1/16. Superselective neurectomy with periorbital primary reconstruction for blepharospasm. Case report.A 66-year old man with blepharospasm and ptosis of the brow was treated with a combined procedure in which the branches of the facial nerve were excised at the margin of the orbicularis, and the periorbital area was reconstructed simultaneously. The condition improved after the treatment with no occurrence of either oral complications or facial anaesthesia.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/16. Blepharoclonus and arnold-chiari malformation.OBJECTIVE: Blepharoclonus (BLC) denotes a large amplitude, involuntary tremors of the orbicularis oculi muscles, observed during gentle closure of the eyelids. BLC may follow major head trauma. Four patients with arnold-chiari malformation (ACM) and BLC are described. MATERIALS AND methods: The first patient had facial numbness for 5 months; the remaining patients had headaches following minor head or cervical spinal injuries. brain magnetic resonance imaging (MRI), electroencephalogram (EEG) blink reflexes, mental and facial nerve responses and facial electromyogram (EMG) were performed. RESULTS: All patients exhibited ACM on brain MRI. The first patient had coincidental dural venous malformation, empty-sella turcica and familial digital dysplasia. She exhibited oculopterygoid synkinesis. The last 3 patients had posttraumatic headache; the second and third patients had limited features of ehlers-danlos syndrome (EDS). The second patient had cervical spinal fusion and the fourth a cervical syrinx. All the patients had BLC on gentle eyelid closure. CONCLUSION: BLC is an underdiagnosed neuro-ophthalmological sign of ACM.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
3/16. Treatment of aberrant facial nerve regeneration with botulinum toxin A.PURPOSE: To assess the effect and efficacy of botulinum toxin type A (BTX-A) at reducing and maintaining eyelid synkinesia in aberrant facial nerve regeneration, while concurrently observing for the presence of side effects to differing treatment doses. methods: A prospective interventional study of five patients with eyelid synkinesia resulting from aberrant regeneration of the facial nerve. patients were treated with injections of either 120, 80 or 40 units of BTX-A (Dysport) into the orbicularis oculi. Objective and subjective reduction in synkinesia, maintenance of response and presence of side effects were recorded. RESULTS: All five patients had improvement of the synkinesia with BTX-A treatment. Lower doses were found to be as effective as higher doses. Mean duration of abolished synkinesia was three months. Two patients developed a ptosis which resolved spontaneously. None of the patients treated with the lowest dose of 40 units developed a ptosis. CONCLUSION: Low-dose BTX-A has a lower incidence of ptosis and is effective in the treatment of aberrant facial nerve regeneration.- - - - - - - - - - ranking = 7keywords = nerve (Clic here for more details about this article) |
4/16. hemifacial spasm due to peripheral injury of facial nerve: a nuclear syndrome?Four cases of hemifacial spasm (HFS) are reported. The spasm followed a few months after injury to a peripheral branch of the seventh nerve. An EMG examination of facial muscles disclosed the typical finding of HFS: spontaneous activity, paradoxical cocontraction, and diffusion of spontaneous or provoked blinking. A nuclear involvement, secondary to the nerve lesion, is the most likely pathophysiological explanation for similar cases in HFS.- - - - - - - - - - ranking = 6keywords = nerve (Clic here for more details about this article) |
5/16. Bell's palsy-induced blepharospasm relieved by passive eyelid closure and responsive to apomorphine.OBJECTIVE: We describe the case of a woman with Bell's Palsy-induced blepharospasm (BPIB) of the right eye that appeared simultaneously with a complete left facial nerve palsy. The involuntary spasm was relieved by passive lowering of the upper eyelid on the paretic side. methods: The recovery curve of the blink reflex was evaluated on the non-paretic side in baseline conditions, after subcutaneous apomorphine and placebo administration and 8 months later, at recovery from the palsy. RESULTS: We found increased recovery of the test-R2 responses at short interstimulus intervals at baseline, which was normalised by apomorphine but not by placebo. At recovery the blink reflex R2 recovery curve returned to normal. CONCLUSIONS: This report demonstrates for the first time a response of BPIB to a dopamine agonist. SIGNIFICANCE: Our findings are in agreement with an animal model of blepharospasm that suggests a combined role of weakness of the orbicularis oculi muscle and a dysfunction of the dopaminergic system in the pathogenesis of this disorder.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
