1/21. Delayed facial paralysis after stapedotomy using KTP laser.OBJECTIVE: Delayed facial paralysis after stapes surgery is uncommon and has been reported after traditional, nonlaser techniques for stapedotomy. The purpose of this paper is to inform the reader of the potential risk of delayed facial nerve paralysis associated with the use of the potassium titanyl phosphate (KTP) laser for stapedotomy. Etiologic mechanisms are discussed. STUDY DESIGN: The study was a descriptive study-case report. SETTING: The study was conducted at a university-based otologic practice. patients: Two patients with otosclerosis and delayed onset facial palsy 5 to 7 days after uncomplicated stapedotomy using the KTP laser were included in the study. INTERVENTION: potassium titanyl phosphate laser stapedotomy was performed. patients received treatment of facial palsy with a tapering course of oral steroids. MAIN OUTCOME MEASURE: House-Brackmann facial nerve grade scores were used. RESULTS: Improvement of House-Brackmann facial nerve scores from Grade VI to Grade I-II in one patient, and improvement from Grade IV to Grade I-II in the other was seen. CONCLUSION: The probable etiology of delayed facial palsy is viral neuritis from reactivation of dormant virus within the facial nerve, initiated by thermal stress of the KTP laser. Presentation and resolution of the facial palsy is similar to other types of delayed facial palsy resulting from nonlaser techniques of stapes surgery and other types of middle ear and neurotologic surgeries previously reported.- - - - - - - - - - ranking = 1keywords = paralysis, palsy (Clic here for more details about this article) |
2/21. Bilateral facial paralysis: a case presentation and literature review.Bilateral facial paralysis is a diagnostic challenge, which may manifest itself as either a simultaneous or alternating form, occurring in 0.3-2.0% of patients that present with facial paralysis. The differential diagnosis of facial paralysis includes congenital, traumatic, neurologic, infectious, metabolic, neoplastic, toxic, iatrogenic and idiopathic etiologies. While idiopathic facial paralysis is the most common diagnosis, a comprehensive evaluation must be completed prior to this diagnosis in patients with bilateral facial paralysis. A representative case of simultaneous bilateral facial paralysis is presented. The literature is reviewed and discussed. A diagnostic protocol for the evaluation of bilateral facial paralysis is proposed. Bilateral facial paralysis requires a thorough evaluation and may prove to be a diagnostic dilemma.- - - - - - - - - - ranking = 1.527256388817keywords = paralysis (Clic here for more details about this article) |
3/21. Motor and sensory polyneuritis with distal conduction failure as uncommon complication of an acute rickettsia conorii infection.rickettsia conorii is endemic in the mediterranean region. Infections are mostly benign and neurological involvement is unusual. We describe a case of a man who presented with acute facial nerve palsy followed by flaccid tetraparesis due to an electrophysiologically established polyneuritis with distal conduction failure. Elevated IgM antibody titres for R. conorii were documented by indirect immunofluorescent antibody test. After doxycycline therapy, the patient presented a rapid clinical improvement. Repeated electrophysiological examinations revealed significantly restored compound muscles, and sensory action potentials, corresponding to the clinical course after treatment and ex juvantibus, indicate the causative relation between R. conorii infection and the described clinical syndrome.- - - - - - - - - - ranking = 0.047274361118299keywords = palsy (Clic here for more details about this article) |
4/21. Histopathology of Bell's palsy.The histopathology of the facial nerve 1 week after the onset of Bell's palsy is reported. The entire nerve was infiltrated by inflammatory cells. Myelin breakdown, axonal changes, and edema were present, suggesting viral neuritis. The role of decompression in this disease process is discussed.- - - - - - - - - - ranking = 0.23637180559149keywords = palsy (Clic here for more details about this article) |
5/21. The Ramsay Hunt syndrome: a dynamic demonstration of applied anatomy.The clinical features of herpes zoster of the geniculate ganglion were reviewed and related to the functional anatomy of the seventh cranial nerve. An illustrative case highlights many of the features of the syndrome that was first described by Ramsay Hunt. The significance of facial palsy is discussed in the light of its distribution.- - - - - - - - - - ranking = 0.047274361118299keywords = palsy (Clic here for more details about this article) |
