Abbas, Haider; Kothari, Nikhil; Bogra, Jaishri
Hypokalemic periodic paralysis is a rare genetic disorder characterized by recurrent attacks of skeletal muscle weakness with associated hypokalemia which is precipitated by stress, cold, carbohydrate load, infection, glucose infusion, hypothermia, metabolic alkalosis, anesthesia, and steroids. We encountered one such incidence of prolonged recovery after general anesthesia, which on further evaluation revealed a case of hypokalemic paralysis. The key to successful management of such a patient was vigilant pre-operative evaluation, perioperative monitoring, and aggressive treatment of hypokalemia when it occurs. PMID:23833504
Hyperthyroid periodic paralysis (HPP) is a rare life threatening complication of hyperthyroidism commonly occurring in young Asian males but sporadically found in other races. It is characterised by hypokalemia and acute onset paraparesis with prevalence of one in one hundred thousand (1 in 100000). The symptoms resolve promptly with potassium supplementation. Nonselective beta blockers like propranol can also be used to ameliorate and prevent subsequent paralytic attack. We report a case of 22 year old male presenting with hyperthyroid periodic paralysis (HPP) having very low serum potassium level. PMID:27648066
... paralysis ) that come and go. There is normal muscle strength between attacks. Attacks usually begin in the teen ... prevent, and even reverse, progressive muscle weakness. Although muscle strength starts out normal between attacks, repeated attacks may ...
Areta-Higuera, J D; Algaba-Montes, M; Oviedo-García, A Á
Periodic paralysis is a rare disorder that causes episodes of severe muscle weakness that can be confused with other diseases, including epilepsy or myasthenia gravis. Hyperkalemic and hypokalemic paralysis are included within these diseases, the latter being divided into periodic paralysis (familial, thyrotoxic or sporadic) and non-periodic paralysis. In this regard, we present a case of familial hypokalemic periodic paralysis in an eighteen year-old female who was diagnosed with epilepsy in childhood, as well as a subclinical hypothyroidism (for which she received replacement therapy) months ago. The diagnosis was made by the anamnesis and the confirmation of hypokalemia.
Villar Jiménez, J; Ruiz Serrato, A E; Bautista Galán, C; Guerrero León, M Á
Thyrotoxic hypokalemic periodic paralysis is an uncommon complication of thyrotoxicosis, characterized by attacks of generalized muscular weakness associated with hypokalemia in patients with hyperthyroidism, most frequently with Graves-Basedow disease. Treatment with antithyroid drugs and potassium supplements reversed the symptoms and the episodes of acute muscular weakness did not reappear.
Wang, Wei; Zhao, Chun-yun; Gao, Yan-ming
To explore the clinical features of hypokalemic periodic paralysis, and compare clinical features of primary group with those of thyrotoxicosis secondary group. Clinical data of 44 patients with hypokalemic periodic paralysis in Peking University First Hospital from 1996 December to 2008 December were retrospectively analyzed. There were 22 patients in primary group, and 22 in thyrotoxicosis group. Identical clinical features of both the groups: (1)It had a predilection in young men. (2)Main symptoms were limb movement disorder and fatigue, and paralysis recurrent attacked in most patients. (3) 40.9% to 68.2% patients had obvious incentives, and the common ones were a heavy meal, sweet drinks, or strenuous exercise. (4) Serum potassium levels of the two groups were obviously lower than the normal range. (5)In 20% patients of primary group and 25% patients of thyrotoxicosis secondary group, CK levels were higher than normal, while LDH and HBDH levels were normal. (6)The doses of potassium replishment were not correlated to serum potassium levels at the onset. Different clinical features of the two groups: (1) Patients of thyrotoxicosis group had hypermetabolism symptoms and thyroid dysfunction. Patients of primary group had no hypermetabolism symptoms, and all of them were euthyroid. (2)Serum potassium levels of thyrotoxicosis secondary group were lower than those of primary group significantly [(2.25 +/- 0.67) vs (2.78 +/- 0.49) mmol/L, P=0.007]. (3) Hyperkalemia is easier than primary group to rebound in thyrotoxicosis secondary group, after replenishment of potassium. Hypokalemic periodic paralysis has its clinical features, and patients with early diagnosis and replenishment of potassium in time have good prognosis. The doses of potassium replenishment are not determined by serum potassium levels at the onset. Hyperkalemia is easier to rebound in thyrotoxicosis secondary group after replenishment of potassium, serum potassium levels should be monitored closely
El-Hennawy, Adel S; Nesa, Mushammat; Mahmood, Aza K
Thyrotoxic hypokalemic periodic paralysis is an uncommon disorder characterized by elevated thyroid hormone, muscle weakness or paralysis, and intracellular shifts of potassium leading to hypokalemia. This article presents a case of thyrotoxic hypokalemic periodic paralysis in a 22-year old Hispanic man with nonfamilial thyrotoxic hypokalemic periodic paralysis triggered by a high carbohydrate diet. Laboratory studies showed elevated thyroid hormone, decreased thyroid-stimulating hormone, and hypokalemia. Rapid reduction in thyroid hormone levels by giving antithyroid drugs such as propylthiouracil and prompt potassium therapy with frequent measurements of serum potassium levels during therapy to avoid catastrophic hyperkalemia when potassium starts to shift back from intracellular to extracellular compartments can lead to successful outcome.
Jung, Young-Lee; Kang, Jae-Young
Rhabdomyolysis continues to appear with increasing frequency and represents a medical emergency requiring rapid appropriate treatment. One of the unusual causes of nontraumatic rhabdomyolysis is hypokalemic periodic paralysis without secondary causes. Primary hypokalemic periodic paralysis is a rare genetic disease characterized by episodic attacks of muscle weakness due to decreases in serum potassium. A 30-year-old woman who had 3 episodic attacks of hypokalemic periodic paralysis was admitted in emergency room with sudden onset symmetrical muscle weakness. After several hours, she started to complain myalgia and severe ache in both calves without any changes. Laboratory test showed markedly elevated creatine phosphokinase, lactic dehydrogenase levels with hypokalemia, rhabdomyolysis resulting from hypokalemia was diagnosed. Here, we report an unusual case of rhabdomyolysis caused by severe hypokalemia, which was suggested a result of familial hypokalemic periodic paralysis. PMID:28255549
Ptacek, L.J.; Leppert, M.F.; Tawil, R.
Hypokalemic periodic paralysis (hypoKPP) is an autosomal dominant skeletal muscle disorder manifested by episodic weakness associated with low serum potassium. Genetic linkage analysis has localized the hypoKPP gene to chromosome 1q31-q32 near a dihydropyridine receptor (DHP) gene. This receptor functions as a voltage-gated calcium channel and is also critical for excitation-contraction coupling in a voltage-sensitive and calcium-independent manner. We have characterized patient-specific DHP receptor mutations in 11 probands of 33 independent hypoKPP kindreds that occur at one of two adjacent nucleotides within the same codon and predict substitution of a highly conserved arginine in the S4 segment of domain 4 with either histidine or glycine. In one kindred, the mutation arose de novo. Taken together, these data establish the DHP receptor as the hypoKPP gene. We are unaware of any other human diseases presently known to result from DHP receptor mutations.
Hung, Yao-Min; Huang, Neng-Chyan; Wann, Shue-Ren; Chang, Yun-Te; Wang, Jyh-Seng
Hypokalemic Periodic Paralysis (HPP) may occur as a rare complication of Sjogren Syndrome (SS) and Renal Tubular Acidosis (RTA). A 64-year male patient came with HPP, and was later diagnosed with distal RTA. The patient, who had no xerostomia and xerophthalmia, was diagnosed with primary SS from serologic and histologic findings of minor salivary gland biopsy. The patient recovered after potassium replacement therapy. Renal biopsy was also performed and revealed evidence of tubulointerstitial nephritis. Corticosteroids were administered and there was no recurrence of HPP during a 4-year follow-up period. The case highlights the significance of acute hypokalemia management in emergency department as it can unmask SS even if the SS is not associated with sicca symptoms. Hypokalemic paralysis associated with normal anion gap metabolic acidosis should prompt toward the diagnosis of SS.
Teagarden, Corey M; Picardo, Carla W
Acute hypokalemic periodic paralysis may be induced by betamethasone injections during pregnancy. A healthy 23-year-old gravid woman at 32 weeks of gestation with preterm premature rupture of membranes received two doses of 12-mg intramuscular betamethasone 24 hours apart to accelerate fetal lung maturation. She developed significant proximal muscle weakness within 16 hours after the initial dose. Her serum potassium was 1.6 mEq/L. Oral and parenteral potassium replacement restored her neuromuscular function over several days. She delivered by repeat cesarean at 34 weeks of gestation without complications for her or the neonate. Hypokalemic periodic paralysis, a rare cause of weakness, may be induced by betamethasone injections during pregnancy and is reversible with low-risk interventions.
Maia, Morgana Lima e; Trevisam, Paula Grasiele Carvalho; Minicucci, Marcos; Mazeto, Glaucia M F S; Azevedo, Paula S
Thyrotoxic hypokalemic periodic paralysis (THPP) is an endocrine emergency marked by recurrent attacks of muscle weakness associated with hypokalemia and thyrotoxicosis. Asiatic male patients are most often affected. On the other hand, African descents rarely present this disease. The case described shows an afrodescendant patient with hypokalemia and tetraparesis, whose diagnosis of hyperthyroidism was considered during this crisis. The THPP, although rare, is potentially lethal. Therefore, in cases of flaccid paresis crisis this diagnosis should always be considered, especially if associated with hypokalemia. In this situation, if no previous diagnosis of hyperthyroidism, this should also be regarded.
Ke, Qing; He, Fangping; Lu, Lingping; Yu, Ping; Jiang, Yajian; Weng, Chen; Huang, Hui; Yi, Xin; Qi, Ming
Primary hypokalemic periodic paralysis is an autosomal dominant skeletal muscle channelopathy. In the present study, we investigated the genotype and phenotype of a Chinese hypokalemic periodic paralysis family. We used whole-exome next-generation sequencing to identify a mutation in the calcium channel, voltage-dependent, L type, alpha subunit gene (CACNA1S), R900S, which is a rare mutation associated with hypokalemic periodic paralysis. We first present a clinical description of hypokalemic periodic paralysis patients harboring CACNA1SR900S mutations: they were non-responsive to acetazolamide, but combined treatment with triamterene and potassium supplements decreased the frequency of muscle weakness attacks. All male carriers of the R900S mutation experienced such attacks, but all three female carriers were asymptomatic. This study provides further evidence for the phenotypic variation and pharmacogenomics of hypokalemic periodic paralysis. Copyright © 2015 Elsevier B.V. All rights reserved.
Matthews, E; Labrum, R; Sweeney, M G; Sud, R; Haworth, A; Chinnery, P F; Meola, G; Schorge, S; Kullmann, D M; Davis, M B; Hanna, M G
Several missense mutations of CACNA1S and SCN4A genes occur in hypokalemic periodic paralysis. These mutations affect arginine residues in the S4 voltage sensors of the channel. Approximately 20% of cases remain genetically undefined. We undertook direct automated DNA sequencing of the S4 regions of CACNA1S and SCN4A in 83 cases of hypokalemic periodic paralysis. We identified reported CACNA1S mutations in 64 cases. In the remaining 19 cases, mutations in SCN4A or other CACNA1S S4 segments were found in 10, including three novel changes and the first mutations in channel domains I (SCN4A) and III (CACNA1S). All mutations affected arginine residues, consistent with the gating pore cation leak hypothesis of hypokalemic periodic paralysis. Arginine mutations in S4 segments underlie 90% of hypokalemic periodic paralysis cases.
Levitt, Jacob O
Management considerations in hypokalemic periodic paralysis include accurate diagnosis, potassium dosage for acute attacks, choice of diuretic for prophylaxis, identification of triggers, creating a safe physical environment, peri-operative measures, and issues in pregnancy. A positive genetic test in the context of symptoms is the gold standard for diagnosis. Potassium chloride is the favored potassium salt given at 0.5–1.0 mEq/kg for acute attacks. The oral route is favored, but if necessary, a mannitol solvent can be used for intravenous administration. Avoidance of or potassium prophylaxis for common triggers, such as rest after exercise, high carbohydrate meals, and sodium, can prevent attacks. Chronically, acetazolamide, dichlorphenamide, or potassium-sparing diuretics decrease attack frequency and severity but are of little value acutely. Potassium, water, and a telephone should always be at a patient's bedside, regardless of the presence of weakness. Perioperatively, the patient's clinical status should be checked frequently. Firm data on the management of periodic paralysis during pregnancy is lacking. Patient support can be found at . PMID:18426576
Gandhi, Kunal; Prasad, Dharmendra; Malhotra, Vinay; Agrawal, Dhananjai
Gitelman's syndrome is an autosomal recessive renal tubular disorder characterized by hypomagnesemia, hypokalemia, hypocalciuria, and metabolic alkalosis. Hypocalcemic tetany as a presentation of Gitelman's syndrome has rarely been reported in literature. We report a rare case of Gitelman's syndrome presenting with hypocalcemic tetany along with hypokalemic periodic paralysis. A 17-year-old female was admitted to our hospital with a history of perioral numbness and carpal spasms of five days duration with progressive quadriparesis developing over a period of few hours. Past history was significant for three episodes of transient lower limb weakness. On examination, blood pressure was 110/70 mm Hg. Chvostek's sign and Trousseau's sign were positive. Neurologically, she was fully oriented. She had Grade 3 power in all the four limbs with intact sensation. Laboratory tests showed hypocalcemia (7.8 mg/dL), hypokalemia (2.2 mEq/L), hypomagnesemia (0.9 mEq/L), and hypocalciuria (104 mg/day). Arterial blood gas showed mild metabolic alkalosis with respiratory compensation. Thus, a clinical diagnosis of GS was made. The patient made a remarkable recovery after the correction of electrolyte imbalance. The aim of this case report is to re-emphasize the fact that hypocalcemia can rarely occur in Gitelman's syndrome.
Cheng, Chih-Jen; Kuo, Elizabeth; Huang, Chou-Long
The extracellular potassium makes up only about 2% of the total body potassium store. The majority of the body potassium is distributed in the intracellular space, and of which about 80% is in skeletal muscle. Movement of potassium in and out of skeletal muscle thus plays a pivotal role in extracellular potassium homeostasis. The exchange of potassium between the extracellular space and skeletal muscle is mediated by specific membrane transporters. These include potassium uptake by Na+, K+-ATPase and release by inward rectifier K+ channels. These processes are regulated by circulating hormones, peptides, ions, and by physical activity of muscle as well as dietary potassium intake. Pharmaceutical agents, poisons and disease conditions also affect the exchange and alter extracellular potassium concentration. Here, we review extracellular potassium homeostasis focusing on factors and conditions that influence the balance of potassium movement in skeletal muscle. Recent findings that mutations of a skeletal muscle-specific inward rectifier K+ channel cause hypokalemic periodic paralysis provide interesting insights into the role of skeletal muscle in extracellular potassium homeostasis. These recent findings will be reviewed. PMID:23953801
Stunnenberg, Bas C; Deinum, Jaap; Links, Thera P; Wilde, Arthur A; Franssen, Hessel; Drost, Gea
It is unknown how often cardiac arrhythmias occur in hypokalemic periodic paralysis (HypoPP) and if they are caused by hypokalemia alone or other factors. This systematic review shows that cardiac arrhythmias were reported in 27 HypoPP patients. Cases were confirmed genetically (13 with an R528H mutation in CACNA1S, 1 an R669H mutation in SCN4A) or had a convincing clinical diagnosis of HypoPP (13 genetically undetermined) if reported prior to the availability of genetic testing. Arrhythmias occurred during severe hypokalemia (11 patients), between attacks at normokalemia (4 patients), were treatment-dependent (2 patients), or unspecified (10 patients). Nine patients died from arrhythmia. Convincing evidence for a pro-arrhythmogenic factor other than hypokalemia is still lacking. The role of cardiac expression of defective skeletal muscle channels in the heart of HypoPP patients remains unclear. Clinicians should be aware of and prevent treatment-induced cardiac arrhythmia in HypoPP.