6/16. Stretch reflex blepharospasm.We studied a patient with blepharospasm provoked by stretching the orbicularis oculi muscles. With the eyes closed, EMG of the orbicularis oculi at rest revealed spontaneous rhythmic muscle activity that was not visible. When she tried to open her eyes, repetitive jerking blepharoclonus and tonic blepharospasm rendered her functionally blind. Passive stretching of the orbicularis oculi evoked a burst of EMG activity with two components. touch or pinprick did not elicit such reflex activity. anesthesia of the supraorbital nerves abolished muscle responses to stretch and improved the blepharospasm.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
7/16. Motor tics of the head and neck: surgical approaches and their complications.Motor tics of the head and neck, especially hemifacial spasm and spastic torticollis, are the substance of this paper. Forty-six cases are presented, and surgical techniques are described. In hemifacial spasm the intracranial neurovascular lysis of Jannetta is a valid operation with the best results to date but has a 7 1/2% risk of unilateral deafness. The extracranial submastoid partial section of Scoville is completely safe and gives excellent results, but there is a probability of mild to moderate return of the spasm in one to two year's time. In spastic torticollis the accepted radical operation consists of bilateral anterior rhizotomy of the upper three roots plus bilateral spinal accessory nerve section in the neck. A tragic complication of this operation has recently been observed by ourselves, Sweet, and Hamlin. This complication is bilateral infarction of the medulla (bilateral Wallenberg's syndrome). This has also been reported as occurring following chiropractic manipulations. For this reason the writer does limited unilateral sectioning of the spinal accessory nerve in the neck and resection of the upper third of the sternomastoid muscle, as a first stage procedure, in those cases in which rotation of the neck is the principal symptom, before doing the radical operation. Safeguards to prevent this complication include preoperative vertebral arteriography and preservation of both motor and sensory radicular arteries under magnification and maintenance of adequate neck support during the early postoperative days.- - - - - - - - - - ranking = 2keywords = nerve (Clic here for more details about this article) |
8/16. facial nerve disorders: anatomical, histological and clinical aspects.Three main problems of facial nerve pathology and surgery are considered in this paper. The intraneural anatomy of the facial nerve with its consequences for surgery, especially surgery for facial hyperkinesia, is studied and an original method of selective funicular neurolysis is proposed as a symptomatic operation. Quantitative and qualitative findings in the normal facial nerve are compared to findings in nerves after palsy. The results show that the introduction of neurometric methods for the quantitative assessment may yield further parameters in the judgement of past pathological processes within the nerve. Finally, prognosis of peripheral facial palsy, seen through electrophysiological testing methods, is discussed.- - - - - - - - - - ranking = 9keywords = nerve (Clic here for more details about this article) |
9/16. blepharospasm associated with brainstem lesions.We studied six patients with clinical and radiographic evidence of rostral brainstem lesion and bilateral blepharospasm. Two patients also had other facial dystonic movements. Four patients suffered rostral brainstem strokes, and two had multiple sclerosis. None had been treated with antipsychotic drugs prior to the onset of blepharospasm. Medical treatment was helpful in two patients, and bilateral selective facial nerve section was used in another patient. Possible pathogenic mechanisms are discussed.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
10/16. blepharospasm--oromandibular dystonia (Meige's syndrome) misdiagnosed as secondary hemifacial spasm.Orofacial dyskinesia (Meige's syndrome) is a rare clinical entity. This disorder was first described in 1910 by Henry Meige as "spasm facial median," a disabling spasm of the facial musculature which had frequently been misdiagnosed and inappropriately treated. This report concerns a patient who presented with tonic hemifacial spasm twenty-two years after contracting Bell's palsy. The condition was initially thought to be secondary to faulty regeneration of the facial nerve until Meige's syndrome became fully manifested over a period of two years. The diagnostic characteristics as well as the forms of treatment for this unusual disorder are presented.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
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