1/16. Bilateral contemporaneous posteroventral pallidotomy for the treatment of Parkinson's disease: neuropsychological and neurological side effects. Report of four cases and review of the literature.The authors report the underestimated cognitive, mood, and behavioral complications in patients who have undergone bilateral contemporaneous pallidotomy, as seen in their early experience with functional neurosurgery for Parkinson's disease (PD) that is accompanied by severe motor fluctuations before pallidal stimulation. Four patients, not suffering from dementia, with advanced (Hoehn and Yahr Stages III-IV), medically untreatable PD featuring severe "on-off" fluctuations underwent bilateral contemporaneous posteroventral pallidotomy (PVP). All patients were evaluated according to the Core Assessment Program for Intracerebral Transplantations (CAPIT) protocol without positron emission tomography scans but with additional neuropsychological cognitive, mood, and behavior testing. For the first 3 to 6 months postoperatively, all patients showed a mean improvement of motor scores on the Unified Parkinson's disease Rating Scale (UPDRS), in the best "on" (21%) and worst "off" (40%) UPDRS III motor subscale, a mean 30% improvement in the UPDRS II activities of daily living (ADL) subscore, and 60% on the UPDRS IV complications of treatment subscale. Dyskinesia disappeared almost completely, and the mean daily duration of the off time was reduced by an average of 60%. Despite these good results in the CAPIT scores, one patient experienced a partially regressive corticobulbar syndrome with dysphagia, dysarthria, and increased drooling. No emotional lability was found in this patient, but he did demonstrate severe bilateral postoperative pretarsal blepharospasm (apraxia of eyelid opening), which interfered with walking and which required treatment with high-dose subcutaneous injections of botulinum toxin. No patient showed visual field defects or hemiparesis, but postoperative depression, changes in personality, behavior, and executive functions were seen in two individuals. Postoperative abulia was reported by the family of one patient, who lost his preoperative aggressiveness and drive in terms of ADL, speech, business, family life, and hobbies, and became more sleepy and fatigued. One patient reported postoperative mental automatisms, such as compulsive mental counting, and circular thoughts and reasoning during off phases; postoperative depression was found in two patients. However, none of the patients demonstrated these symptoms during intraoperative microelectrode stimulation. These findings are compatible with previous reports on bilateral pallidal lesions. A progressive lowering of UPDRS subscores was seen after 12 months, consistent with the progression of the disease. Bilateral simultaneous pallidotomy may be followed by emotional, behavioral, and cognitive deficits such as depression, obsessive-compulsive disorders, and loss of psychic autoactivation-abulia, as well as disabling corticobulbar dysfunction and apraxia of eyelid opening, in addition to previously described motor and visual field deficits, which make this surgery undesirable even though significant improvement in motor deficits can be achieved.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/16. multiple sclerosis with caudate lesions on MRI.A 31-year-old woman displayed sleepiness and impairment of recent memory. T2-weighted MRI revealed high signal intensity lesions in the bilateral basal ganglia, thalamus, and brainstem. Although remission was achieved with corticosteroid therapy, she again displayed memory dysfunction and emotional disturbance one year later, at which time MRI disclosed new lesions in the right caudate nucleus and left frontal white matter. Corticosteroid therapy lead to improvement, and she suffered no recurrence on maintenance steroid therapy. These findings suggest that caudate lesions do occur in multiple sclerosis, the manifestations of which can be abulia and memory dysfunction, as in the present case.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
3/16. Management of dysphagia in inclusion body myositis.Inclusion body myositis is an inflammatory myopathy in which dysphagia has been considered a rare finding. However, recent literature finds dysphagia an increasingly common symptom as more cases of inclusion body myositis are identified. Unlike some inflammatory myopathic disorders, inclusion body myositis is resistant to treatment with corticosteroids, and therefore, the otolaryngologist may be consulted regarding surgical options for relief of dysphagia. A patient is described in whom severe progressive dysphagia associated with inclusion body myositis developed. Impaired pharyngeal wall motion and cricopharyngeal achalasia were demonstrated by videofluoroscopic evaluation, and the patient was successfully treated by cricopharyngeal myotomy. The pathophysiologic nature of inclusion body myositis and the mechanisms of cervical dysphagia in the inflammatory myopathies are reviewed.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
4/16. Diffuse idiopathic skeletal hyperostosis: an uncommon case of dysphagia in an older adult.Diffuse idiopathic skeletal hyperostosis (DISH) is a common disorder among older adults. It is characterized by ossification of the anterior longitudinal ligament of the spine and various extra-spinal ligaments. Although stiffness and decreased range of motion of the spine are the most common clinical presentations of DISH, extra-skeletal manifestations may also be present. We report the case of a 65-year-old man complaining of progressive dysphagia due to DISH. barium swallow showed compression and lateral displacement of the cervical tract of the esophagus, secondary to compression by a large osteophyte. The patient received medical treatment with COX-2 inhibitors and liquid diet. In conclusion, DISH should be considered an important, although rare, cause of dysphagia among older adults. However, it should not be accepted as the cause of dysphagia until all other causes have been ruled out.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