Cheng, Chih-Jen; Kuo, Elizabeth; Huang, Chou-Long
Extracellular potassium makes up only about 2% of the total body's potassium store. The majority of the body potassium is distributed in the intracellular space, of which about 80% is in skeletal muscle. Movement of potassium in and out of skeletal muscle thus plays a pivotal role in extracellular potassium homeostasis. The exchange of potassium between the extracellular space and skeletal muscle is mediated by specific membrane transporters. These include potassium uptake by Na(+), K(+)-adenosine triphosphatase and release by inward-rectifier K(+) channels. These processes are regulated by circulating hormones, peptides, ions, and by physical activity of muscle as well as dietary potassium intake. Pharmaceutical agents, poisons, and disease conditions also affect the exchange and alter extracellular potassium concentration. Here, we review extracellular potassium homeostasis, focusing on factors and conditions that influence the balance of potassium movement in skeletal muscle. Recent findings that mutations of a skeletal muscle-specific inward-rectifier K(+) channel cause hypokalemic periodic paralysis provide interesting insights into the role of skeletal muscle in extracellular potassium homeostasis. These recent findings are reviewed. Copyright © 2013 Elsevier Inc. All rights reserved.
Minaker, K L; Meneilly, G S; Flier, J S; Rowe, J W
To elucidate a potential role for insulin-mediated extra-renal potassium disposal in the clinical syndrome of hypokalemic periodic paralysis, an obese affected man was studied using the euglycemic insulin clamp, which, in normal and obese subjects, produces predictable, insulin dose-dependent declines in plasma potassium levels. During a 20 mU/m2/minute euglycemic clamp (insulin level, 88 microU/ml) procedure, while the patient with hypokalemic periodic paralysis demonstrated severe resistance to insulin-mediated glucose uptake (glucose uptake 50 percent of that of normal control subjects, n = 17), his plasma potassium declined to a degree similar to that seen in normal subjects. During a subsequent higher dose, 200 mU/m2/minute insulin infusion (insulin level, 914 microU/ml), plasma potassium declined to 2.5 meq/liter, a value significantly below that seen in normal (n = 19) (3.3 +/- 0.1 meq/liter) and obese (n = 6) (3.2 +/- 0.1 meq/liter) subjects. During this study, paralysis began in the patient's hand and forearm at the potassium nadir and lasted three hours, despite restoration of normokalemia 30 minutes after paralysis began. Glucose disposal rates during this high-dose insulin infusion were one-half that seen in lean control subjects (n = 19) and similar to those in obese control subjects. If these findings are representative of hypokalemic periodic paralysis and can be generalized to larger numbers of patients, they indicate several new features of this syndrome. The ability of insulin to induce hypokalemia is enhanced in this syndrome even in the presence of marked coexistent obesity-related resistance to the action of insulin to promote glucose utilization. Enhanced sensitivity of potassium uptake systems to activation by insulin (and other factors) may be a central feature of this syndrome. Additionally, paralytic hypokalemia can be induced during a euglycemic insulin clamp procedure, which could be utilized as a diagnostic test for this syndrome.
Thakkar, Mitesh; Biswas, T K; Desle, Hrishikesh B
Andersen-Tawil Syndrome (ATS) is a rare potassium channel disorder, characterized by episodic weakness, ventricular arrhythmias and dysmorphic features (short stature, scoliosis, clinodactyly, hypertelorism, small or prominent low set ears, micrognathia and broad forehead). We report a case of hypokalemic periodic paralysis with dysmorphic facial features and ventricular arrhythmia resembling Andersen-Tawil syndrome.
Nair, A; Prashanth, M R; Indira, R; Rao, S; Javarajan, A
Hypokalemic paralysis is an uncommon entity with varied etiology. Renal tubular acidosis is an unusual cause of this disorder. Its occurrence with pregnancy is rare. We report such a case and mention the implications of the association and review relevant literature breifly.
Akinyemi, Emmanuel; Bercovici, Silvia; Niranjan, Selvanayagam; Paul, Nisha; Hemavathy, Bhakthavatsalam
Herbal and dietary supplements for weight loss and in treatment of obesity are growing in popularity and acceptance in the United States. Most of these supplements can be obtained over the counter and can have serious adverse effects associated with their consumption. We describe 2 patients who developed thyrotoxic hypokalemic periodic paralysis 2-3 weeks after consuming thyroxine-containing weight-loss supplements. This is the first known case of thyrotoxic hypokalemic periodic paralysis secondary to dietary supplements. It is important that patients and physicians are aware of the severe adverse reactions associated with dietary supplements. Physicians should as a routine inquire about herbal and dietary supplement consumption during all patient encounters.
Chen, Dong-Mei; Yu, Ye-Rong
To study the relationship between hyperinsulinemia and primary periodic paralysis in overweight/obesity people. Overweight/obesity people with primary hypokalemic periodic paralysis were administrated as disease group. Serum potassium, insulin and glucose were analyzed at different time (0 h, 1 h, 2 h, 3 h, 4 h) after taking 100 g carbohydrates and the results were compared with that of control group matched by gender, age and body mass index (BMI). (1) Males were much more than females in disease group (14 males and 2 females), the onset age ranged from 20 to 50 years old. (2) Both the highest insulin level and the lowest potassium level appeared at one hour after taking the carbohydrates. And the highest insulin level of disease group was significant higher than that of control group. (3) The area under the curve of insulin and insulin/potassium of disease group was significant higher than that of control group. The postprandial hyperinsulinemia was an important factor in overweight/obesity people with hypokalemic periodic paralysis.
Im, Eun Joo; Lee, Jung Min; Kim, Ji Hyun; Chang, Sang Ah; Moon, Sung Dae; Ahn, Yu Bae; Son, Hyun Shik; Cha, Bong Yun; Lee, Kwang Woo; Son, Ho Young
A 19-year-old girl presented at our emergency room with hypokalemic periodic paralysis. She had a thyrotoxic goiter and had experienced three paralytic attacks during the previous 2 years on occasions when she stopped taking antithyroid drugs. In addition to thyrotoxic periodic paralysis (TPP), she had metabolic acidosis, urinary potassium loss, polyuria and polydipsia. Her reduced ability to acidify urine during spontaneous metabolic acidosis was confirmed by detection of coexisting distal renal tubular acidosis (RTA). The polyuria and polydipsia were caused by nephrogenic diabetes insipidus, which was diagnosed using the water deprivation test and vasopressin administration. Her recurrent and frequent paralytic attacks may have been the combined effects of thyrotoxicosis and RTA. Although the paralytic attack did not recur after improving the thyroid function, mild acidosis and nephrogenic DI have been remained subsequently. Patients with TPP, especially females with atypical metabolic features, should be investigated for possible precipitating factors.
Wang, Yufan; Zhao, Li; Li, Fan; Chen, Hai-xi; Fang, Fang; Peng, Yong-de
A 39-year-old Chinese man presented to the study hospital with right-sided gynecomastia. Underlying Graves' disease was not diagnosed until recurrent episodes of hypokalemic periodic paralysis were observed. The estradiol (E2) and progesterone levels and the E2-to-testosterone (T) (E2/T) ratio of the patient were elevated before treatment. Immediate intravenous potassium supplementation was started to reverse the paralysis. Additionally, antithyroid drugs were administered to restore a euthyroid state. After treatment, the patient gained strength. Gynecomastia regressed with a return to the euthyroid state; the E2 and progesterone levels normalized and the plasma E2/T ratio declined. In addition to the classic symptoms, some atypical symptoms of Graves' disease may also occur. One of the challenges lies in recognizing the underlying etiology. Early diagnosis and appropriate treatment can avoid unnecessary investigations and serious cardiopulmonary complications.
Kim, June-Bum; Lee, Gyung-Min; Kim, Sung-Jo; Yoon, Dong-Ho; Lee, Young-Hyuk
Familial hypokalemic periodic paralysis is an autosomal-dominant disorder characterized by episodic attacks of muscle weakness with hypokalemia. The combination of sarcolemmal depolarization and hypokalemia has been attributed to abnormalities of the potassium conductance governing the membrane potential; however, the molecular mechanism that causes hypokalemia has not yet been determined. To test the hypothesis that the expression patterns of delayed rectifier potassium channel genes in the skeletal muscle cells of patients with familial hypokalemic periodic paralysis differ from those in normal cells. We examined both mRNA and protein levels of two major delayed rectifier potassium channel genes KCNQ3 and KCNQ5 in the skeletal muscle cells from three patients with familial hypokalemic periodic paralysis and three healthy controls. When normal cells were exposed to 50 mM potassium buffer, which was used to induce depolarization, the KCNQ3 protein level significantly increased in the membrane fraction but decreased in the cytosolic fraction, whereas the opposite was true in patient cells. Abnormal subcellular distribution of the KCNQ3 protein was observed in patient cells. Our results suggest that the altered expression of KCNQ3 in patient cells exposed to high extracellular potassium levels could possibly hinder normal function of the channel protein. These findings may provide an important clue to understanding the molecular mechanism of familial hypokalemic periodic paralysis.
Mayr, Florian B; Domanovits, Hans; Laggner, Anton N
Severe hypokalemia is a potentially life-threatening disorder and is associated with variable degrees of skeletal muscle weakness, even to the point of paralysis. On rare occasions, diaphragmatic paralysis from hypokalemia can lead to respiratory arrest. There may also be decreased motility of smooth muscle, manifesting with ileus or urinary retention. Rarely, severe hypokalemia may result in rhabdomyolysis. Other manifestations of severe hypokalemia include alteration of cardiac tissue excitability and conduction. Hypokalemia can produce electrocardiographic changes such as U waves, T-wave flattening, and arrhythmias, especially if the patient is taking digoxin. Common causes of hypokalemia include extrarenal potassium losses (vomiting and diarrhea) and renal potassium losses (eg, hyperaldosteronism, renal tubular acidosis, severe hyperglycemia, potassium-depleting diuretics) as well as hypokalemia due to potassium shifts (eg, insulin administration, catecholamine excess, familial periodic hypokalemic paralysis, thyrotoxic hypokalemic paralysis). Although the extent of diuretic misuse in professional bodybuilding is unknown, it may be regarded as substantial. Hence, diuretics must always be considered as a cause of hypokalemic paralysis in bodybuilders.
Foppiani, Luca; Cuttica, Carla Micaela; Marugo, Alessandro; Del Monte, Patrizia
Thyrotoxic periodic paralysis (TPP) is an uncommon but potentially lethal manifestation of hyperthyroidism characterized by muscle paralysis and hypokalemia. We have reported 3 cases of TPP in male patients, which manifested with morning muscle weakness evolved into paralysis. In all patients were found severe hypokalemia, abnormalities on electrocardiogram, and Graves' hyperthyroidism. Intravenous potassium administration led to normalization of potassium levels, and resolution of neurological symptoms. In addition, beta blockers and methimazole were started. Two patients required total thyroidectomy for poor control of hyperthyroidism with antithyroid drug. In patients presenting with periodic paralysis or diffuse muscle weakness thyroid function should be investigated in order to find out the cases secondary to unknown hyperthyroidism and to start an early appropriate combined therapy. The correct management of TPP can prevent serious cardiopulmonary complications.
Sillen, A.; Wadelius, C.; Gustabson, K.H.
Familial hypokalemic periodic paralysis (HOKPP) is an autosomal dominant disease with attacks of paralysis of varying severity. The attacks occur at intervals of days to years in otherwise healthy people combined with hypokalemia during attacks. The paralysis attacks are precipitated by a number of different factors, like carbohydrate-rich meals, cold, exercise and mental stress. Recently linkage for HOKPP was shown for chromosome 1q31-32 and the disease was mapped between D1S413 and D1S249. The gene for the calcium channel alfa1-subunit (CACNL 1A3) maps to this interval and in two families no recombination was found between a polymorphism in the CACNL 1A3 gene and the disease. This gene is therefore considered to be a candidate for HOKPP. The analysis of a large Danish family excludes linkage to this region and to the CACNL 1A3 gene. In each direction from D1S413, 18.8 cM could be excluded and for D1S249, 14.9 cM. The present study clearly excludes the possibility that the gene causing HOKPP in a large Danish family is located in the region 1q31-32. This result shows that HOKPP is a heterogenous disease, with only one mapped gene so far.
Wu, Fenfen; Mi, Wentao; Burns, Dennis K.; Fu, Yu; Gray, Hillery F.; Struyk, Arie F.; Cannon, Stephen C.
Hypokalemic periodic paralysis (HypoPP) is an ion channelopathy of skeletal muscle characterized by attacks of muscle weakness associated with low serum K+. HypoPP results from a transient failure of muscle fiber excitability. Mutations in the genes encoding a calcium channel (CaV1.1) and a sodium channel (NaV1.4) have been identified in HypoPP families. Mutations of NaV1.4 give rise to a heterogeneous group of muscle disorders, with gain-of-function defects causing myotonia or hyperkalemic periodic paralysis. To address the question of specificity for the allele encoding the NaV1.4-R669H variant as a cause of HypoPP and to produce a model system in which to characterize functional defects of the mutant channel and susceptibility to paralysis, we generated knockin mice carrying the ortholog of the gene encoding the NaV1.4-R669H variant (referred to herein as R669H mice). Homozygous R669H mice had a robust HypoPP phenotype, with transient loss of muscle excitability and weakness in low-K+ challenge, insensitivity to high-K+ challenge, dominant inheritance, and absence of myotonia. Recovery was sensitive to the Na+/K+-ATPase pump inhibitor ouabain. Affected fibers had an anomalous inward current at hyperpolarized potentials, consistent with the proposal that a leaky gating pore in R669H channels triggers attacks, whereas a reduction in the amplitude of action potentials implies additional loss-of-function changes for the mutant NaV1.4 channels. PMID:21881211
Chen, Ying-Ying; Wang, Xiao-Ying; Fu, Qiu-Xia; Kang, Yi; Yao, He-Bin
The pathogenesis of hypokalemic periodic paralysis (HypoPP) remains unclear. Though some mutations in skeletal muscle ion channels were revealed previously, the exact mechanism remains to be fully elucidated. Increased Na+/K+-ATPase activity in skeletal muscle is postulated to contribute to attacks of HypoPP. Before the link between Na+/K+-ATPase dysfunction and these ion channel mutations is established, mutations in Na+/K+-ATPase and their regulators are the first to be excluded. Phospholemman, which is a protein encoded by the FXYD domain-containing ion transport regulator 1 (FXYD1) gene, is predominantly expressed in skeletal muscle and is the major regulator of Na+/K+-ATPase. Therefore, the aim of the present study was to determine the genetic involvement of phospholemman in HypoPP development. Genomic DNA was extracted from the peripheral blood of five HypoPP probands with typical manifestations. The coding exons of FXYD1, exons 2–7, were polymerase chain reaction (PCR)-amplified and sequenced. No mutations were detected in FXYD1 in any of the subjects studied. To conclude, mutations in phospholemman encoding genes may not be involved with HypoPP and the relationship between phospholemman and Na+/K+-ATPase dysfunction in attacks of HypoPP requires further study. PMID:28912873
Wi, Jung-Kook; Lee, Hong Joo; Kim, Eun Young; Cho, Joo Hee; Chin, Sang Ouk; Rhee, Sang Youl; Moon, Ju-Young; Lee, Sang-Ho; Jeong, Kyung-Hwan; Ihm, Chun-Gyoo
Recognizing the underlying causes of hypokalemic paralysis seems to be essential for the appropriate management of affected patients and their prevention of recurrent attacks. There is, however, a paucity of documented reports on the etiology of hypokalemic paralysis in Korea. We retrospectively analyzed 34 patients with acute flaccid weakness due to hypokalaemia who were admitted during the 5-year study period in order to determine the spectrum of hypokalemic paralysis in Korea and to identify the differences in clinical parameters all across the causes of hypokalemic paralysis. We divided those 34 patients into 3 groups; the 1st group, idiopathic hypokalemic periodic paralysis (HPP), the 2nd, thyrotoxic periodic paralysis (TPP), and the 3rd group, secondary hypokalemic paralysis (HP) without TPP. Seven of the patients (20.6%) were diagnosed as idiopathic HPP considered the sporadic form, and 27 patients (79.4%) as secondary HP. Among the patients diagnosed as secondary HP, 16 patients (47.1%) had TPP. Patients of secondary hypokalemic paralysis without TPP required a longer recovery time compared with those who had either idiopathic HPP or TPP. This is due to the fact that patients of secondary HP had a significantly negative total body potassium balance, whereas idiopathic HPP and TPP were only associated with intracellular shift of potassium. Most of the TPP patients included in our study had overt thyrotoxicosis while 3 patients had subclinical thyrotoxicosis. This study shows that TPP is the most common cause of hypokalemic paralysis in Korea. And we suggest that doctors should consider the presence of TPP in patients of hypokalemic paralysis even if they clinically appear to be euthyroid state. PMID:23508689
Mi, Wentao; Rybalchenko, Volodymyr
Missense mutations at arginine residues in the S4 voltage-sensor domains of NaV1.4 are an established cause of hypokalemic periodic paralysis, an inherited disorder of skeletal muscle involving recurrent episodes of weakness in conjunction with low serum K+. Expression studies in oocytes have revealed anomalous, hyperpolarization-activated gating pore currents in mutant channels. This aberrant gating pore conductance creates a small inward current at the resting potential that is thought to contribute to susceptibility to depolarization in low K+ during attacks of weakness. A critical component of this hypothesis is the magnitude of the gating pore conductance relative to other conductances that are active at the resting potential in mammalian muscle: large enough to favor episodes of paradoxical depolarization in low K+, yet not so large as to permanently depolarize the fiber. To improve the estimate of the specific conductance for the gating pore in affected muscle, we sequentially measured Na+ current through the channel pore, gating pore current, and gating charge displacement in oocytes expressing R669H, R672G, or wild-type NaV1.4 channels. The relative conductance of the gating pore to that of the pore domain pathway for Na+ was 0.03%, which implies a specific conductance in muscle from heterozygous patients of ∼10 µS/cm2 or 1% of the total resting conductance. Unexpectedly, our data also revealed a substantial decoupling between gating charge displacement and peak Na+ current for both R669H and R672G mutant channels. This decoupling predicts a reduced Na+ current density in affected muscle, consistent with the observations that the maximal dV/dt and peak amplitude of the action potential are reduced in fibers from patients with R672G and in a knock-in mouse model of R669H. The defective coupling between gating charge displacement and channel activation identifies a previously unappreciated mechanism that contributes to the reduced excitability of affected
Vishnu, Venugopalan Y; Kattadimmal, Anoop; Rao, Suparna A; Kadhiravan, Tamilarasu
A wide variety of neurological manifestations are known in patients with diabetes mellitus. We describe a 40-year-old man who presented with hypokalemic paralysis. On evaluation, we found that the cause of the hypokalemia was osmotic diuresis induced by marked hyperglycemia due to undiagnosed diabetes mellitus. The patient had an uneventful recovery with potassium replacement, followed by glycemic control with insulin. Barring a few instances of symptomatic hypokalemia in the setting of diabetic emergencies, to our knowledge uncomplicated hyperglycemia has not been reported to result in hypokalemic paralysis.
