning the faradic-galvanic tests in the management of facial paralysis. Use of constant current square pulse stimulators in early days of facial paralysis. Electromyography of value in later stages.Present-day difficulties in acquiring skill for facial nerve surgery. Importance of the stylomastoid artery. Recent investigations on the blood supply of the facial nerve: gross vascular pattern and the interfascicular plexus. Further work necessary to relate these anatomical facts to the condition of Bell's palsy.
Topics: Acute Disease; Bell Palsy; Chronic Disease; Ear Diseases; Face; Facial Nerve; Facial Paralysis; Family Practice; Humans; Northern Ireland; Otitis Media; Otitis Media, Suppurative; Otolaryngology; Paralysis; Prognosis; United Kingdom
PubMed: 14371586
DOI: No ID Found