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Strabismus Dec 2021While most cases of superior oblique (SO) hypofunction represent contractile weakness due to denervation, sometimes the lesion is exclusively in the tendon. This study...
While most cases of superior oblique (SO) hypofunction represent contractile weakness due to denervation, sometimes the lesion is exclusively in the tendon. This study sought to distinguish the pattern of incomitant strabismus caused by deficiency of SO oculorotary force caused by tendon abnormalities versus that of neurogenic palsy. Clinical and magnetic resonance imaging (MRI) findings of 7 cases of unilateral SO tendon interruption or extirpation were compared with 11 cases of age matched unilateral SO palsy having intact tendons. We compared angles of misalignment with high-resolution MRI in central gaze and deorsumversion. Muscle bellies in neurogenic palsy were markedly atrophic with maximal cross sections averaging 6.5 ± 2.7 mm, in contrast with 13.5 ± 3.0 mm contralesionally ( < .0001). In contrast, SO muscle bellies ipsilateral to tendon interruption had maximum cross sections averaging 15.1 ± 3.0 mm occurring more posterior than on the contralesional side whose maximum averaged 12.1 ± 2.4 mm. While cross sections of SO bellies ipsilateral to tendon interruption exhibited normal contractile increase in infraduction ( < .0005), there was nevertheless strabismus with incomitance similar to that in SO atrophy. Binocular alignment was statistically similar ( > .5) in the two groups for all diagnostic positions, including head tilt, except in deorsumversion, where cases with SO tendon abnormalities averaged 20.5 ± 6.9Δ ipsilateral hypertropia, significantly more than 8.5 ± 6.6Δ in neurogenic SO atrophy ( = .001). The average difference in hypertropia Hypertropia averaged 9D greater in deorsumversion than central gaze in tendon abnormalities, but 4.1Δ less in SO atrophy (P< .019). In contralesional version, average overelevation in adduction was 1.7 (scale of 0-4) in tendon abnormalities, and 2.6 in SO atrophy ( = .23), while average underdepression in adduction was -2.3 in cases of tendon abnormalities and -1.6 in SO atrophy ( = .82). Repair of the SO tendon in three cases was effective, while alternative procedures were performed when repair was infeasible. While both denervation and tendon interruption impair SO oculorotary function, interruption causes greater hypertropia in infraversion. Surgical tightening of interrupted SO tendons may have particularly gratifying effects. Posterior SO thickening and large hypertropia in infraversion suggest SO tendon interruption that may guide a surgical strategy of tendon repair.
Topics: Atrophy; Humans; Oculomotor Muscles; Paralysis; Strabismus; Tendons; Trochlear Nerve Diseases
PubMed: 34787034
DOI: 10.1080/09273972.2021.1987931 -
Acta Orthopaedica Et Traumatologica... Dec 2021The aim of this study was to clarify the cut-off values of the spinal canal parameters as risk factors for C5 palsy after posterior cervical spine surgery with and...
OBJECTIVE
The aim of this study was to clarify the cut-off values of the spinal canal parameters as risk factors for C5 palsy after posterior cervical spine surgery with and without foraminotomy.
METHODS
One hundred three consecutive patients (67 males, 36 females; mean age = 66 years, age range = 27-87 years) with cervical myelopathy who underwent posterior cervical spine surgery at our institution were retrospectively reviewed and included in the study. The first consecutive 69 patients who underwent posterior cervical spine surgery with prophylactic bilateral C4/5 foraminotomy were designated as the F (+) group. The subsequent 34 consecutive patients who underwent posterior cervical spine surgery without prophylactic bilateral C4/5 foraminotomy were designated as the F (-) group. All patients were then divided into four subgroups. In the F (+) group, patients with C5 palsy were designated as the F (+) P (+) subgroup (n = 13), while those without C5 palsy were designated as the F (+) P (-) subgroup (n = 56). In the F (-) group, patients with C5 palsy were designated as the F (-) P (+) subgroup (n = 5), while those without C5 palsy were designated as the F (-)P(-) subgroup (n = 29). Receiver operating characteristic curves were used to investigate the cut-off values of the spinal canal parameters for the development of postoperative C5 palsy. The assessed spinal parameters were the gutter positions (GP), laminar inclination angles (LIA), and postoperative cross-sectional areas (CSA) of the dural sac. The risk ratios (RR) of the spinal canal parameters as risk factors for C5 palsy were evaluated.