Appel, C C; Myles, T D
Excessive ingestion of caffeine can induce hypokalemia, which affects the neuromuscular system and can lead to paralysis. A 24-year-old woman, gravida 3, para 2-0-0-2 at 33 weeks' gestation presented with muscular paralysis and hypokalemia secondary to drinking 6 to 7 L of cola per day with little other oral intake. After potassium replacement and stopping caffeine ingestion, the symptoms resolved quickly. The physiologic changes of pregnancy might potentiate the effect of caffeine on serum potassium concentration.
Arzel-Hézode, Marianne; McGoey, Suzanne; Sternberg, Damien; Vicart, Savine; Eymard, Bruno; Fontaine, Bertrand
Hypokalemic periodic paralysis is a rare disorder characterized by episodic attacks of muscle flaccidity associated with low serum potassium levels. We report twelve patients with normokalemic and hypokalemic periodic paralysis due to various mutations who developed hypokalemic paralytic episodes following a single dose or short-term administration of glucocorticoids. We hypothesize that glucocorticoids cause hypokalemia due to their stimulation of the Na(+)-K(+) ATPase mediated by insulin and amylin and due to their side effect of insulin resistance resulting in hyperglycemia. This report adds to the clinical description of glucocorticoids as a trigger of attacks of hypokalemic periodic paralysis indicating that glucocorticoids should be administered with caution in patients with periodic paralysis.
Ramteke, Vishal V.; Deshpande, Rushi V.; Srivastava, Om; Wagh, Adinath
Tenofovir induced fanconi syndrome (FS) presenting as hypokalemic paralysis is an extremely rare complication in patients on anti-retroviral therapy. We report a 50-year-old male with acquired immunodeficiency syndrome on tenofovir-based anti-retroviral therapy who presented with acute onset quadriparesis. On evaluation, he was found to have hypokalemia with hypophosphatemia, glucosuria and proteinuria suggesting FS. He regained normal power in limbs over next 12 h following correction of hypokalemia. Ours would be the second reported case in India. PMID:26692618
Periodic paralysis - hyperkalemic; Familial hyperkalemic periodic paralysis; HyperKPP; HyperPP; Gamstorp disease ... factors include having other family members with periodic paralysis. It affects men more often than women.
Hypokalemic Periodic Paralysis and the Dihydropyridine Receptor (CACNLIA3): Genotype/Phenotype Correlations for two Predominant Mutations and Evidence for the Absence of a Founder Effect in 16 Caucasian Families
Elbaz, A.; Vale-Santos, J.; Jurkat-Rott, K.; Lapie, P.; Ophoff, R. A.; Bady, B.; Links, T. P.; Piussan, C.; Vila, A.; Monnier, N.; Padberg, G. W.; Abe, K.; Feingold, N.; Guimaraes, J.; Wintzen, A. R.; van der Hoeven, J. H.; Saudubray, J. M.; Grunfeld, J. P.; Lenoir, G.; Nivet, H.; Echenne, B.; Frants, R. R.; Fardeau, M.; Lehmann-Horn, F.; Fontaine, B.
Hypokalemic periodic paralysis (hypoPP) is an autosomal dominant disorder belonging to a group of muscle diseases involving the abnormal function of ion channels. This group of muscle diseases also comprises hyperkalemic periodic paralysis and paramyotonia congenita, both sodium-channel diseases, and myotonia congenita, a chloride-channel disorder. HypoPP is characterized by acute attacks of muscle weakness concomitant with a fall in blood potasium levels. We recently localized the hypoPP locus (hypoPP1) to chromosome 1q31-32, in an interval where the α1 subunit of the dihydropyridine receptor calcium channel (CACNL1A3) also maps. Subsequently, deleterious mutations in the voltage-sensor segment S4 were found, establishing the dihydropyridine receptor CACNL1A3 as the causative gene for hypoPP. In this paper, we report the study of 16 hypoPP families of Caucasian origin. We found only two mutations—Arg528His and Arg1239His—that cosegregated with hypoPP, each in half of the families. Analysis of the clinical characteristics of both groups of families demonstrated that incomplete penetrance is a distinctive feature of the Arg528His mutation. Using dinucleotide repeats contained within or close to the dihydropyridine receptor gene, in conjunction with evidence of a de novo Arg1239His mutation, we show that a founder effect is unlikely to account for the two predominant mutations. ImagesFigure 1 PMID:7847370
Lee, Tae Won; Bae, Eunjin; Hwang, Kyungo; Chang, Ha Nee; Park, Hee Jung; Jeon, Dae-Hong; Cho, Hyun Seop; Chang, Se-Ho; Park, Dong Jun
Severe hypokalemia can be a potentially life-threatening disorder and is associated with variable degrees of skeletal muscle weakness. We report a case of severe hypokalemic paralysis and rhabdomyolysis in a 28-year-old bodybuilder. He was admitted to the emergency room due to progressive paralysis in both lower extremities, which had begun 12 hours earlier. He was a bodybuilder trainer and had participated in a regional competition 5 days earlier. He went on a binge, consuming large amounts of carbohydrates over 4 days, resulting in a gain of 10 kg in weight. He had no family history of paralysis and this was his first attack. He strongly denied drug abuse, such as anabolic steroids, thyroid and growth hormone, and diuretics. Neurological examinations revealed symmetrical flaccid paralysis in his lower extremities, but the patient was alert and his sensory system was intact. His initial serum potassium and phosphate level was 1.8 mmol/L and 1.4 mg/dL, respectively. The calculated transtubular potassium gradient (TTKG) was 2.02. His thyroid function was normal. Serum potassium levels increased to 3.8 mmol/L with intravenous infusion of about 50 mmol of potassium chloride over 20 hours. His muscular symptoms improved progressively and he was discharged from the hospital 7 days after admission on foot. He was followed in our outpatient clinic, without recurrence. Physicians should keep in mind that large intakes of food during short periods can provoke hypokalemic paralysis and rhabdomyolysis, especially in bodybuilders.
Tengan, C H; De Oliveira, A S; Gabbai, A A
Twenty patients with periodic paralysis were evaluated and the aspects studied included epidemiological data, clinical manifestations, ancillary tests, treatment and evolution. Sixteen patients had the hypokalemic form (5 familiar, 5 sporadic, 5 thyrotoxic and 1 secondary). No patient with the normokalemic form was detected. Predominance of men was found (14 patients), especially in the cases with hyperthyroidism (5 patients). No thyrotoxic patient was of oriental origin. Only 4 patients had the hyperkalemic form (3 familiar, 1 sporadic). Attacks of paralysis began during the first decade in the hyperkalemic form and up to the third decade in the hypokalemic. In both forms the attacks occurred preferentially in the morning with rest after exercise being the most important precipitating factor. Seventy five percent of the hyperkalemic patients referred brief attacks (< 12 hours). Longer attacks were referred by 43% of the hypokalemic patients. The majority of the attacks manifested with a generalized weakness mainly in legs, and its frequency was variable. Creatinokinase was evaluated in 10 patients and 8 of them had levels that varied from 1.1 to 5 times normal. Electromyography was done in 6 patients and myotonic phenomenon was the only abnormality detected in 2 patients. Carbonic anhydrase inhibitors, especially acetazolamide, were used for prophylactic treatment in 9 patients with good results in all. Although periodic paralysis may be considered a benign disease we found respiratory distress in 5 patients, permanent myopathy in 1, electrocardiographic abnormalities during crises in 4; death during paralysis occurred in 2. Therefore correct diagnosis and immediate treatment are crucial. This study shows that hyperthyroidism is an important cause of periodic paralysis in our country, even in non oriental patients. Hence endocrine investigation is mandatory since this kind of periodic paralysis will only be abated after return to the euthyroid state.
Velarde-Mejía, Yelitza; Gamboa-Cárdenas, Rocío; Ugarte-Gil, Manuel; Asurza, César Pastor
Acute hypokalemic paralysis is a rare and potentially fatal condition, with few related causes, one of which highlights distal renal tubular acidosis (dRTA). Distal renal tubular acidosis is a rare complication of several autoimmune diseases such as systemic lupus erythematosus, Sjögren’s syndrome, and Hashimoto thyroiditis. We report a case of a lupic patient who presented rapidly progressive quadriparesis in the context of active renal disease. Research revealed severe refractory hypokalemia, metabolic acidosis, and alkaline urine suggestive of dRTA. We diagnosed Sjögren’s syndrome based on sicca symptoms, an abnormal salivary glands’ nuclear scan and the presence of anti-Ro/SSA and anti-La/SSB. In addition, the finding of thyroid peroxidase, thyroglobulin antibodies, and hypothyroidism led us to the diagnosis of Hashimoto thyroiditis. Due to the active renal involvement on the context of systemic lupus erythematosus and Sjögren’s syndrome, the patient received immunosuppression with rituximab, resulting in a progressive and complete improvement. PMID:28839447
Jain, Rajendra Singh; Gupta, Pankaj Kumar; Agrawal, Rakesh; Kumar, Sunil; Khandelwal, Kapil
Neurological manifestations are unusual in dengue fever and can be due to neurotropic effect, systemic complications of dengue infection, or immune mediated. Acute hypokalemic paralysis is a rare systemic complication of dengue infection; however, hypokalemia along with hypomagnesemia has not been reported earlier. We herein report an extremely unusual and probably the first case of dengue infection in a 30-year-old male who presented to us with hypokalemic paralysis along with hypomagnesemia. This case report highlights that hypomagnesemia may be a significant complication in dengue infection. Correction of hypomagnesemia is of paramount importance to avoid refractory hypokalemia leading to severe consequences.
Cope, Thomas E; Samaraweera, Amal P R; Burn, David J
Thyrotoxic periodic paralysis is rare in Caucasian populations, but affects approximately 2% of East Asians with thyrotoxicosis (13% of males, 0.17% of females). The presentation is characterized by abrupt-onset hypokalemia and profound proximal muscular weakness, and commonly occurs after carbohydrate loading or exercise. To raise awareness of this condition through the description of a typical case of thyrotoxic periodic paralysis; to remind readers that, despite intravascular hypokalemia, total body potassium is normal and that correction must be done with caution; to highlight the differences in treatment compared to familial hypokalemic periodic paralysis. We describe the presentation of a 36-year-old Filipino man with a background history of Graves disease. Over-administration of intravenous potassium was narrowly averted in this case. It may be important to check thyroid function in patients presenting with acute paralysis, especially those of Asian origin. In patients with thyrotoxic periodic paralysis, administration of potassium, with cardiac monitoring and a total dose of <50 mmol, limits the dysrhythmia risk. Patients are likely to benefit from the prescription of non-selective beta-blockers until they become euthyroid. In contrast to familial periodic paralysis, regular oral potassium supplementation is ineffective in thyrotoxic periodic paralysis, and acetazolamide precipitates, rather than prevents, attacks. Copyright © 2013 Elsevier Inc. All rights reserved.
Periodic paralysis is a muscle disorder that belongs to the family of diseases called channelopathies, manifested by episodes of painless muscle weakness. Periodic paralysis is classified as hypokalemic when episodes occur in association with low potassium levels. Most cases are hereditary. Acquired cases have been described in association with hyperthyroidism. Diagnosis is made on clinical and biochemical grounds. Patients may be markedly hypokalemic during the episode and respond well to potassium supplementation. Episodes can be prevented by achieving a euthyroid state. This report describes a young gentleman presenting with thyrotoxic hypokalemic paraparesis. The condition needs to be considered in the differential diagnosis of neuromuscular weakness in the context of hypokalemia by the treating physicians.
Arambewela, M H; Sumanathilaka, M R; Pathirana, K D; Bodinayaka, C K
Acute hypokalemic periodic paralysis (HPP), a clinical syndrome characterised by acute systemic weakness and low serum potassium (K+), is a rare but treatable cause of acute limb weakness. Hypokalemia can be caused by K+ loss via the kidneys or extra renal routes mainly the gut, or due to transcellular potassium shifts where extracellular K+ will move into the cell. In the latter situation, although there is hypokalaemia, there is no deficit of K+ in the body. The main causes for intracellular shift of K+ are familial hypokalemic periodic paralysis, thyrotoxic periodic paralysis, barium poisoning, insulin excess and alkalosis. Although the association between thyrotoxicosis and HPP is known, HPP with hypothyroidism is extremely rare. We report a case of hypokalemic periodic paralysis associated with hypothyroidism and neuromyotonia.
Soriano, Paolo K; Bhattarai, Mukul; Vogler, Carrie N; Hudali, Tamer H
BACKGROUND Trigger-point injection (TPI) therapy is an effective modality for symptomatic treatment of myofascial pain. Serious adverse effects are rarely observed. In this report, we present the case of a 39-year-old man who experienced severe, transient hypokalemic paralysis in the context of TPI therapy with methylprednisolone, bupivacaine, and epinephrine. He was successfully treated with electrolyte replacement in a closely monitored setting. CASE REPORT A 39-year-old man with no past medical history except for chronic left hip pain from a work-related injury received a TPI with methylprednisolone and bupivacaine. The TPI targeted the left iliopsoas tendon and was administered using ultrasound guidance. There were no immediately perceived complications, but within 12 h he presented with severe hypokalemic paralysis with a serum potassium 1.7 mmol/L. Judicious potassium repletion was initiated. Repeated tests after 6 h consistently showed normal potassium levels of 4.5 mmol/L. CONCLUSIONS Severe hypokalemic paralysis in the context of trigger-point injection is an incredibly rare occurrence and this is the first case report in English literature. A high index of clinical suspicion and a systematic approach are therefore required for prompt diagnosis and management of this obscure iatrogenic entity. Clinicians can enhance patient safety by allowing the primary pathology to guide them.
Ferreiro, J.E.; Arguelles, D.J.; Rams, H. Jr.
A case of thyrotoxic periodic paralysis is reported in a Hispanic man with an unusual recurrence six weeks after radioactive iodine treatment. Thyrotoxic periodic paralysis has now been well characterized in the literature: it occurs primarily in Orientals with an overwhelming male preponderance and a higher association of specific HLA antigens. Clinical manifestations include onset after high carbohydrate ingestion or heavy exertion, with progressive symmetric weakness leading to flaccid paralysis of the extremities and other muscle groups, lasting several hours. If hypokalemia is present, potassium administration may help abort the attack. Although propranolol can be efficacious in preventing further episodes, the only definitive treatment is establishing a euthyroid state. The pathophysiology is still controversial, but reflects altered potassium and calcium dynamics as well as certain morphologic characteristics within the muscle unit itself.
