1/6. Mobius and Mobius-like patients: etiology, diagnosis, and treatment options.The surgical goal in Mobius patients is far more modest and differs from patients with unilateral developmental facial paralysis. It is impossible to restore a true smile in these mask-like, expressionless faces. Despite sophisticated microneurovascular transplantations, movement can only be restored along one vector and enhanced firmness in the cheeks, thus multiple differentiated facial animation is not achievable. A detailed neurological evaluation can identify possible motor donors or residual function, which can be used for additional dynamic restorations. Due to the multiple cranial nerve involvement a thorough clinical and electrophysiological examination is mandatory. In addition, electromyographic survey of the potential motor donors is very helpful to avoid weak wasted regeneration and prevent further downgrading of function. Because of the variety of cranial nerves involved in Mobius' syndrome, a standard procedure for dynamic restoration cannot and should not be promoted; instead, a careful preoperative objective and quantitative assessment should guide the reconstructive surgeon to the optimal reconstruction strategy. Useful movement can be restored in afflicted patients that may signal physical and psychological rehabilitation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/6. A neurologist's approach to a patient with hearing impairment.This article is a review of the central auditory pathways from an anatomic and clinical perspective. An approach to the assessment of patients with hearing impairment of central origin is provided. The review of the patient's history, physical examination, and laboratory assessment are dealt with in detail.- - - - - - - - - - ranking = 9.8814130600518keywords = physical examination, physical (Clic here for more details about this article) |
3/6. Acute cranial polyneuritis with vertigo after stapedectomy.Acute vertigo occurring 48 hours after stapedectomy is assumed to be related to inner ear trauma. Similarly, acute vertigo occurring weeks after stapedectomy could be related to a fistula of the oval window. No one has tested the hypothesis that some of these cases could represent concomitant cranial polyneuritis. We report the development after stapedectomy of five cases of acute cranial polyneuritis with vertigo diagnosed by physical examination of the cranial nerves. In another case we determined that vertigo occurring after stapedectomy was not related to concomitant cranial polyneuritis. Although all the patients were treated with corticosteroids, the vertigo resolved within 12 to 24 hours only in those whose vertigo we had ascribed to polyneuritis.- - - - - - - - - - ranking = 9.8814130600518keywords = physical examination, physical (Clic here for more details about this article) |
4/6. Alveolar bone necrosis and tooth loss. a rare complication associated with herpes zoster infection of the fifth cranial nerve.Eleven case reports involving herpes zoster infection associated with alveolar bone necrosis and tooth loss were reviewed in order to develop a patient profile for this rare combination of physical findings. The clinical course of a 56-year-old white woman with herpes zoster infection of the fifth cranial nerve and related alveolar bone necrosis, tooth loss, and oroantral fistula development is reported. The etiology and management of herpes zoster infection associated with destructive oral sequelae are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/6. Complications of posterior fossa craniotomy.The nurse, as primary and continuous accessor of the patient, must have a thorough knowledge of complications related to posterior fossa surgery. Continuous evaluation of neuro status will alert her to any changes. These changes can occur quickly and require immediate intervention to prevent life-threatening situations. Attentive nursing care, both physiological and psychological, with utilization of other health care team members (social service, mental health counselors, physical and occupational therapy) can ensure a more secure recuperative period.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/6. Isolated vagal nerve palsy associated with a dissection of the extracranial internal carotid artery.A 40-year-old man had paralysis of the right vocal cord. Imaging showed a dissection of the extracranial internal carotid artery, and physical examination disclosed paresis of the right side of the soft palate. To our knowledge, this is only the second report of carotid dissection presenting as an isolated vagal neuropathy. Most often, multiple lower cranial nerves are involved. The CT, MR imaging, and MR angiographic findings are presented and the topic is reviewed.- - - - - - - - - - ranking = 9.8814130600518keywords = physical examination, physical (Clic here for more details about this article) |