RESULTS
The incidence of C5 palsy was similar between the F (+) group (18.8%) and the F (-) group (14.7%). The cut-off values for each spinal canal parameter in the F (+) group (GP: 0.82-0.84, LIA: 58.9-62.4°, and CSA: 189.5-200 mm2 ) were similar to those in the F (-) group (0.81-0.89, 61.7-62.5°, and 197.5-199.5 mm2, respectively). In the RR results for C5 palsy, the LIA was highest in both groups. The F (+) P (-) subgroup had significantly larger mean CSA at C4/5 and C5/6 (202.3 mm2 and 200.9 mm2, respectively) than the F (-)P(-) subgroup (177.3 mm2 and 178.9 mm2, respectively) (P = 0.0181 and P = 0.0277, respectively). Prophylactic C4/5 foraminotomy did not specifically prevent postoperative C5 palsy due to foraminal stenosis at C4/5.
CONCLUSION
C4/5 foraminotomy should not be recommended for avoidance of C5 palsy. Although the bony spinal parameters were similar between the F (+) and F (-) groups, the CSA in the F (+) group was significantly than that in the F (-) group in the patients without C5 palsy.
Topics: Adult; Aged; Aged, 80 and over; Cervical Vertebrae; Decompression, Surgical; Female; Foraminotomy; Humans; Male; Middle Aged; Paralysis; Postoperative Complications; Retrospective Studies
PubMed: 34967742
DOI: 10.5152/j.aott.2021.21239 -
Anesthesiology Apr 2010
Review
Topics: Anesthesia; Anesthesia Recovery Period; Brain Damage, Chronic; Humans; Monitoring, Intraoperative; Nerve Block; Neuromuscular Nondepolarizing Agents; Paralysis; Postoperative Complications; Respiratory Tract Diseases
PubMed: 20234315
DOI: 10.1097/ALN.0b013e3181cded07 -
Proceedings of the Royal Society of... Jun 1948
Topics: Cerebral Palsy; Humans; Paralysis
PubMed: 18864738
DOI: No ID Found -
Hawai'i Journal of Health & Social... Mar 2022Femoral nerve palsy is a rare but devastating complication of anterior total hip arthroplasty. Its etiology is still unknown, but several studies have suggested that...
Femoral nerve palsy is a rare but devastating complication of anterior total hip arthroplasty. Its etiology is still unknown, but several studies have suggested that anterior acetabular retractors may place the femoral nerve at increased risk. This study hypothesized that hip extension and traction places tension on the femoral nerve, offering an additional explanation for the development of femoral nerve palsy. A spring device was secured across 6 transected femoral nerves from 5 lower extremity cadavers and the hip was extended and pulled into traction with and without retractor placement. The change in spring length was used to determine femoral nerve tension. The average spring length changed +8.83 mm with hip extension, +3.73 mm with traction, -0.7 mm with traction and placement of the anterior acetabular retractor, and -1.15 mm with extension and placement of the femoral retractor. Femoral nerve tension was greatest with hip extension followed by traction. Acetabular and femoral retractor placement decreased average femoral nerve tension in both traction and hip extension. This may be due to medialization of the femoral nerve by the retractors, reducing the overall distance traveled, and thereby reducing tension. Previous studies have found femoral nerve pressure to be greatest during anterior acetabular retractor placement. It is likely that both pressure and tension contribute to femoral nerve palsy. Careful retractor placement, staying safely on anterior acetabular bone, and efficient femoral preparation to decrease time under hip extension and traction may help to minimize the risk of femoral nerve palsy.
Topics: Acetabulum; Arthroplasty, Replacement, Hip; Cadaver; Femoral Nerve; Humans; Paralysis
PubMed: 35340935
DOI: No ID Found -
BMJ Case Reports May 2011The authors report an unusual case of post extubation stridor resulting in insertion of a tracheostomy. Regional anaesthesia using interscalene nerve blockade in the...