... properly regulate the flow of ions into muscle cells, which reduces the ability of skeletal muscles to contract. Because muscle contraction is needed for movement, a disruption in normal ion transport leads to episodes of ...
Min, Hong Ki; Kim, Eun Oh; Lee, Sang Ju; Chang, Yoon Kyung; Suh, Kwang Sun; Yang, Chul Woo; Kim, Suk Young; Hwang, Hyeon Seok
Rifampin is one of the most important drugs in first-line therapies for tuberculosis. The renal toxicity of rifampin has been reported sporadically and acute tubulointerstitial nephritis (ATIN) is a frequent histological finding. We describe for the first time a case of ATIN and Fanconi syndrome presenting as hypokalemic paralysis, associated with the use of rifampin. A 42-year-old man was admitted with sudden-onset lower extremity paralysis and mild renal insufficiency. He had been treated for pulmonary tuberculosis with isoniazid, rifampin, and ethambutol for 2 months. Laboratory tests revealed proteinuria, profound hypokalemia, hyperchloremic metabolic acidosis with a normal anion gap, positive urine anion gap, hypophosphatemia with hyperphosphaturia, hypouricemia with hyperuricosuria, glycosuria with normal serum glucose level, generalized aminoaciduria, and β2-microglobulinuria. A kidney biopsy revealed findings typical of ATIN and focal granular deposits of immunoglubulin A and complement 3 in the glomeruli and tubules. Electron microscopy showed epithelial foot process effacement and electron-dense deposits in the subendothelial and mesangial spaces. Cessation of rifampin resolved the patient's clinical presentation of Fanconi syndrome, and improved his renal function and proteinuria. This case demonstrates that rifampin therapy can be associated with Fanconi syndrome presenting as hypokalemic paralysis, which is a manifestation of ATIN. Kidney function and the markers of proximal tubular injury should be carefully monitored in patients receiving rifampin.
Al Moteri, Barakat Lafi G.; Aslam, Mohammad
Thyrotoxic periodic paralysis (TPP) is a rare complication of hyperthyroidism characterized by episodes of muscle weakness and hypokalemia. TPP is typically present in young Asian men, female, and non-Asian ethnic group can also be affected. TPP is a curable cause of hypokalemic periodic paralysis, can often be the first manifestation of thyrotoxicosis. Factors such as high carbohydrate diet, strenuous exercise, emotional stress, and steroid can precipitate an attack of TPP. The presence of both hypokalemia and elevated level of thyroxine (T4) and triiodothyronine (T3) are important diagnostic features during the acute episode. Treatment of TPP involves two steps, immediate action to reverse the paralysis by correction of hypokalemia followed by measures to prevent future attacks by restoration of a euthyroid state. We report a first case of TPP, which was delayed to diagnose, from our hospital due to Graves’ disease in Asian man who present with second episode of paralytic attack before the diagnosis was made which is also unusual as attacks were not frequent. PMID:28293157
Thyrotoxic hypokalemic periodic paralysis (TPP) is a condition characterized by the triad of acute hypokalemia without total body potassium deficit, episodic muscle paralysis, and thyrotoxicosis. We describe two cases of thyrotoxic periodic paralysis who presented to our hospital with potassium values of 1.3 MeQ/l and 1.2 MeQ/l, respectively. Surprisingly, the two patients had no documented past medical history. Based on the clinical features of high heart rate, palpitations (seen in both the patients), and exophthalmos (seen in one patient), thyrotoxic periodic paralysis was suspected. A thorough laboratory workup confirmed the diagnosis of thyrotoxicosis. Beta blockers were initiated promptly, along with intravenous potassium chloride, and the patients eventually improved symptomatically. These patients were eventually diagnosed with Graves’ disease and were placed on methimazole, which prevented further attacks. Thyroid periodic paralysis (TPP) is a rare clinical manifestation of hyperthyroidism. Patients present with sudden onset paralysis associated with severe hypokalemia. The presence of paralysis and hypokalemia in a patient who has a history of hyperthyroidism should prompt the physician about thyrotoxic periodic paralysis. A high index of suspicion, prompt diagnosis, and management of the condition can prevent severe complications, such as cardiac arrhythmias. PMID:26623197
Cheung, Kitty K. T.; So, Wing-Yee; Kong, Alice P. S.; Ma, Ronald C. W.; Chow, Francis C. C.
We report a case of life-threatening hypokalemia in a 28-year-old bodybuilder who presented with sudden onset bilateral lower limbs paralysis few days after his bodybuilding competition. His electrocardiogram (ECG) showed typical u-waves due to severe hypokalemia (serum potassium 1.6 mmol/L, reference range (RR) 3.5–5.0 mmol/L). He was admitted to the intensive care unit (ICU) and was treated with potassium replacement. The patient later admitted that he had exposed himself to weight loss agents of unknown nature, purchased online, and large carbohydrate loads in preparation for the competition. He made a full recovery after a few days and discharged himself from the hospital against medical advice. The severe hypokalemia was thought to be caused by several mechanisms to be discussed in this report. With the ever rising number of new fitness centers recently, the ease of online purchasing of almost any drug, and the increasing numbers of youngsters getting into the bodybuilding arena, clinicians should be able to recognize the possible causes of sudden severe hypokalemia in these patients in order to revert the pathophysiology. PMID:24660073
Cheung, Kitty K T; So, Wing-Yee; Kong, Alice P S; Ma, Ronald C W; Chow, Francis C C
We report a case of life-threatening hypokalemia in a 28-year-old bodybuilder who presented with sudden onset bilateral lower limbs paralysis few days after his bodybuilding competition. His electrocardiogram (ECG) showed typical u-waves due to severe hypokalemia (serum potassium 1.6 mmol/L, reference range (RR) 3.5-5.0 mmol/L). He was admitted to the intensive care unit (ICU) and was treated with potassium replacement. The patient later admitted that he had exposed himself to weight loss agents of unknown nature, purchased online, and large carbohydrate loads in preparation for the competition. He made a full recovery after a few days and discharged himself from the hospital against medical advice. The severe hypokalemia was thought to be caused by several mechanisms to be discussed in this report. With the ever rising number of new fitness centers recently, the ease of online purchasing of almost any drug, and the increasing numbers of youngsters getting into the bodybuilding arena, clinicians should be able to recognize the possible causes of sudden severe hypokalemia in these patients in order to revert the pathophysiology.
Garza-Alpirez, A.; Esquivel-Valerio, J. A.; Villarreal-Alarcón, M. A.; Galarza-Delgado, D. A.
Tubulointerstitial nephritis (TIN) is the main renal involvement associated with primary Sjögren syndrome (pSS). TIN can manifest as distal renal tubular acidosis (RTA), nephrogenic diabetes insipidus, proximal tubular dysfunction, and others. We present a 31-year-old female with hypokalemic paralysis due to distal RTA (dRTA). She received symptomatic treatment and hydroxychloroquine with a good response. There is insufficient information on whether to perform a kidney biopsy in these patients or not. The evidence suggests that there is an inflammatory background and therefore a potential serious affection to these patients, such as hypokalemic paralysis. We found 52 cases of hypokalemic paralysis due to dRTA in pSS patients. The majority of those patients were treated only with symptomatic medication. Patients who received corticosteroids had stable evolution even though they did not have another symptomatology. With such heterogeneous information, prospective studies are needed to assess the value of adding corticosteroids as a standardized treatment of this manifestation. PMID:28835864
Lin, Shih-Hua; Huang, Chou-Long
The pathogenesis of thyrotoxic periodic paralysis has long been thought related to increased Na(+)-K(+) ATPase activity stimulated by thyroid hormone and/or hyperadrenergic activity and hyperinsulinemia. This mechanism alone, however, cannot adequately explain how hypokalemia occurs during acute attacks or the associated paradoxical depolarization of the resting membrane potential. Recent findings that loss of function mutations of the skeletal muscle-specific inward rectifying K(+) (Kir) channel, Kir2.6, associate with thyrotoxic periodic paralysis provide new insights into how reduced outward K(+) efflux in skeletal muscle, from either channel mutations or inhibition by hormones (adrenalin or insulin), can lead to a vicious cycle of hypokalemia and paradoxical depolarization, which in turn, inactivates Na(+) channels and causes muscle unexcitability and paralysis.
Kulkarni, Maitri; Tv, Srividya; Gopal, N
Hypokalemic myopathy may range from numbness/weakness to complete paralysis. The aetiology may be congenital or acquired. It is characterized by acute muscular weakness with low levels of potassium (<3.5 meq/L). We present a case of 26-year-old multigravida at 36 weeks of gestation with gestational hypertension on treatment, who came with acute onset of pain, numbness and weakness of both legs which worsened following betamethasone injection. She was diagnosed to have Hypokalemic paralysis with potassium levels of 2.1 meq/L. The medical profile remitted promptly on intravenous potassium replacement. Pregnancy was continued till 37 weeks with oral potassium supplements, antihypertensives and regular monitoring of serum potassium levels. The pregnancy was terminated after 37 weeks in view of gestational hypertension. Postpartum period was uneventful, patient was discharged after two weeks when potassium levels and BP returned to normal.
TV, Srividya; Gopal, N
Hypokalemic myopathy may range from numbness/weakness to complete paralysis. The aetiology may be congenital or acquired. It is characterized by acute muscular weakness with low levels of potassium (<3.5 meq/L). We present a case of 26-year-old multigravida at 36 weeks of gestation with gestational hypertension on treatment, who came with acute onset of pain, numbness and weakness of both legs which worsened following betamethasone injection. She was diagnosed to have Hypokalemic paralysis with potassium levels of 2.1 meq/L. The medical profile remitted promptly on intravenous potassium replacement. Pregnancy was continued till 37 weeks with oral potassium supplements, antihypertensives and regular monitoring of serum potassium levels. The pregnancy was terminated after 37 weeks in view of gestational hypertension. Postpartum period was uneventful, patient was discharged after two weeks when potassium levels and BP returned to normal. PMID:25121034
Periodic paralyses are neuromuscular disorders characterized by attacks of muscle weakness coinciding with changes in blood potassium levels. They are thus classified as hypokalaemic, normokalaemic or hyperkalaemic. Most forms are genetic, with autosomal dominant inheritance. These diseases are channelopathies, i.e. caused by mutations in ion channel genes. The culprit genes encode muscle sodium, calcium and potassium channels. Mutations in calcium or potassium channels cause periodic paralyses of the same type (hypokalaemic periodic paralysis or Andersen-Tawil Syndrome). In contrast, distinct mutations in the gene encoding the sodium channel can cause the entire range of periodic paralysis (hypokalaemic, normokalaemic or hyperkalaemic). The physiological consequences of mutations have been studied with patch-clamp techniques and electromyography. Generally speaking, mutations alter the excitability cycle of the muscle membrane, resulting in a loss of function (paralysis). Electromyographic studies have demonstrated a good correlation between symptoms and physiological parameters, giving rise to a classification that can help orient the molecular diagnosis. Work on the genetics and pathophysiology of periodic paralyses has helped to improve the diagnosis and management of these syndromes.
Sung, Chih-Chien; Cheng, Chih-Jen; Lo, Yi-Fen; Lin, Mei-Shan; Yang, Sung-Sen; Hsu, Yu-Chuan; Lin, Shih-Hua
Sporadic periodic paralysis (SPP), the second leading cause of hypokalemic periodic paralysis (HPP) in Asia, has a presentation similar to that of familial periodic paralysis (FPP) and is caused by gene mutations in the calcium (Ca(2+)) (CACNA1S) and sodium (Na(+)) (SCN4A) channels of skeletal muscle. The authors determined whether SPP shares similar genotype and phenotype with FPP. Sixty SPP patients who did not have a family history of paralysis, abnormal thyroid function tests and other identifiable causes of HPP, and 8 FPP patients were enrolled. Genomic DNA was isolated from blood leukocytes of all SPP and FPP patients. Genetic analysis of whole S4 segment in CACNA1S and SCN4A was performed. Phenotypic analysis included clinical presentations, laboratory data and precipitating events. All FPP patients had mutations in either CACNA1S or SCN4A, but only 4 SPP patients had de novo mutations in CACNA1S (R1239H) and SCN4A (R669×2, R1135H). SPP patients with de novo mutations manifested a phenotype indistinguishable from that of FPP patients except a later age of onset. SPP patients without mutations also had a later age of onset, significantly fewer attacks of paralysis than FPP patients, and unidentifiable precipitating factors. A minority of SPP patients had de novo CACNA1S or SCN4A mutations and may have a variant of FPP. The majority of SPP patients, those without mutations in CACNA1S and SCN4A, represent a unique subgroup of HPP patients, and this form of SPP usually manifests at a later age, is associated with fewer attacks and lacks apparent triggering factors.
Hsiao, Yu-Hsin; Fang, Yu-Wei; Leu, Jyh-Gang; Tsai, Ming-Hsein
BACKGROUND Thyrotoxic periodic paralysis (TPP) is commonly observed in patients with acute paralysis and hyperthyroidism. However, there is a possibility of secondary causes of hypokalemia in such a setting. CASE REPORT Herein, we present the case of a 38-year-old woman with untreated hypertension and hyperthyroidism. She presented with muscle weakness, nausea, vomiting, and diarrhea since one week. The initial diagnosis was TPP. However, biochemistry tests showed hypokalemia with metabolic alkalosis and renal potassium wasting. Moreover, a suppressed plasma renin level and a high plasma aldosterone level were noted, which was suggestive of primary aldosteronism. Abdominal computed tomography confirmed this diagnosis. CONCLUSIONS Therefore, it is imperative to consider other causes of hypokalemia (apart from TPP) in a patient with hyperthyroidism but with renal potassium wasting and metabolic alkalosis. This can help avoid delay in diagnosis of the underlying disease.
Hsiao, Yu-Hsin; Fang, Yu-Wei; Leu, Jyh-Gang; Tsai, Ming-Hsien
Patient: Female, 38 Final Diagnosis: Primary hyperaldosteronism Symptoms: Paralysis Medication: — Clinical Procedure: — Specialty: Nephrology Objective: Challenging differential diagnosis Background: Thyrotoxic periodic paralysis (TPP) is commonly observed in patients with acute paralysis and hyperthyroidism. However, there is a possibility of secondary causes of hypokalemia in such a setting. Case Report: Herein, we present the case of a 38-year-old woman with untreated hypertension and hyperthyroidism. She presented with muscle weakness, nausea, vomiting, and diarrhea since one week. The initial diagnosis was TPP. However, biochemistry tests showed hypokalemia with metabolic alkalosis and renal potassium wasting. Moreover, a suppressed plasma renin level and a high plasma aldosterone level were noted, which was suggestive of primary aldosteronism. Abdominal computed tomography confirmed this diagnosis. Conclusions: Therefore, it is imperative to consider other causes of hypokalemia (apart from TPP) in a patient with hyper-thyroidism but with renal potassium wasting and metabolic alkalosis. This can help avoid delay in diagnosis of the underlying disease. PMID:28050008
Tachamo, Niranjan; Lohani, Saroj; Nazir, Salik; Juliano, Noelle
Thyrotoxic periodic paralysis is a potentially life-threatening condition associated with recurrent episodes of muscle weakness and hypokalaemia due to hyperthyroidism. Diagnosis is often delayed or misdiagnosed due to its rarity in the western world and subtle features of hyperthyroidism on initial presentation. Here we present the case of a 25-year-old man who presented to the emergency department (ED) with sudden onset weakness of bilateral upper and lower extremities. His labs revealed hypokalaemia with elevated T4 and suppressed thyroid-stimulating hormone and he was diagnosed with thyrotoxic periodic paralysis. He was treated with potassium repletion, atenolol and methimazole with complete reversal of his paralysis within the next day. Unfortunately, he failed to keep the follow-up appointment after discharge, ran out of his methimazole and landed up in the ED again. 2017 BMJ Publishing Group Ltd.
... that can trigger attacks include rest after exercise, potassium-rich foods such as bananas and potatoes, stress, ... with hyperkalemic periodic paralysis have increased levels of potassium in their blood (hyperkalemia) during attacks. Hyperkalemia results ...