5/16. Long term follow-up of diffuse idiopathic skeletal hyperostosis in the cervical spine. Analysis of progression of ossification.In eleven patients with diffuse idiopathic skeletal hyperostosis who presented with extensive ossification in the cervical spine, progression or regression of ossification during the follow-up period were measured in extent and thickness radiographically. Intervertebral range of motion was also measured and the relation between changes of ossification and intervertebral mobility was analyzed. The range of motion at the segments at which ossification progressed was statistically quite different from those at which no progression was observed. It was found that ossification grew in thickness at mobile segments and no growth of ossification was present at immobile segments. Dysphagia caused by massive ossification was cured by surgical removal in two cases. Recurrent ossifications were detected in them some years after surgery, and one of them complained of dysphagia again. To prevent recurrent ossification and dysphagia, it was considered that immobilization of the concerned segment was necessary by bone grafting or preservation of the continuity of ossification.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/16. Cricopharyngeal dysfunction in chronic obstructive pulmonary disease.Dysphagia due to cricopharyngeal dysfunction is well known; however, there have been no previous data indicating an association between cricopharyngeal dysfunction and COPD. After observing marked cricopharyngeal dysfunction with aspiration in three patients who had frequent and severe exacerbations of COPD, we performed pharyngoesophageal examinations with videotaping in another 22 nonrandomized patients. cineradiography or videofluoroscopic recording with capabilities of slow-motion and freeze-frame playback is mandatory, since the transit time of the bolus through the pharynx is rapid. Severe cricopharyngeal dysfunction was observed in 17 elderly patients with COPD. deglutition disorders were elicited by careful questioning in 15 of these. In eight subjects, cricopharyngeal myotomy resulted in improvement of swallowing and complete or partial relief of acute exacerbations of respiratory distress. In one subject, myotomy relieved only the swallowing problem. The mechanism of cricopharyngeal dysfunction in elderly patients with COPD is unknown at this time, but may be related to gastroesophageal reflux, therapeutic agents, and/or alterations in pharyngoesophageal anatomic structures. We conclude that investigations for swallowing disorders should be considered in patients with COPD who have frequent acute exacerbations of respiratory distress.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
7/16. mastication in patients treated for head and neck cancer: a pilot study.patients with head and neck cancer will experience alteration of oral anatomy and physiology caused by the disease and the treatment required. Despite the implied effects on the dynamics of mastication, objective studies have not been conducted to evaluate masticatory function of these patients. Masticatory performance and swallowing threshold performance were evaluated with Frito corn chips as the test substance. Edentulous patients treated for cancer demonstrated deficiencies in both tests. Masticatory performance and swallowing threshold performance improved with prosthodontic rehabilitation but this improvement was less than with comparable controls. Techniques to evaluate masticatory factors such as dentition, dentures, biting force, temporomandibular joint status, range of motion, and saliva are suggested.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
8/16. An integrated team approach to the management of patients with oropharyngeal dysphagia.This paper describes a team approach to the assessment and management of patients with oropharyngeal dysphagia of neurologic origin. The team's major focus was to determine the need for adjustments to the patient's diet to maintain or restore the safety of oral feeding. This involved the development of a detailed radiographic examination and a series of dysphagia diets, in addition to comprehensive evaluations by an occupational therapist, physiotherapist, and speech pathologist. The effects of deteriorating swallowing ability on the physical, cognitive, and emotional status of the patient are discussed in the context of a multidisciplinary approach.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
9/16. Progressive speech deterioration and dysphagia in amyotrophic lateral sclerosis: case report.amyotrophic lateral sclerosis (ALS) is a degenerative neurologic disease having both upper and lower motor neuron signs and symptoms. When the speech musculature is involved, a mixed dysarthria and dysphagia usually result. In a 49-year-old man with ALS, dysarthria and dysphagia progressed from mild to severe forms over 17 months. Eleven months after the patient first experienced symptoms, neurologic examination showed fasciculations of the extremities and tongue, limb weakness, and hyperreflexia of the limbs and velopharyngeal mechanism. tongue strength was one-fourth that of normal. Lingual alternate motions rates for consonant-vowel syllables were also reduced. To enhance lingual strength and swallowing, a tongue-strengthening program was developed for use with articulation training; to augment velopharyngeal function, a palatal lift was fitted; and to increase extremity strength, physical therapy was initiated. Six months after the initial neurologic examination, medical and speech reevaluation showed progressive weakness of the body parts affected initially; continued decline in tongue strength and lingual alternate motion rate; hypoactive reflex activity, indicative of progressive involvement of the lower motor neuron system; and continued deterioration of articulation and phonation owing to the progressive nature of the disease.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/16. Anterolateral extrapharyngeal approach for cervical osteophyte-induced dysphagia. literature review.While it is estimated that hypertrophic cervical osteophytes occur in up to 20% to 30% of the population, they are only rarely associated with dysphagia. Pathophysiologically, dysphagia may occur secondary to 1) mechanical compression with partial obstruction, or 2) periesophageal inflammation caused by pharyngoesophageal motion over the osteophytes. A careful history, indirect laryngoscopy, cineesophagography, and lateral cervical spine films establish the diagnosis in most patients. While routine rigid endoscopy is potentially hazardous in view of the recognized risk of inadvertent pharyngoesophageal perforation, it may be necessary in selected patients to rule out the presence of other more common causes of dysphagia. Conservative management consisting of sedation, antiinflammatory medication, and reassurance is often sufficient in patients with only mild to moderate and often transient symptoms. The value of surgical therapy for this disorder has been debated, but most agree that surgical excision is appropriate in selected patients whose symptoms are severe and progressive. In this report, two patients illustrate the dichotomy between and value of both conservative and surgical approaches. While both transoropharyngeal and transcervical extrapharyngeal surgical approaches have been used, a comprehensive review of the results of such procedures has not been reported. In this report a detailed description of the anterolateral extrapharyngeal approach for the excision of these osteophytes is given, and its value compared to other surgical techniques discussed.- - - - - - - - - - ranking = 0.5keywords = motion (Clic here for more details about this article) |
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