The authors report an unusual case of post extubation stridor resulting in insertion of a tracheostomy. Regional anaesthesia using interscalene nerve blockade in the presence of an unrecognised contralateral recurrent laryngeal nerve palsy resulted in bilateral recurrent laryngeal nerve palsies. The authors discuss the differential causes of stridor and recurrent laryngeal nerve palsy, their importance and way of identification on preoperative assessment.
Topics: Aged; Airway Extubation; Fatal Outcome; Female; Humans; Respiratory Sounds; Tracheostomy; Vocal Cord Paralysis
PubMed: 22689277
DOI: 10.1136/bcr.06.2011.4374 -
Anales de Pediatria (Barcelona, Spain :... Dec 2003Idiopathic velopalatine palsy is a condition of unknown etiology and is rarely seen in childhood. Consequently, diagnosis requires a high degree of suspicion. We report... (Review)
Review
Idiopathic velopalatine palsy is a condition of unknown etiology and is rarely seen in childhood. Consequently, diagnosis requires a high degree of suspicion. We report a case of sudden onset dysfunction of the lower cranial pairs (IX and X) in a 5-year-old girl who was previously asymptomatic. The clinical course was favorable and the results of complementary investigations were normal and the patient was diagnosed with velopalatine palsy. Based on this case, we aim to report our experience of this condition and provide a review of the literature. This disease should be suspected in patients aged between 5 and 15 years old who present a palsy of the IX and X cranial nerves of sudden onset and without any other symptoms in order to rationalize diagnostic and therapeutic tools. Treatment is based on support measures. The prognosis is excellent, with a high percentage of complete recovery and absence of recurrences.
Topics: Child, Preschool; Female; Glossopharyngeal Nerve Diseases; Humans; Paralysis; Velopharyngeal Insufficiency; Vocal Cord Paralysis
PubMed: 14636527
DOI: 10.1016/s1695-4033(03)78786-4 -
Revista de NeurologiaIn this paper we review the main studies conducted on therapy applied to the bony and soft parts in spastic paralysis of the upper extremity. (Review)
Review
AIMS
In this paper we review the main studies conducted on therapy applied to the bony and soft parts in spastic paralysis of the upper extremity.
DEVELOPMENT
Spasticity presents muscular hypertonia and hyperexcitability of the stretch reflex, which are typical of upper motoneuron syndrome. Physiopathologically, spasticity is due to the medullar and supramedullar alteration of the afferent and efferent pathways. Treatment is multidisciplinary and involves the collaboration of rehabilitators, neurophysiologists, neurologists, paediatricians, orthopaedic surgeons and psychologists, who all contribute with their different therapeutic aspects and characteristics (which can be pharmacological, peripheral neurological blockages, surgical, etc.). The characteristic posture of the upper extremities in spastic cerebral palsy is the inward rotation of the shoulder, flexion of the elbow and pronated forearm, and the deformity of the fingers (swan-neck and thumbs-in-palm). The primary objectives in these patients will be to improve communication with their surroundings, perform activities of daily living, increase mobility and walking.
CONCLUSIONS
The surgical treatment applied by orthopaedic surgeons in the upper extremities are aimed at achieving an enhanced adaptive functionality rather than morphological normality. Factors to be taken into account include age, voluntary control over muscles and joints, level of severity of the spasticity (Ashworth scale) and stereognostic sensitivity. In general, on soft parts we will use procedures such as dehiscence or lengthening of the flexor muscles of the shoulder and elbow or of the adductor of the thumb; transfer of the pronators in order to adopt the supinating function or of the flexors so as to reinforce the extensors of the forearm, and capsulodesis or tenodesis in the hand. The bony procedures will consist in derotational osteotomies of the humerus and radius and arthrodesis in the wrist or in the metacarpophalangeal joints of the thumb, depending on whether there is greater rigidity or age in the former cases or instability in the latter.
Topics: Humans; Muscle Spasticity; Neuromuscular Agents; Palliative Care; Paralysis; Upper Extremity
PubMed: 14533096
DOI: No ID Found -
Danish Medical Journal Aug 2022Several infectious aetiologies have been associated with peripheral facial palsy, among others Herpes viridae and Borrelia burgdorferi and, rarely, cases of...
INTRODUCTION
Several infectious aetiologies have been associated with peripheral facial palsy, among others Herpes viridae and Borrelia burgdorferi and, rarely, cases of rickettsiosis. In this study, we prospectively included 19 patients with peripheral facial palsy from the Department of Neurology, University Hospital of Southern Denmark, and 29 healthy controls to examine infectious causes and risk factors of peripheral facial palsy.