Naylor, J M
The purpose of this review is to present an up-to-date summary of the signs, diagnosis, treatment, and implications of equine hyperkalemic periodic paralysis. The review encompasses all original articles published between 1986 and early 1993. Hyperkalemic periodic paralysis is the result of a genetic mutation in the skeletal muscle sodium channel gene. It is inherited as an autosomal dominant trait; most affected horses are heterozygotes. The classical signs are muscle fasciculation, spasm, and weakness associated with hyperkalemia. However, these signs are only rarely observed in affected horses. Potential sequelae to attacks are abrasions and involuntary recumbency; these problems are not specific for hyperkalemic periodic paralysis, but they occur more frequently in hyperkalemic periodic paralysis-affected horses. It is also likely that hyperkalemic periodic paralysis results in greater muscle mass. There are suggestions that homozygotes may be more severely affected and show signs of upper respiratory obstruction as foals. The practitioner needs to be aware of the tests for hyperkalemic periodic paralysis, and their limitations, so that he can properly diagnose this condition. The industry has the difficult problem of deciding whether or not testing should be mandatory and the fate of positive horses. Images Figure 2. PMID:8050073
Prasad, D.; Agarwal, D.; Malhotra, V.; Beniwal, P.
We report recurrent hypokalemic periodic quadriparesis in a 30-year-old woman. Patient had also symptoms of multiple large and small joint pain, recurrent oral ulceration, photosensitivity and hair loss that were persisting since last 6 months and investigations revealed systemic lupus erythematosus (SLE) with distal tubular acidosis. Our patient was successfully treated with oral potassium chloride, sodium bicarbonate, hydroxychloroquine and a short course of steroids. Thus, tubular dysfunction should be carefully assessed in patients with SLE. PMID:25249723
Wei, Cui-jie; Wang, Dong; Wang, Shuo; Jiao, Hui; Hong, Dao-jun; Pu, Li-hua; Xiong, Hui
Periodic paralysis (PP) is one type of skeletal muscle channelopathies characterized by episodic attacks of weakness. It is usually classified into hyperkalemic periodic paralysis (HyperPP), hypokalemic periodic paralysis (HypoPP) and normokalemic periodic paralysis (NormoPP) based on the blood potassium levels. HypoPP is the most common type of these three and NormoPP is the rarest one. The aim of this study was to explore the clinical and genetic features of a Chinese family with normokalemic periodic paralysis (NormoKPP). Clinical features of all patients in the family with NormoKPP were analyzed. Genomic DNA was extracted from peripheral blood leukocytes and amplified with PCR. We screened all 24 exons of SCN4A gene and then sequence analysis was performed in those who showed heteroduplex as compared with unaffected controls. (1) Fifteen members of the family were clinically diagnosed NormoKPP, and their common features are: onset within infacy, episodic attacks of weakness, the blood potassium levels were within normal ranges, high sodium diet or large dosage of normal saline could attenuate the symptom. One muscle biopsy was performed and examination of light and electronic microscopy showed occasionally degenerating myofibers. (2) Gene of 12 patients were screened and confirmed mutations of SCN4A genes--c. 2111 T > C/p. Thr704Met. The study further defined the clinical features of patients with NormoKPP, and molecular genetic analysis found SCN4A gene c. 2111 T > C/p. Thr704Met point mutation contributed to the disease. In line with the autosomal dominant inheritance laws, this family can be diagnosed with periodic paralysis, and be provided with genetic counseling. And the study may also help the clinical diagnosis, guide treatment and genetic counseling of this rare disease in China.
Tanneau, R S; Pennec, Y L; Morin, J F; Codet, J P; Bourbigot, B; Garre, M; Le Menn, G
Eleven episodes of severe hyponatremia secondary to hiccup-induced potomania were recorded in 3 years in a man who had essential hypertension, a low protein intake and a normal diluting ability. Paradoxical increase in hematocrit and plasma protein with acute extensive natriuresis was associated as well as urine potassium loss and hypokalemia producing paralysis in 1 episode. During a chronic water loading test, the defect in water excretion was related to a low urine solute delivery which was partially reverted by the natriuretic response to plasma volume expansion, promoting water diuresis. In acute water intoxication, this natriuretic response was exaggerated, producing a brisk water diuresis. Plasma volume was rapidly normalized but without any improvement in plasma sodium due to the concomitant negative sodium balance. Thus, water diuresis persisted until plasma volume was significantly contracted. Potassium loss appeared to be related to sodium excretion. Metabolic disturbances have not reoccurred despite persistent hiccup and potomania during 2 years of urea therapy.
Jones, Peter; Papadimitropoulos, Laura; Tessaro, Mark O
Thyrotoxic periodic paralysis is a reversible metabolic disorder that is characterized by acute muscle weakness and hypokalemia. It predominantly affects males of Asian descent. We describe the youngest such patient yet reported, a 13-year-old Asian male with a history of transient attacks of weakness who presented to our emergency department with weakness in his extremities and mild tachycardia. Laboratory test results initially revealed marked hypokalemia and later confirmed associated hyperthyroidism. Correction of the hypokalemia reversed the patient's weakness in the emergency department.
Fábregas, N; Taurá, P; Castillo, J; Tomás, A; Planella, V L; Naldá, M A
In 8 healthy patients (ASA I-II) there was analyzed the effect of salbutamol over serum levels of potassium, glucose, insulin, AMPc and GMPc. Also were determined the arterial blood pressure and heart rate. The drug was administered intravenously, as bronchodilator, during the preoperative period. There was a significant decrease in kaliemia (p less than 0.001 immediately after receiving the salbutamol infusion and p less than 0.05 at 60 min). Their plasma potassium levels dropped from 4.03 +/- 25 to 3.45 +/- 0.16 mEq.l-1. The plasma levels of glucose and insulin increased with a significance of p less than 0.001 post salbutamol perfusion. There were no changes in the plasmatic AMPc and GMPc. Heart rate increased from 67 +/- 10.8 to 80.5 +/- 13.7 (p less than 0.01) post perfusion, returning afterwards to their basal values. Arterial blood pressure was unmodified.
Pappa, Theodora; Papanastasiou, Labrini; Markou, Athina; Androulakis, Ioannis; Kontogeorgos, George; Seretis, Andreas; Piaditis, George
Thyrotoxic Periodic Paralysis (TPP) is a rare manifestation of hyperthyroidism characterized by muscle weakness and hypokalemia. Thyroid-Stimulating Hormone (TSH)-secreting pituitary adenoma is a rare cause of hyperthyroidism. Even more rare is the occurrence of TPP as the first manifestation of a TSH-secreting pituitary adenoma. We report a 31-year-old Asian male patient suffering from TPP caused by a TSH-secreting adenoma, who was evaluated for persistent episodes of muscle paralysis. Laboratory investigation revealed hypokalemia as well as elevated levels of both thyroid hormones and TSH. The Magnetic Resonance Imaging (MRI) of the pituitary gland revealed a microadenoma, thus suggesting the presence of a TSH-secreting adenoma. The patient underwent transphenoidal resection and the pathological investigation confirmed the diagnosis of TSH-secreting pituitary adenoma. After the adenomectomy and the restoration of euthyroidism, the patient did not experience any episode of hypokalemic paralysis or weakness. Despite its rarity, TSH-secreting pituitary adenoma should be included in the differential diagnosis of TPP.
A literature review of the clinical syndrome HYPP (Hyperkalemic periodic paralysis) affecting Quarter Horses is given. HYPP is characterized by sporadic attacks of muscle tremors, weakness and/or collapse, lasting for variable periods of time. Diagnosis is based on physical findings in association with hyperkalemia. In horses with HYPP, the regulation of ion transport through the sodium channels in the muscle cells occasionally fails, causing uncontrollable muscle twitching. Further investigations into molecular genetics reveals a mutation in the gene responsible for sodium and potassium regulation. The identification of this gene mutation is the basis for the blood test used to diagnose HYPP. HYPP is inherited as an autosomal dominant trait. Treatment of HYPP attacks by intravenous application of calcium gluconate, bicarbonate and glucose results in rapid recovery. Consequent dietary management and daily administration of acetazolamide effectively controls the disease.
Boissier, E; Georgin-Lavialle, S; Cochereau, D; Ducloux, R; Ranque, B; Aslangul, E; Pouchot, J
Periodic thyrotoxic hypokalemic paralysis (TPP) is a neuromuscular complication of hyperthyroidism. It is more common in young Asian males than in Caucasian and African patients. We report four new cases and review the literature. Four consecutive patients were diagnosed with TPP. They were all men with a median age of 34.5 years at presentation. Two patients originated from the Philippines, one was African and one was Caucasian ethnic background. They all presented with a paresis or flaccid paralysis, without respiratory failure. Previous similar episodes in their past medical history, the presence of profound hypokalemia (mean serum potassium level of 2 mmol/L) and the presence of clinical and biological signs of hyperthyroidism led to the diagnosis of TPP. All four patients were diagnosed with Graves' disease. Outcome was favourable in all four patients with the symptomatic treatment of TPP and treatment of Graves' disease. TPP is a severe condition, due to a dysfunction of the Na(+)-K(+) ATPase pump. Initial management relies on β-blocker treatment and careful potassium supplementation. Then, medical or surgical etiological treatment of the thyrotoxicosis is essential to prevent a recurrence. The disease is probably underdiagnosed: it must be suspected when a profound hypokaliema resolves very quickly (<12hours); hyperthyroidism should always be included in the differential diagnosis of a paresis associated with hypokalemia. Copyright © 2013 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.
Barahona, M. J.; Vinagre, I.; Sojo, L.; Cubero, J. M.; Pérez, Antonio
We describe a 37-year-old man with a 4-month history of episodic muscular weakness, involving mainly lower-limbs. Hypokalemia was documented in one episode and managed with intravenous potassium chloride. Hyperthyroidism was diagnosed 4 months after onset of attacks because of mild symptoms. The patient was subsequently diagnosed as having thyrotoxic periodic paralysis associated with Graves’ disease. Treatment with propranolol and methimazol was initiated and one year later he remains euthyroid and symptom free. Thyrotoxic periodic paralysis is a rare disorder, especially among Caucasians, but it should always be considered in patients with acute paralysis and hypokalemia, and thyroid function should be evaluated. PMID:19625499
Iranzo, A; Santamaria, J
A 24-year-old man with sporadic hyperkalemic periodic paralysis (HPP) presented with moderate excessive daytime sleepiness and transitory episodes of weakness which occurred during and after sleep. Multiple sleep latency test (MSLT) demonstrated the presence of five sleep onset REM periods (SOREMPs) and a sleep latency of five minutes. Treatment with a diuretic which decreases serum potassium resolved all the clinical symtomps and a new MSLT showed the absence of SOREMPs and a sleep latency of 13.5 minutes. To our knowledge, the patient herein reported is the first case that associates sleep abnormalities and multiple SOREMPs with HPP. Furthermore, the present case suggests that SOREMPs may be explained by an increased extracellular potassium conductance related to HPP.
Paralysis is the loss of muscle function in part of your body. It happens when something goes ... way messages pass between your brain and muscles. Paralysis can be complete or partial. It can occur ...
Bailey, J E; Pablo, L; Hubbell, J A
A 7-month-old Quarter Horse filly was admitted for surgical repair of a right olecranon fracture. Anesthesia was achieved with xylazine hydrochloride, guaifenesin, ketamine hydrochloride, and halothane. Two and a half hours after induction of anesthesia, myotonia, muscle fasciculations, and sweating, concurrent with high serum potassium concentration and associated electrocardiographic changes consistent with hyperkalemic periodic paralysis, were observed. Treatment included intermittent positive-pressure ventilation, changing intravenous administration of fluids from lactated Ringer's solution to 0.9% NaCl solution, and administration of calcium gluconate, glycopyrrolate, dopamine, and sodium bicarbonate. Clinical signs resolved with the return of serum potassium concentrations to the reference range. The horse was confirmed to be heterozygous for hyperkalemic periodic paralysis by DNA testing.
Thyrotoxic periodic paralysis (TPP) is a rare, but serious condition characterized by acute paralytic attacks and hypokalemia in association with thyrotoxicosis. Although carbohydrate rich meals, strenuous exercise, alcohol, emotional stress are known precipitants of TPP, steroid treatment has rarely been reported to induce TPP. We report a case in which a patient with previously untreated Grave's disease developed TPP following administration of Intravenous hydrocortisone for control of severe anaphylaxis, which to best of our knowledge is very rare. PMID:25810683
Molecular cloning of ion channels in Felis catus that are related to periodic paralyses in man: a contribution to the understanding of the genetic susceptibility to feline neck ventroflexion and paralysis
Zapata, Marlyn; Kunii, Ilda S.; Paninka, Rolf M.; Simões, Denise M. N.; Castillo, Víctor A.; Reche, Archivaldo; Maciel, Rui M. B.; Dias da Silva, Magnus R.
ABSTRACT Neck ventroflexion in cats has different causes; however, the most common is the hypokalemia associated with flaccid paralysis secondary to chronic renal failure. In humans, the most common causes of acute flaccid paralysis are hypokalemia precipitated by thyrotoxicosis and familial forms linked to mutations in sodium, potassium, and calcium channel genes. Here, we describe the sequencing and analysis of skeletal muscle ion channels in Felis catus that could be related to periodic paralyses in humans, contributing to the understanding of the genetic susceptibility to feline neck ventroflexion and paralysis. We studied genomic DNA from eleven cats, including five animals that were hyperthyroid with hypokalemia, although only one presented with muscle weakness, and six healthy control domestic cats. We identified the ion channel ortholog genes KCNJ2, KCNJ12, KCNJ14, CACNA1S and SCN4A in the Felis catus genome, together with several polymorphic variants. Upon comparative alignment with other genomes, we found that Felis catus provides evidence for a high genomic conservation of ion channel sequences. Although we hypothesized that neck ventroflexion in cats could be associated with a thyrotoxic or familial periodic paralysis channel mutation, we did not identify any previously detected human channel mutation in the hyperthyroid cat presenting hypokalemia. However, based on the small number of affected cats in this study, we cannot yet rule out this molecular mechanism. Notwithstanding, hyperthyroidism should still be considered as a differential diagnosis in hypokalemic feline paralysis. PMID:25063199
Chen, Dan Yun; Schneider, Peter F; Zhang, Xiang Song; He, Zhi Min; Chen, Tang Hua
Thyrotoxic periodic paralysis (TPP) is a variant of periodic paralysis (PP) that occurs in patients with underlying mutations in genes for cation channels, if they develop thyrotoxicosis. It is disabling, and fatalities sometimes occur. Here, we present a patient with TPP who developed hypokalemic paralysis that was probably aggravated by the administration of a carbohydrate, probably contributing to, if not causing, a fatal outcome. A 30-year-old Chinese patient received (131)I treatment for Graves' disease (GD) in our hospital. Three days later in the middle of the night, he developed aggravating paralytic symptoms after a heavy evening meal. The next morning, he was seen in a small clinic and was treated with 1250 mL 5% glucose containing 25 mL 10% potassium chloride (KCl). By early afternoon, he had not improved and was transferred to a city hospital, arriving with grade I muscle strength and severed facial and bulbar paralysis that was shortly followed by cardiac arrest with failure of resuscitation. Shortly before he died, his serum K(+) was 1.15 mEq/L (normal=3.5-5). We postulate that severe hypokalemia developed in our patient in part in response to the high intravenous glucose load that he received. We advocate caution against using intravenous glucose solutions for potassium administration in patients with TPP and recommend a review of guidelines suggesting this form of treatment. In rural settings with limited resources, we favor oral potassium, not to exceed 100 mEq per day, and transfer to a modern medical facility in settings where muscle weakness is developing in patients with TPP.
Shields, Denise L
Thyrotoxic periodic paralysis is an acute endocrine emergency characterized by hyperthyroidism, profound muscle weakness and/or paralysis, and hypokalemia that is not due to potassium deficiency. Typically described in young males of Asian descent, it is becoming increasingly recognized outside of this demographic group and is believed to be an underrecognized cause of symptomatic hypokalemia. Thyrotoxic periodic paralysis usually manifests as acute onset of symmetrical distal extremity weakness and is treated with careful potassium replacement and nonselective β-blockers. In this case, a 43-year-old African American woman with thyrotoxic periodic paralysis had recurrent lower extremity myopathy and acute respiratory failure precipitated by noncompliance with treatment for Graves disease. ©2015 American Association of Critical-Care Nurses.