6/21. neuritis cordis due to the acute polyneuritis of the guillain-barre syndrome.Three patients with the guillain-barre syndrome which followed the course of Landry's acute ascending paralysis died a sudden cardiac death. Autonomic dysfunction had appeared clinically, consisting of sphincter disturbances in one patient and fluctuating blood pressure and bradycardia in the other. In a twenty-three year old female patient cardiac function had been inconspicuous, apart from tachycardia, but the ECG showed S-T segment depression and flat T waves. Postmortem examination revealed acute inflammatory demyelinating polyradiculoneuritis involving the peripheral autonomic nervous system and especially the nerves of the heart. Immunohistochemically, the inflammatory cell infiltrations of this neuritis cordis consisted of macrophages (MAC 387 positive) and T lymphocytes (UCHL1 positive). No indication of a direct viral infection of the inflamed cardiac nerves was detectable by immunohistochemistry (HSV, CMV, influenza virus) nor by electron microscopy. The neuritis cordis was classified as an inflammatory cardio-neuropathy secondary to a patchy acute polyneuritis of the guillain-barre syndrome, involving the autonomic nervous system. myocarditis could be discounted, and the neuritis cordis was thought to be responsible for the sudden cardiac death.- - - - - - - - - - ranking = 0.12727136573475keywords = paralysis (Clic here for more details about this article) |
7/21. Paralytic brachial neuritis or Parsonage-turner syndrome anterior interosseous nerve involvement. Report of three cases.Paralytic brachial neuritis or Parsonage-turner syndrome principally involves the shoulder girdle, rarely muscles moving the hand and fingers. Three cases are reported. After an acute episode with severe pain in the arm and fore-arm there appeared, a palsy of flexor pollicis longus and flexor indicis profundus, due to an isolated lesion of the anterior interosseous nerve. Two cases spontaneously recovered their full function, the third incompletely. Delay in recovery may be long; more than two years. Mechanical nerve entrapement should not be confused with this syndrome.- - - - - - - - - - ranking = 0.047274361118299keywords = palsy (Clic here for more details about this article) |
8/21. A combination of cranial and peripheral nerve palsies in infectious mononucleosis.A 44 year old woman presented with bilateral brachial neuritis and an isolated Bell's palsy. Subsequently she was found to have infectious mononucleosis. The association of cranial and brachial neuropathy has not previously been reported. Without any specific drug therapy she recovered completely within 5 months.- - - - - - - - - - ranking = 0.047274361118299keywords = palsy (Clic here for more details about this article) |
9/21. Post mastectomy pain after brachial plexus palsy: metastases or radiation neuritis?Three patients have been reported who developed metastatic tumour within the neural tissue of the brachial plexus three years, four years and fourteen years respectively after treatment of breast carcinoma by simple mastectomy and postoperative radiotherapy. A fourth patient who developed bilateral upper limb paralysis after radiotherapy for a lymphoma is also reported. At exploration of the brachial plexus extensive fibrosis was present in all cases with metastases only diagnosed through biopsy of neural tissue. The clinical features and the role of surgery are discussed in the light of our experience and a review of available literature.- - - - - - - - - - ranking = 0.31636881020795keywords = paralysis, palsy (Clic here for more details about this article) |
10/21. Brachial neuritis involving the bilateral phrenic nerves.Brachial neuritis with bilateral hemidiaphragmatic paralysis has been reported in two previous cases in the literature. We report a patient who experienced severe right shoulder discomfort three weeks prior to hospital admission which evolved to include both shoulders. Two weeks prior to admission he noticed the onset of discomfort in breathing in the supine position and shortness of breath with minor exertion. The admitting diagnoses were myocardial infarction due to significant ECG changes and idiopathic elevated bilateral hemidiaphragms. The patient had findings significant for tachypnea, dyspnea, decreased breath sounds at the bases bilaterally, impaired motion of the bilateral lung bases on inspiration and paradoxical respirations. Comprehensive medical testing and evaluation revealed bilateral elevated hemidiaphragms and vital capacity 40% of normal. Weakness of the proximal shoulder girdle and bicep musculature bilaterally was noted. electromyography was significant for reduced recruitment pattern in the bilateral shoulder girdle musculature. Nerve conduction studies suggested bilateral phrenic neuropathy. This case is an unusual presentation of brachial neuritis affecting the bilateral shoulder girdle with phrenic nerve involvement. The differential diagnosis of acute shoulder pain associated with respiratory symptomatology should therefore include brachial neuritis.- - - - - - - - - - ranking = 0.12727136573475keywords = paralysis (Clic here for more details about this article) |
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