METHODS
Patients and controls completed a questionnaire regarding exposures, and the patients' medical files were examined. Serum from patients and controls were tested for antibodies against B. burgdorferi, Rickettsia felis and Rickettsia helvetica. Cerebrospinal fluids were tested using polymerase chain reaction for the presence of herpes simplex virus 1 and 2, herpes zoster virus and spotted fever group rickettsial DNA and for intrathecal production of antibodies against B. burgdorferi with an antibody index test.
RESULTS
One patient was diagnosed with peripheral facial palsy associated with neuroborreliosis with a positive antibody index test but had a negative serological analysis. No patients had evidence of herpes or rickettsial infection. Fourteen out of the 19 patients had symptom onset in the winter months. Preceding myalgia was the only significant difference in symptoms between patients and controls (p = 0.011).
CONCLUSION
Rickettsiosis is unlikely as a common cause of facial palsy in Southern Jutland, Denmark.
FUNDING
The study was supported financially by the Knud and Edith Eriksen Mindefond and the Region of Southern Denmark.
TRIAL REGISTRATION
The study population and the control group were approved by the Regional Committees on Health Research Ethics for Southern Denmark (S-20170136 and S-20170049) and by the Danish Data Protection Agency (17/31901 and 18/28928). All participants provided informed consent before their enrollment in the study.
Topics: Bell Palsy; Denmark; Facial Paralysis; Humans; Polymerase Chain Reaction; Rickettsia Infections
PubMed: 36065885
DOI: No ID Found -
Pain Physician Nov 2022Postoperative upper-limb palsy (ULP) is a serious complication after cervical spine surgery. ULP after posterior percutaneous endoscopic cervical foraminotomy and... (Observational Study)
Observational Study
BACKGROUND
Postoperative upper-limb palsy (ULP) is a serious complication after cervical spine surgery. ULP after posterior percutaneous endoscopic cervical foraminotomy and discectomy (PPCED) has not yet been reported.
OBJECTIVE
To introduce cases of postoperative ULP after PPCED and associated risk factors.
STUDY DESIGN
A single-center, retrospective, observational study.
SETTING
Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
METHODS
From January 2016 through January 2022, PPCED involving a total of 663 segments was performed in 610 patients with radiculopathy who were diagnosed with cervical radiculopathy or mixed cervical spondylosis caused by foraminal stenosis or posterolateral disc herniation.
RESULTS
PPCED was successfully completed in 610 patients, 6 of whom (0.98%) developed ULP. Two patients were diagnosed with double-segment cervical nerve root canal stenosis (C4/5/6, C5/6/7) and 2 with migrated cervical disc soft herniation (a magnetic resonance image of one showed a migrated disc herniation downward from C4/5 in the sagittal plane; another showed this upward from C5/6); one patient was diagnosed with C5/6 intervertebral foraminal stenosis, and one had simple C4/5 lateral disc herniation. Postoperative ULP rates for C4/5 (2/30, 6.67%) and C5/6 (2/177, 1.13%) were much higher than those for the other levels. Anatomically, the width of the intervertebral foramen on computed tomography was 2.3 ± 1.12 mm in ULP cases, which was significantly lower than that in non-ULP cases (3.4 ± 1.83, P < 0.05). This suggests that preoperative foramen width correlates highly negatively with postoperative ULP incidence.
LIMITATIONS
This was a single-center, retrospective, nonrandomized study with a low level of evidence.
CONCLUSIONS
PPCED is a good treatment for cervical radiculopathy. The rate of postoperative ULP after PPCED is much lower than that after posterior cervical foraminotomy. Perturbation to the C5 (or C6) nerve root, thermal injury due to burr use or the radiofrequency applied, and marked foraminal stenosis are possible relevant factors associated with postoperative ULP.
Topics: Humans; Foraminotomy; Intervertebral Disc Displacement; Radiculopathy; Constriction, Pathologic; Retrospective Studies; Cervical Vertebrae; China; Diskectomy; Paralysis; Upper Extremity; Treatment Outcome
PubMed: 36375202
DOI: No ID Found