Nellen, H; Mercado, M; Mendoza, V; Villanueva, S; Pérez, M; Hernández, A; Arellano, J
Thyrotoxic periodic paralysis (TPP) is characterized by episodes of neuromuscular weakness occurring in the context of hypokalemia and hyperthyroidism and has been predominantly described in Oriental populations. Whereas it is uncommon in Caucasians and Blacks, TPP does occur in individuals of Native American descent. The objective was to analyze the clinical, biochemical, and HLA characteristics of a group of Mexican mestizo patients with TPP. The sample was comprised of 14 men with TPP diagnosed since January 1990, based on one or more episodes of flaccid paralysis, accompanied by hypokalemia and occurring in the context of clinical and biochemical hyperthyroidism. Eight were available for HLA testing. Hyperthyroidism was diagnosed before the development of periodic paralysis in five of the patients, whereas in six it occurred afterward. The severity of paralysis did not correlate with the degree of either hypokalemia or hyperthyroidism. An increased frequency of HLA-DR3 was found in Graves' patients without paralysis but not in those with paralysis, as compared to the general population. TPP is more common than previously thought in Mexicans, in whom it behaves as in other Native American groups. The lack of HLA-DR3 association in Graves' patients with TPP is interesting, but at the moment has no pathophysiological implications.
Endogenous insulin production in patients with familial periodic hypokalemia has not previously been studied during induced attacks. The serum insulin, serum potassium, and blood glucose concentrations were measured in six patients with familial periodic hypokalemia during six attacks of paralysis induced by long-lasting glucose stimulation. The same parameters were measured in four normal subjects under the same conditions. There was no difference in insulin response or in blood glucose between the two groups. Basal insulin levels showed no difference. There was no correlation between the occurrence of the attack and the serum insulin level in the patients. All the patients responded by severe paralysis and hypokalemia.
Methods: Seven male patients were enlisted who presented to the emergency department over a period of three years with weakness and paralysis in the morning. Results: Initial electrolyte studies revealed hypokalaemia in these patients, and later thyroid function tests confirmed thyrotoxicosis for all. Only two of these patients had clinical symptoms and signs of thyrotoxicosis, the others being asymptomatic. Conclusions: Early morning paralysis can be the first manifestation of hyperthyroidism in Asian men, without the other more typical symptoms of weight loss, increased appetite, excitability, sweaty palms or goitre. Treatment to a euthyroid state will ameliorate the syndrome. PMID:11777887
Oh, Sang Bo; Ahn, Jinhee; Oh, Min Young; Choi, Bo Gwang; Kang, Ji Hyun; Jeon, Yun Kyung; Kim, Sang Soo; Kim, Bo Hyun; Kim, Yong Ki; Kim, In Joo
Thyrotoxic periodic paralysis (TPP) is a rare manifestation of hyperthyroidism characterized by muscle weakness and hypokalemia. All ethnicities can be affected, but TPP typically presents in men of Asian descent. The most common cause of TPP in thyrotoxicosis is Graves' disease. However, TPP can occur with any form of thyrotoxicosis. Up to our knowledge, very few cases ever reported the relationship between TPP and painless thyroiditis. We herein report a 25-yr-old Korean man who suffered from flaccid paralysis of the lower extremities and numbness of hands. The patient was subsequently diagnosed as having TPP associated with transient thyrotoxicosis due to painless thyroiditis. The paralytic attack did not recur after improving the thyroid function. Therefore, it is necessary that early diagnosis of TPP due to transient thyrotoxicosis is made to administer definite treatment and prevent recurrent paralysis.
Renaud, Jean-Marc; Hayward, Lawrence J
Hyperkalemic periodic paralysis (HyperKPP) is a disease characterized by periods of myotonic discharges and paralytic attacks causing weakness, the latter associated with increases in plasma [K(+)]. The myotonic discharge is due to increased Na(+) influx through defective Na(+) channels that triggers generation of several action potentials. The subsequent increase in extracellular K(+) concentration causes excessive membrane depolarization that inactivates Na(+) channels triggering the paralysis. None of the available treatments is fully effective. This paper reviews the capacity of Na(+) K(+)ATPase pumps, KATP and ClC-1 Cl(-) channels in improving membrane excitability during muscle activity and how using these three membrane components we can study future and more effective treatments for HyperKPP patients. The review of current patents related to HyperKPP reinforces the need of novel approaches for the treatment of this channelopathy.
Matta, Abhishek; Koppala, Jahnavi; Gossman, William
A 26-year-old Hispanic man with no significant medical history presented to our emergency room with gradual onset weakness of his lower extremities. He was haemodynamically stable and examination revealed loss of motor function in his lower limbs up to the level of hips. Laboratory data revealed hypokalaemia. The patient was started on potassium supplementation and he recovered his muscle strength. Differential diagnosis included familial hypokalaemic periodic paralysis and thyrotoxic periodic paralysis (TPP). Further investigations revealed a low thyroid-stimulating hormone and high free thyroxine levels. Radio iodine 123 scan revealed an enhanced homogeneous uptake in the thyroid suggesting Graves' disease. Thyroid stimulating antibodies were also found to be elevated. The patient was started on methimazole and propranolol and he never had another attack of TPP even at 1 year follow-up.
Corrochano, Silvia; Männikkö, Roope; Joyce, Peter I.; McGoldrick, Philip; Lassi, Glenda; Raja Rayan, Dipa L.; Blanco, Gonzalo; Quinn, Colin; Liavas, Andrianos; Lionikas, Arimantas; Amior, Neta; Dick, James; Healy, Estelle G.; Stewart, Michelle; Carter, Sarah; Hutchinson, Marie; Bentley, Liz; Fratta, Pietro; Cortese, Andrea; Cox, Roger; Brown, Steve D. M.; Tucci, Valter; Wackerhage, Henning; Amato, Anthony A.; Greensmith, Linda; Koltzenburg, Martin; Hanna, Michael G.; Acevedo-Arozena, Abraham
Mutations in the skeletal muscle channel (SCN4A), encoding the Nav1.4 voltage-gated sodium channel, are causative of a variety of muscle channelopathies, including non-dystrophic myotonias and periodic paralysis. The effects of many of these mutations on channel function have been characterized both in vitro and in vivo. However, little is known about the consequences of SCN4A mutations downstream from their impact on the electrophysiology of the Nav1.4 channel. Here we report the discovery of a novel SCN4A mutation (c.1762A>G; p.I588V) in a patient with myotonia and periodic paralysis, located within the S1 segment of the second domain of the Nav1.4 channel. Using N-ethyl-N-nitrosourea mutagenesis, we generated and characterized a mouse model (named draggen), carrying the equivalent point mutation (c.1744A>G; p.I582V) to that found in the patient with periodic paralysis and myotonia. Draggen mice have myotonia and suffer from intermittent hind-limb immobility attacks. In-depth characterization of draggen mice uncovered novel systemic metabolic abnormalities in Scn4a mouse models and provided novel insights into disease mechanisms. We discovered metabolic alterations leading to lean mice, as well as abnormal AMP-activated protein kinase activation, which were associated with the immobility attacks and may provide a novel potential therapeutic target. PMID:25348630
Jennette, John; Tauferner, Dustin
Thyrotoxic periodic paralysis (TPP) is an endocrine disorder presenting with proximal motor weakness, typically greatest in the lower extremities, hypokalemia, and signs or laboratory findings consistent with hyperthyroidism. The incidence of TPP is highest in Asian males. This is a case report of a 30-year-old male active duty Soldier who presented to the emergency department complaining of several recent episodes of lower extremity paralysis. The patient underwent a workup which included serum and cerebrospinal fluid studies, and was found to be hypokalemic and hyperthyroid. Following consultation with neurology, the patient was admitted to the medicine service and treated for thyrotoxic periodic paralysis with potassium replacement and treatment of his hyperthyroidism. Since achieving a euthyroid state, he has had no recurrences of TPP. This disease should be considered in patients presenting with symmetric motor weakness and hypokalemia, whether or not symptoms of hyperthyroidism are elicited during the review of systems.
Mishra, Vikas; Harbada, Rishit; Sharma, Akhilesh; Mishra, Meenakshi
Dengue infection is the leading cause of illness and death in tropical and subtropical regions of the world. The common complications associated with dengue fever are usual hematological abnormalities, shock, and organ failure. The neurological complications of dengue are uncommon. However, evidence of dengue virus neurotropism and complications has been slowly but surely rising as seen from increased literature on this subject over the last decade. We report an uncommon case of hypokalemic quadriparesis with dengue that had a favorable outcome.
Corrochano, Silvia; Männikkö, Roope; Joyce, Peter I; McGoldrick, Philip; Wettstein, Jessica; Lassi, Glenda; Raja Rayan, Dipa L; Blanco, Gonzalo; Quinn, Colin; Liavas, Andrianos; Lionikas, Arimantas; Amior, Neta; Dick, James; Healy, Estelle G; Stewart, Michelle; Carter, Sarah; Hutchinson, Marie; Bentley, Liz; Fratta, Pietro; Cortese, Andrea; Cox, Roger; Brown, Steve D M; Tucci, Valter; Wackerhage, Henning; Amato, Anthony A; Greensmith, Linda; Koltzenburg, Martin; Hanna, Michael G; Acevedo-Arozena, Abraham
Mutations in the skeletal muscle channel (SCN4A), encoding the Nav1.4 voltage-gated sodium channel, are causative of a variety of muscle channelopathies, including non-dystrophic myotonias and periodic paralysis. The effects of many of these mutations on channel function have been characterized both in vitro and in vivo. However, little is known about the consequences of SCN4A mutations downstream from their impact on the electrophysiology of the Nav1.4 channel. Here we report the discovery of a novel SCN4A mutation (c.1762A>G; p.I588V) in a patient with myotonia and periodic paralysis, located within the S1 segment of the second domain of the Nav1.4 channel. Using N-ethyl-N-nitrosourea mutagenesis, we generated and characterized a mouse model (named draggen), carrying the equivalent point mutation (c.1744A>G; p.I582V) to that found in the patient with periodic paralysis and myotonia. Draggen mice have myotonia and suffer from intermittent hind-limb immobility attacks. In-depth characterization of draggen mice uncovered novel systemic metabolic abnormalities in Scn4a mouse models and provided novel insights into disease mechanisms. We discovered metabolic alterations leading to lean mice, as well as abnormal AMP-activated protein kinase activation, which were associated with the immobility attacks and may provide a novel potential therapeutic target. © The Author (2014). Published by Oxford University Press on behalf of the Guarantors of Brain.
Habbout, Karima; Poulin, Hugo; Rivier, François; Giuliano, Serena; Sternberg, Damien; Fontaine, Bertrand; Eymard, Bruno; Morales, Raul Juntas; Echenne, Bernard; King, Louise; Hanna, Michael G.; Männikkö, Roope; Chahine, Mohamed; Nicole, Sophie
Objective: To determine the molecular basis of a complex phenotype of congenital muscle weakness observed in an isolated but consanguineous patient. Methods: The proband was evaluated clinically and neurophysiologically over a period of 15 years. Genetic testing of candidate genes was performed. Functional characterization of the candidate mutation was done in mammalian cell background using whole cell patch clamp technique. Results: The proband had fatigable muscle weakness characteristic of congenital myasthenic syndrome with acute and reversible attacks of most severe muscle weakness as observed in periodic paralysis. We identified a novel homozygous SCN4A mutation (p.R1454W) linked to this recessively inherited phenotype. The p.R1454W substitution induced an important enhancement of fast and slow inactivation, a slower recovery for these inactivated states, and a frequency-dependent regulation of Nav1.4 channels in the heterologous expression system. Conclusion: We identified a novel loss-of-function mutation of Nav1.4 that leads to a recessive phenotype combining clinical symptoms and signs of congenital myasthenic syndrome and periodic paralysis, probably by decreasing channel availability for muscle action potential genesis at the neuromuscular junction and propagation along the sarcolemma. PMID:26659129
Piekaar, Roderick S M; Kwak, Aron R; Kelderman, Nienke; Eustatia-Rutten, Carmen F A
Thyreotoxic hypokalaemic periodic paralysis (THPP) is a rare and potentially life-threatening syndrome. It principally affects men of East-Asian origin and has rarely been described in a white person. A 34-year-old Dutch man, suffering from Graves' disease, presented with weakness in his lower limbs. Laboratory investigation showed severe hypokalaemia (1.8 mmol/l) and increased creatinine kinase levels. An electrocardiogram showed atrial fibrillation with a prolonged QTc-interval. The patient was admitted, cardiac rhythm was monitored, and he received potassium supplements. Laboratory investigation of thyroid function showed thyrotoxicosis. The patient was treated with propranolol and thiamazol. At follow-up, thyroid function, potassium levels and muscle strength had normalized. Hypokalaemia due to thyrotoxicosis should be considered in cases of unexplained paralysis. The treatment of THPP consists of treating for hyperthyroidism plus propranolol. Since the hypokalaemia is self-limiting, potassium supplementation is only necessary in cases of rhythm disturbances or cardiac-conduction disturbances. Despite adequate treatment, there is a risk of recurrence. Regular monitoring is indicated until euthyroidism is achieved.
Naylor, J M
Thirty offspring of a Quarter Horse sire, affected by hyperkalemic periodic paralysis (HPP), were examined electromyographically. On the basis of the detection of or lack of spontaneous activity with high frequency myotonic or pseudomyotonic discharges, the horses were diagnosed as being affected (14 horses) or unaffected (16 horses) with HPP. The show performance of these horses was evaluated for the first 3 to 9 years of their life by use of American Quarter Horse Association records. Horses affected with HPP performed significantly (P < 0.01) better in halter classes than did unaffected horses; mean halter points for the 2 groups were 11.9 and 0.4, respectively. The mean total performance points were not significantly different. None of the offspring had a successful racing record.
Traub-Dargatz, J L; Ingram, J T; Stashak, T S; Kiper, M L; Tarr, S; Child, G; MacAllister, C G
Four Quarter Horse foals ranging in age from 6 days to 2 months were determined to have upper airway stridor secondary to polymyopathy suspected to be hyperkalemic periodic paralysis. Electromyography revealed spontaneous muscle activity in all muscles examined. Electromyographic findings were similar in the dams of 3 foals (No. 1, 3 and 4). Hyperkalemia was found in foals 1 and 4. Endoscopically, the upper airway stridor in foals 1 and 3 was confirmed to be attributable to laryngeal and pharyngeal collapse or spasm. Foals 1, 2, and 3 were treated with acetazolamide. Foal 4 was not treated, at the owner's request. Foals 2 and 3 improved with treatment, foal 4's condition was static, and foal 1 required a tracheostomy and laryngeal surgery to manage its upper airway stridor.
Cherif, Eya; Ben Hassine, Lamia; Kechaou, Ines; Khalfallah, Narjess
Hypokalaemic rhabdomyolysis represents a medical emergency requiring rapid diagnosis and appropriate aetiological treatment. Renal tubular acidosis is a common cause of hypokalemia which can be idiopathic or secondary to systemic disorders such as Sjogren's syndrome. It can remain asymptomatic or manifest with metabolic abnormalities including hypokalemia paralysis, hypocalcaemia and hyperchloremic metabolic acidosis. Rhabdomyolysis presenting with severe hypokalemia as the first manifestation of Sjogren's syndrome is rare. We report a case of a 59-year-old woman who presented to our department with severe weakness of all limbs. Laboratory examination demonstrated hypokalemic rhabdomyolysis caused by distal renal tubular acidosis. Investigations revealed Sjogren's syndrome as the underlying cause of the metabolic disorders. PMID:24165505
Nielsen, Ole Bækgaard; Clausen, Johannes D.; Pedersen, Thomas Holm; Hayward, Lawrence J.
In patients with hyperkalemic periodic paralysis (HyperKPP), attacks of muscle weakness or paralysis are triggered by K+ ingestion or rest after exercise. Force can be restored by muscle work or treatment with β2-adrenoceptor agonists. A missense substitution corresponding to a mutation in the skeletal muscle voltage-gated Na+ channel (Nav1.4, Met1592Val) causing human HyperKPP was targeted into the mouse SCN4A gene (mutants). In soleus muscles prepared from these mutant mice, twitch, tetanic force, and endurance were markedly reduced compared with soleus from wild type (WT), reflecting impaired excitability. In mutant soleus, contractility was considerably more sensitive than WT soleus to inhibition by elevated [K+]o. In resting mutant soleus, tetrodotoxin (TTX)-suppressible 22Na uptake and [Na+]i were increased by 470 and 58%, respectively, and membrane potential was depolarized (by 16 mV, P < 0.0001) and repolarized by TTX. Na+,K+ pump–mediated 86Rb uptake was 83% larger than in WT. Salbutamol stimulated 86Rb uptake and reduced [Na+]i both in mutant and WT soleus. Stimulating Na+,K+ pumps with salbutamol restored force in mutant soleus and extensor digitorum longus (EDL). Increasing [Na+]i with monensin also restored force in soleus. In soleus, EDL, and tibialis anterior muscles of mutant mice, the content of Na+,K+ pumps was 28, 62, and 33% higher than in WT, respectively, possibly reflecting the stimulating effect of elevated [Na+]i on the synthesis of Na+,K+ pumps. The results confirm that the functional disorders of skeletal muscles in HyperKPP are secondary to increased Na+ influx and show that contractility can be restored by acute stimulation of the Na+,K+ pumps. Calcitonin gene-related peptide (CGRP) restored force in mutant soleus but caused no detectable increase in 86Rb uptake. Repeated excitation and capsaicin also restored contractility, possibly because of the release of endogenous CGRP from nerve endings in the isolated muscles. These
Zhang, Hong-tao; Qiu, Lian-li
To observe clinical effects of "Santong needling" by stages for patients with moderate and severe peripheral facial paralysis (PFP) in the acute period. Sixty patients with moderate and severe PFP were equally and randomly divided into Santong needling group and control group. The patients of the Santong needling group were treated by shallow puncture of Yifeng (TE 17, on the affected side) and Hegu (LI 4, on the healthy side) without needle manipulation in the acute stage ("Qing-tong", mild dredging) , by oblique-penetrative puncture of Dicang (ST 4) to Jiache (ST 6), etc. , and moderate manipulation of needles in the resting stage ("Qiang-tong", stronger dredging) , and by oblique-penetrative puncture of Dicang (ST 4) to Jiache (ST 6), etc., and reinforcing needling manipulation in the recovery stage("Bu-tong", tonifying dredging). The patients of the control group were treated by "Jingjin" (musculotendon) puncture of the same acupoints. The treatment was conducted once daily, 5 times per week for 6 weeks. The 0-3-grade scores of therapeutic effects were evaluated according to the severity of the patients' symptoms and signs (including forehead stripes, palpebral fissure, nasolabial groove, drooping of the mouth angle, bulging cheek-air leak, food residue, dysgeusis, hyperacusi, lacrimation, and orbicularis oculi reflex). The therapeutic effect index = (score of pre-treatment--score of post-treatment)/score of pre-treatment x100% . The patients' life quality scores were assessed by using the World Health Organization Quality of Life (WHOQOL)-BREF questionnaire. After the treatment, the scores of clinical symptoms and signs were significantly decreased in both control and Santong needling groups in comparison with pre-treatment in the same one group (P < 0.05), suggesting an improvement of facial nerve function after 6 weeks' treatment. Of the two 30 patients in the control group and Santong needling group, 11 (36.7%) and 15 (50.0%) were cured, 8 (26.7%) and 9 (30
de Miguel, Marcos; Peláez, Eva M; Caubet, Enric; González, Óscar; Velasco, Mercedes; Rigual, Lidia
Transcutaneous laryngeal ultrasound (TLUS) has emerged as a promising imaging tool for vocal cord examination in patients undergoing thyroid surgery. The focus of this prospective, double-blind study was to assess the accuracy of TLUS in the diagnosis of vocal cord paralysis in the immediate postoperative period following total thyroidectomy. The study included 93 patients undergoing total thyroidectomy and assessed by videostrobolaryngoscopy (VSL) and TLUS. VSL was carried out the day before surgery and was repeated at 4 days postoperatively. TLUS was performed before surgery in the preanesthesia holding area and at completion of the procedure in the postanesthesia care unit. The preoperative and postoperative TLUS results were correlated with those of VSL. The statistical analysis included the sensitivity, specificity, positive predictive value, and negative predictive value (with 95% CI) of TLUS for detecting vocal cord paralysis. The visualization rate associated with TLUS was 93%. The total vocal cord paralysis rate was 16.1%. The performance of TLUS for diagnosing this condition was as follows: sensitivity, 93.3% (95% CI, 77.3%-100%); specificity 96.1% (95% CI, 91.2%-100%); positive predictive value, 82.3% (95% CI, 61.2%-100%); negative predictive value, 98.6% (95%CI, 95.4%-100%). TLUS may be a suitable technique for detecting vocal cord paralysis shortly after total thyroidectomy.
Ligtenberg, J J; Van Haeften, T W; Van Der Kolk, L E; Smit, A J; Sluiter, W J; Reitsma, W D; Links, T P
1. Hypokalaemic periodic paralysis is characterized by attacks of muscle weakness. Glucose, insulin and an abnormal regulation of ATP-sensitive potassium channels may be involved in these attacks. We studied the effect of hyperglycaemia and of the potassium channel opener pinacidil on insulin release and muscle strength in patients with hypokalaemic periodic paralysis. 2. Insulin release was assessed on two occasions in four patients with hypokalaemic periodic paralysis and in eight matched control subjects, with and without treatment with 25 mg pinacidil orally, during a hyperglycaemic glucose clamp at a blood glucose level of 10 mmol/l, in a placebo-controlled, double-blind study. Muscle strength was measured in the hypokalaemic periodic paralysis patients before and during hyperglycaemia using a handheld dynamometer. 3. During the clamp, the mean glucose concentration (10-180 min) in control subjects was 9.9 +/- 0.07 and 10.0 +/- 0.03 mmol/l with and without pinacidil respectively, and in patients with hypokalaemic periodic paralysis was 10.0 +/- 0.04 and 10.1 +/- 0.06 mmol/l respectively (not significantly different). In both groups, the areas under the insulin curve from 0 to 10 min (first-phase insulin release) and from 30 to 180 min (second phase) were not different on the pinacidil study day compared with on the placebo day. The areas under the insulin curve of the first and second phases also did not differ between control subjects and patients with hypokalaemic periodic paralysis (with or without pinacidil). The M/I ratio, a measure of insulin sensitivity, was not different in the two groups. On the placebo day, baseline muscle strength in patients with hypokalaemic periodic paralysis was 165 +/- 16 N for the hip abductors and 168 +/- 19 N for the knee flexors. During the period of hyperglycaemia on the placebo day, muscle strength did not decrease in either muscle group. On the pinacidil study day, an increase in muscle strength was found only in the two
Ammar, Tarek; Lin, Wei; Higgins, Amanda; Hayward, Lawrence J.
The diaphragm muscle of hyperkalemic periodic paralysis (HyperKPP) patients and of the M1592V HyperKPP mouse model rarely suffers from the myotonic and paralytic symptoms that occur in limb muscles. Enigmatically, HyperKPP diaphragm expresses the mutant NaV1.4 channel and, more importantly, has an abnormally high Na+ influx similar to that in extensor digitorum longus (EDL) and soleus, two hindlimb muscles suffering from the robust HyperKPP abnormalities. The objective was to uncover the physiological mechanisms that render HyperKPP diaphragm asymptomatic. A first mechanism involves efficient maintenance of resting membrane polarization in HyperKPP diaphragm at various extracellular K+ concentrations compared with larger membrane depolarizations in HyperKPP EDL and soleus. The improved resting membrane potential (EM) results from significantly increased Na+ K+ pump electrogenic activity, and not from an increased protein content. Action potential amplitude was greater in HyperKPP diaphragm than in HyperKPP soleus and EDL, providing a second mechanism for the asymptomatic behavior of the HyperKPP diaphragm. One suggested mechanism for the greater action potential amplitude is lower intracellular Na+ concentration because of greater Na+ K+ pump activity, allowing better Na+ current during the action potential depolarization phase. Finally, HyperKPP diaphragm had a greater capacity to generate force at depolarized EM compared with wild-type diaphragm. Action potential amplitude was not different between wild-type and HyperKPP diaphragm. There was also no evidence for an increased activity of the Na+–Ca2+ exchanger working in the reverse mode in the HyperKPP diaphragm compared with the wild-type diaphragm. So, a third mechanism remains to be elucidated to fully understand how HyperKPP diaphragm generates more force compared with wild type. Although the mechanism for the greater force at depolarized resting EM remains to be determined, this study provides support for
Ammar, Tarek; Lin, Wei; Higgins, Amanda; Hayward, Lawrence J; Renaud, Jean-Marc
The diaphragm muscle of hyperkalemic periodic paralysis (HyperKPP) patients and of the M1592V HyperKPP mouse model rarely suffers from the myotonic and paralytic symptoms that occur in limb muscles. Enigmatically, HyperKPP diaphragm expresses the mutant NaV1.4 channel and, more importantly, has an abnormally high Na(+) influx similar to that in extensor digitorum longus (EDL) and soleus, two hindlimb muscles suffering from the robust HyperKPP abnormalities. The objective was to uncover the physiological mechanisms that render HyperKPP diaphragm asymptomatic. A first mechanism involves efficient maintenance of resting membrane polarization in HyperKPP diaphragm at various extracellular K(+) concentrations compared with larger membrane depolarizations in HyperKPP EDL and soleus. The improved resting membrane potential (EM) results from significantly increased Na(+) K(+) pump electrogenic activity, and not from an increased protein content. Action potential amplitude was greater in HyperKPP diaphragm than in HyperKPP soleus and EDL, providing a second mechanism for the asymptomatic behavior of the HyperKPP diaphragm. One suggested mechanism for the greater action potential amplitude is lower intracellular Na(+) concentration because of greater Na(+) K(+) pump activity, allowing better Na(+) current during the action potential depolarization phase. Finally, HyperKPP diaphragm had a greater capacity to generate force at depolarized EM compared with wild-type diaphragm. Action potential amplitude was not different between wild-type and HyperKPP diaphragm. There was also no evidence for an increased activity of the Na(+)-Ca(2+) exchanger working in the reverse mode in the HyperKPP diaphragm compared with the wild-type diaphragm. So, a third mechanism remains to be elucidated to fully understand how HyperKPP diaphragm generates more force compared with wild type. Although the mechanism for the greater force at depolarized resting EM remains to be determined, this study
Johnston, J D
Dr. Mary Walker discovered in 1934 that physostigmine and Prostigmin temporarily restored muscle function in patients with myasthenia gravis. In the next five years, Dr. Walker and colleagues provided clinical evidence for the weakness of myasthenia gravis being caused by a "disturbance of transmission of excitation from motor nerve to voluntary muscle presumably caused by a deficiency of acetylcholine. Physostigmine (or Prostigmin) compensated for the lack of acetylcholine by delaying its destruction." Dr. Walker and colleagues also described the association between familial periodic paralysis and hypokalaemia.
Kim, Jin Hwa; Park, Geon; Kim, Sang Yong; Bae, Hak Yeon
11β hydroxylase deficiency (OHD) is one of the main causes of congenital adrenal hyperplasia. There have been only a few reported cases of nonclassic 11β OHD, a milder form of the disease. It is difficult to detect occult nonclassic 11β OHD because patients present with no or mild symptoms. We herein present a case of thyrotoxic periodic paralysis (TPP) with Graves' disease leading to the discovery of a hidden nonclassic 11β OHD. In this case, increased levels of thyroid hormone seem to have induced symptoms of occult nonclassic 11β OHD and aggravated TPP.
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Wu, Fenfen; Mi, Wentao; Cannon, Stephen C
Transient attacks of weakness in hypokalaemic periodic paralysis are caused by reduced fibre excitability from paradoxical depolarization of the resting potential in low potassium. Mutations of calcium channel and sodium channel genes have been identified as the underlying molecular defects that cause instability of the resting potential. Despite these scientific advances, therapeutic options remain limited. In a mouse model of hypokalaemic periodic paralysis from a sodium channel mutation (NaV1.4-R669H), we recently showed that inhibition of chloride influx with bumetanide reduced the susceptibility to attacks of weakness, in vitro. The R528H mutation in the calcium channel gene (CACNA1S encoding CaV1.1) is the most common cause of hypokalaemic periodic paralysis. We developed a CaV1.1-R528H knock-in mouse model of hypokalaemic periodic paralysis and show herein that bumetanide protects against both muscle weakness from low K+ challenge in vitro and loss of muscle excitability in vivo from a glucose plus insulin infusion. This work demonstrates the critical role of the chloride gradient in modulating the susceptibility to ictal weakness and establishes bumetanide as a potential therapy for hypokalaemic periodic paralysis arising from either NaV1.4 or CaV1.1 mutations.
Ataoglu, Esra Hayriye; Demir, Betul; Tuna, Mazhar; Cavus, Bilger; Cetin, Faik; Temiz, Levent Umit; Ozturk, Savas; Yenigun, Mustafa
Sjögren syndrome (SS) is an autoimmune-lymphoproliferative disorder characterized by mononuclear cell infiltration of exocrine glands. Clinically, Sjögren syndrome (SS) has a wide spectrum, varying from autoimmune exocrinopathy to systemic involvement. There have been few cases reporting that primary SS developed with distal renal tubular acidosis clinically. Here, we present a case with primary Sjögren syndrome accompanied by hypopotassemic paralysis due to renal tubular acidosis. Severe hypopotassemia, hyperchloremic metabolic acidosis, alkaline urine and disorder in urinary acidification test were observed in the biochemical examination of the 16-year-old female patient, who had applied to our clinic for extreme loss of muscle force. After the examinations it was determined that the patient had developed Type 1 RTA (distal RTA) due to primary Sjögren syndrome. Potassium and alkaline replacement was made and an immediate total recovery was achieved. Hypopotassemic paralysis due to primary Sjögren syndrome is a rare but severe disorder that could lead to death if not detected early and cured appropriately. Thus, effective treatment should be immediately initiated in cases where severe hypopotassemia is accompanied by metabolic acidosis, and the cases should also be examined for extraglandular involvement of SS.
Donovan, Lois; Parkins, Vicky M; Mahalingham, Aishling
Thyrotoxic periodic paralysis (TPP) is an unusual presentation of hyperthyroidism in women. The occurrence of this condition in the context of pregnancy is even more uncommon. Impaired glucose tolerance, pregnancy, and TPP impact overall management of thyrotoxicosis. There is little guidance in the literature for management under this constellation of circumstances. This is a case report of a previously healthy 36-year-old Filipino female presenting at 15 weeks gestation with tetraparesis, hypokalemia, and new onset Graves' disease with impaired glucose tolerance. Normal thyroid function was achieved in the mother without further episodes of TPP and a healthy, euthyroid male was delivered at 38 weeks gestation. Acute and long-term management strategies used in this case are described in detail. A synthesis of the available literature allowed development of a practical management strategy applicable to a variety of situations involving TPP in pregnancy.
Wu, Fenfen; Mi, Wentao; Fu, Yu; Struyk, Arie
Over 60 mutations of SCN4A encoding the NaV1.4 sodium channel of skeletal muscle have been identified in patients with myotonia, periodic paralysis, myasthenia, or congenital myopathy. Most mutations are missense with gain-of-function defects that cause susceptibility to myotonia or periodic paralysis. Loss-of-function from enhanced inactivation or null alleles is rare and has been associated with myasthenia and congenital myopathy, while a mix of loss and gain of function changes has an uncertain relation to hypokalaemic periodic paralysis. To better define the functional consequences for a loss-of-function, we generated NaV1.4 null mice by deletion of exon 12. Heterozygous null mice have latent myasthenia and a right shift of the force-stimulus relation, without evidence of periodic paralysis. Sodium current density was half that of wild-type muscle and no compensation by retained expression of the foetal NaV1.5 isoform was detected. Mice null for NaV1.4 did not survive beyond the second postnatal day. This mouse model shows remarkable preservation of muscle function and viability for haploinsufficiency of NaV1.4, as has been reported in humans, with a propensity for pseudo-myasthenia caused by a marginal Na+ current density to support sustained high-frequency action potentials in muscle. PMID:27048647
Wu, Fenfen; Mi, Wentao; Fu, Yu; Struyk, Arie; Cannon, Stephen C
Over 60 mutations of SCN4A encoding the NaV1.4 sodium channel of skeletal muscle have been identified in patients with myotonia, periodic paralysis, myasthenia, or congenital myopathy. Most mutations are missense with gain-of-function defects that cause susceptibility to myotonia or periodic paralysis. Loss-of-function from enhanced inactivation or null alleles is rare and has been associated with myasthenia and congenital myopathy, while a mix of loss and gain of function changes has an uncertain relation to hypokalaemic periodic paralysis. To better define the functional consequences for a loss-of-function, we generated NaV1.4 null mice by deletion of exon 12. Heterozygous null mice have latent myasthenia and a right shift of the force-stimulus relation, without evidence of periodic paralysis. Sodium current density was half that of wild-type muscle and no compensation by retained expression of the foetal NaV1.5 isoform was detected. Mice null for NaV1.4 did not survive beyond the second postnatal day. This mouse model shows remarkable preservation of muscle function and viability for haploinsufficiency of NaV1.4, as has been reported in humans, with a propensity for pseudo-myasthenia caused by a marginal Na(+) current density to support sustained high-frequency action potentials in muscle.
Park, Suyeon; Kim, Tae Yong; Sim, Soyoung; Oh, Hye-Seon; Song, Eyun; Kim, Mijin; Kwon, Hyemi; Choi, Yun Mi; Jeon, Min Ji; Kim, Won Gu; Shong, Young Kee; Kim, Won Bae
Objective: Thyrotoxic periodic paralysis (TPP) is characterized by acute onset paralysis and hypokalemia predominantly in male patients with thyrotoxicosis. Recent studies have emphasized the importance of potassium channels, which might explain the underlying mechanism of TPP. The KCNJ2 gene encodes the inward-rectifying potassium channel. In this study, we evaluated the role of KCNJ2 in the development of TPP. Design: Case-control analysis of KCNJ2 genetic association with TPP. Patients: 83 male patients with Graves' disease (GD) were recruited for this study; 43 patients had TPP, whereas 40 patients had no history of TPP. Measurements: We analyzed the genotype and allelic frequency of a single-nucleotide polymorphism (SNP; rs312691) (C>T) adjacent to the KCNJ2 gene that is known to be related to TPP development. Results: The frequency of the CC genotype of the rs312691 SNP was 0.51 in TPP patients and 0.05 in controls (p-value=6.18×10(-6)). The C allele frequency of the SNP was 0.67 in the TPP group and 0.38 in the control group (odds ratio 3.24; 95% confidence interval 1.65-6.51; p-value, 3.1×10(-4)). The rs312691 SNP was significantly associated with TPP. Conclusions: We demonstrated that the rs312691 SNP was significantly associated with TPP. These findings suggest that KCNJ2 plays an important role in the pathophysiology of TPP in Korean GD patients with TPP. © Georg Thieme Verlag KG Stuttgart · New York.
Lehmann-Horn, Frank; Fan, Chunxiang; Wolf, Markus; Winston, Vern; Merlini, Luciano
Hypokalaemic periodic paralysis is typically associated with mutations of voltage sensor residues in calcium or sodium channels of skeletal muscle. To date, causative sodium channel mutations have been studied only for the two outermost arginine residues in S4 voltage sensor segments of domains I to III. These mutations produce depolarization of skeletal muscle fibres in response to reduced extracellular potassium, owing to an inward cation-selective gating pore current activated by hyperpolarization. Here, we describe mutations of the third arginine, R3, in the domain III voltage sensor i.e. an R1135H mutation which was found in two patients in separate families and a novel R1135C mutation identified in a third patient in another family. Muscle fibres from a patient harbouring the R1135H mutation showed increased depolarization tendency at normal and reduced extracellular potassium compatible with the diagnosis. Additionally, amplitude and rise time of action potentials were reduced compared with controls, even for holding potentials at which all NaV1.4 are fully recovered from inactivation. These findings may be because of an outward omega current activated at positive potentials. Expression of R1135H/C in mammalian cells indicates further gating defects that include significantly enhanced entry into inactivation and prolonged recovery that may additionally contribute to action potential inhibition at the physiological resting potential. After S4 immobilization in the outward position, mutant channels produce an inward omega current that most likely depolarizes the resting potential and produces the hypokalaemia-induced weakness. Gating current recordings reveal that mutations at R3 inhibit S4 deactivation before recovery, and molecular dynamics simulations suggest that this defect is caused by disrupted interactions of domain III S2 countercharges with S4 arginines R2 to R4 during repolarization of the membrane. This work reveals a novel mechanism of disrupted S
Fan, Chunxiang; Lehmann-Horn, Frank; Weber, Marc-André; Bednarz, Marcin; Groome, James R.; Jonsson, Malin K. B.
We studied a two-generation family presenting with conditions that included progressive permanent weakness, myopathic myopathy, exercise-induced contracture before normokalaemic periodic paralysis or, if localized to the tibial anterior muscle group, transient compartment-like syndrome (painful acute oedema with neuronal compression and drop foot). 23Na and 1H magnetic resonance imaging displayed myoplasmic sodium overload, and oedema. We identified a novel familial Cav1.1 calcium channel mutation, R1242G, localized to the third positive charge of the domain IV voltage sensor. Functional expression of R1242G in the muscular dysgenesis mouse cell line GLT revealed a 28% reduced central pore inward current and a −20 mV shift of the steady-state inactivation curve. Both changes may be at least partially explained by an outward omega (gating pore) current at positive potentials. Moreover, this outward omega current of 27.5 nS/nF may cause the reduction of the overshoot by 13 mV and slowing of the upstroke of action potentials by 36% that are associated with muscle hypoexcitability (permanent weakness and myopathic myopathy). In addition to the outward omega current, we identified an inward omega pore current of 95 nS/nF at negative membrane potentials after long depolarizing pulses that shifts the R1242G residue above the omega pore constriction. A simulation reveals that the inward current might depolarize the fibre sufficiently to trigger calcium release in the absence of an action potential and therefore cause an electrically silent depolarization-induced muscle contracture. Additionally, evidence of the inward current can be found in 23Na magnetic resonance imaging-detected sodium accumulation and 1H magnetic resonance imaging-detected oedema. We hypothesize that the episodes are normokalaemic because of depolarization-induced compensatory outward potassium flux through both delayed rectifiers and omega pore. We conclude that the position of the R1242G residue
Groome, James R; Lehmann-Horn, Frank; Fan, Chunxiang; Wolf, Markus; Winston, Vern; Merlini, Luciano; Jurkat-Rott, Karin
Hypokalaemic periodic paralysis is typically associated with mutations of voltage sensor residues in calcium or sodium channels of skeletal muscle. To date, causative sodium channel mutations have been studied only for the two outermost arginine residues in S4 voltage sensor segments of domains I to III. These mutations produce depolarization of skeletal muscle fibres in response to reduced extracellular potassium, owing to an inward cation-selective gating pore current activated by hyperpolarization. Here, we describe mutations of the third arginine, R3, in the domain III voltage sensor i.e. an R1135H mutation which was found in two patients in separate families and a novel R1135C mutation identified in a third patient in another family. Muscle fibres from a patient harbouring the R1135H mutation showed increased depolarization tendency at normal and reduced extracellular potassium compatible with the diagnosis. Additionally, amplitude and rise time of action potentials were reduced compared with controls, even for holding potentials at which all NaV1.4 are fully recovered from inactivation. These findings may be because of an outward omega current activated at positive potentials. Expression of R1135H/C in mammalian cells indicates further gating defects that include significantly enhanced entry into inactivation and prolonged recovery that may additionally contribute to action potential inhibition at the physiological resting potential. After S4 immobilization in the outward position, mutant channels produce an inward omega current that most likely depolarizes the resting potential and produces the hypokalaemia-induced weakness. Gating current recordings reveal that mutations at R3 inhibit S4 deactivation before recovery, and molecular dynamics simulations suggest that this defect is caused by disrupted interactions of domain III S2 countercharges with S4 arginines R2 to R4 during repolarization of the membrane. This work reveals a novel mechanism of disrupted S
Fan, Chunxiang; Lehmann-Horn, Frank; Weber, Marc-André; Bednarz, Marcin; Groome, James R; Jonsson, Malin K B; Jurkat-Rott, Karin
We studied a two-generation family presenting with conditions that included progressive permanent weakness, myopathic myopathy, exercise-induced contracture before normokalaemic periodic paralysis or, if localized to the tibial anterior muscle group, transient compartment-like syndrome (painful acute oedema with neuronal compression and drop foot). 23Na and 1H magnetic resonance imaging displayed myoplasmic sodium overload, and oedema. We identified a novel familial Ca(v)1.1 calcium channel mutation, R1242G, localized to the third positive charge of the domain IV voltage sensor. Functional expression of R1242G in the muscular dysgenesis mouse cell line GLT revealed a 28% reduced central pore inward current and a -20 mV shift of the steady-state inactivation curve. Both changes may be at least partially explained by an outward omega (gating pore) current at positive potentials. Moreover, this outward omega current of 27.5 nS/nF may cause the reduction of the overshoot by 13 mV and slowing of the upstroke of action potentials by 36% that are associated with muscle hypoexcitability (permanent weakness and myopathic myopathy). In addition to the outward omega current, we identified an inward omega pore current of 95 nS/nF at negative membrane potentials after long depolarizing pulses that shifts the R1242G residue above the omega pore constriction. A simulation reveals that the inward current might depolarize the fibre sufficiently to trigger calcium release in the absence of an action potential and therefore cause an electrically silent depolarization-induced muscle contracture. Additionally, evidence of the inward current can be found in 23Na magnetic resonance imaging-detected sodium accumulation and 1H magnetic resonance imaging-detected oedema. We hypothesize that the episodes are normokalaemic because of depolarization-induced compensatory outward potassium flux through both delayed rectifiers and omega pore. We conclude that the position of the R1242G residue
Li, Wang; Changsheng, Chen; Jiangfang, Fu; Bin, Gao; Nanyan, Zhang; Xiaomiao, Li; Deqiang, Li; Ying, Xing; Wensong, Zai; Qiuhe, Ji
Our study is to determine the expression of thyroid hormone, sex hormone, insulin, and C-peptide in Chinese male patients with thyrotoxic periodic paralysis (TPP). This study covered 102 patients with hyperthyroidism from Xijing Hospital. According to whether occurrence of TPP or not, patients were divided into two groups (those that were hyperthyroid with and without TPP) that were, matched with age, blood pressure, urea, and creatinine. We found the body mass index (BMI) in patients with TPP was higher than that in pure hyperthyroidism patients. The levels of the total thyroxine (T4), free triiodothyronine (FT3), and free thyroxine (FT4) were significantly lower in patients with TPP compared with pure hyperthyroidism patients, while serum testosterone levels were higher compared with pure hyperthyroidism patients. Moreover, after glucose administration, the concentration of insulin at 60, 120, and 180 min were significantly higher in patients with TPP than those in pure hyperthyroidism patients. The insulin area under the curve (AUC) was significantly increased in patients with TPP compared with pure hyperthyroidism patients. The levels of thyroid hormone, sex hormone, and insulin were different in Chinese male patients with TPP compared to those with only hyperthyroidism.
Zhou, Haiyan; Lillis, Suzanne; Loy, Ryan E; Ghassemi, Farshid; Rose, Michael R; Norwood, Fiona; Mills, Kerry; Al-Sarraj, Safa; Lane, Russell J M; Feng, Lucy; Matthews, Emma; Sewry, Caroline A; Abbs, Stephen; Buk, Stefan; Hanna, Michael; Treves, Susan; Dirksen, Robert T; Meissner, Gerhard; Muntoni, Francesco; Jungbluth, Heinz
The skeletal muscle ryanodine receptor plays a crucial role in excitation-contraction (EC) coupling and is implicated in various congenital myopathies. The periodic paralyses are a heterogeneous, dominantly inherited group of conditions mainly associated with mutations in the SCN4A and the CACNA1S genes. The interaction between RyR1 and DHPR proteins underlies depolarization-induced Ca(2+) release during EC coupling in skeletal muscle. We report a 35-year-old woman presenting with signs and symptoms of a congenital myopathy at birth and repeated episodes of generalized, atypical normokalaemic paralysis in her late teens. Genetic studies of this patient revealed three heterozygous RYR1 substitutions (p.Arg2241X, p.Asp708Asn and p.Arg2939Lys) associated with marked reduction of the RyR1 protein and abnormal DHPR distribution. We conclude that RYR1 mutations may give rise to both myopathies and atypical periodic paralysis, and RYR1 mutations may underlie other unresolved cases of periodic paralysis with unusual features.
... high levels of thyroid hormone in their blood ( hyperthyroidism , thyrotoxicosis). Causes This is a rare condition that occurs only in people with high thyroid hormone levels (thyrotoxicosis). It is common in Asian and Hispanic ... Symptoms involve attacks of muscle weakness or ...
... Tick species that cause Tick Paralysis: Deer tick, dog tick, Rocky Mtn. wood tick, Lone Star tick ... glands and transmits it to its host during feeding. Experiments have indicated that the greatest amount of ...
Abbott, Geoffrey W; Butler, Margaret H; Goldstein, Steve A N
MinK-related peptide 2 (MiRP2) and Kv3.4 subunits assemble in skeletal muscle to create subthreshold, voltage-gated potassium channels. MiRP2 acts on Kv3.4 to shift the voltage dependence of activation, speed recovery from inactivation, suppress cumulative inactivation and increase unitary conductance. We previously found an R83H missense mutation in MiRP2 that segregated with periodic paralysis in two families and diminished the effects of MiRP2 on Kv3.4. Here we show that MiRP2 has a single, functional PKC phosphorylation site at serine 82 and that normal MiRP2-Kv3.4 function requires phosphorylation of the site. The R83H variant does not prevent PKC phosphorylation of neighboring S82; rather, the change shifts the voltage dependence of activation and endows MiRP2-Kv3.4 channels with sensitivity to changes in intracellular pH across the physiological range. Thus, current passed by single R83H channels decreases as internal pH is lowered (pK(a) approximately 7.3, consistent with histidine protonation) whereas wild-type channels are largely insensitive. These findings identify a key regulatory domain in MiRP2 and suggest a mechanistic link between acidosis and episodes of periodic paralysis.
Statland, Jeffrey M.; Barohn, Richard J.
Purpose of Review The muscle channelopathies are a group of rare inherited diseases caused by mutations in muscle ion channels. Mutations cause an increase or decrease in muscle membrane excitability, leading to a spectrum of related clinical disorders: the nondystrophic myotonias are characterized by delayed relaxation after muscle contraction, causing muscle stiffness and pain; the periodic paralyses are characterized by episodes of flaccid muscle paralysis. This review describes the clinical characteristics, molecular pathogenesis, and treatments of the nondystrophic myotonias and periodic paralyses. Recent Findings Advances have been made in both the treatment and our understanding of the molecular pathophysiology of muscle channelopathies: (1) a recent controlled trial showed that mexiletine was effective for reducing symptoms and signs of myotonia in nondystrophic myotonia; (2) the mechanisms by which hypokalemic periodic paralysis leads to a depolarized but unexcitable sarcolemma membrane have been traced to a novel gating pore current; and (3) an association was demonstrated between mutations in a potassium inward rectifier and patients with thyrotoxic periodic paralysis. Summary The muscle channelopathies are an expanding group of muscle diseases caused by mutations in sodium, chloride, potassium, and calcium ion channels that result in increased or decreased muscle membrane excitability. Recognizing patients with channelopathies and confirming the diagnosis is important, as treatment and management strategies differ based on mutation and clinical phenotype. PMID:24305449
Institutional paralysis of higher education is the result of the disjunction between faculty and administration; the disjunction between substantive planning and bugetary decision-making; the disjunction between departmental structures and functional areas of university concern; and the disjunction between the theory of direct democracy and its…
Garcia-Lopez, Isabel; Peñorrocha-Teres, Julio; Perez-Ortin, Magdalena; Cerpa, Mauricio; Rabanal, Ignacio; Gavilan, Javier
Vocal fold paralysis (VFP) is a relatively common cause of stridor and dysphonia in the paediatric population. This report summarises our experience with VFP in the paediatric age group. All patients presenting with vocal fold paralysis over a 12-month period were included. Medical charts were revised retrospectively. The diagnosis was performed by flexible endoscopic examination. The cases were evaluated with respect to aetiology of the paralysis, presenting symptoms, delay in diagnosis, affected side, vocal fold position, need for surgical treatment and outcome. The presenting symptoms were stridor and dysphonia. Iatrogenic causes formed the largest group, followed by idiopathic, neurological and obstetric VFP. Unilateral paralysis was found in most cases. The median value for delay in diagnosis was 1 month and it was significantly higher in the iatrogenic group. Surgical treatment was not necessary in most part of cases. The diagnosis of VFP may be suspected based on the patient's symptoms and confirmed by flexible endoscopy. Infants who develop stridor or dysphonia following a surgical procedure have to be examined without delay. The surgeon has to keep in mind that there is a possibility of late spontaneous recovery or compensation. Copyright © 2012 Elsevier España, S.L. All rights reserved.
Gil-Peña, Helena; Mejia, Natalia; Alvarez-Garcia, Oscar; Loredo, Vanessa; Santos, Fernando
Growth retardation remains a major complication in children with primary tubular disorders, despite adequate supplemental treatment with electrolytes, water and bicarbonate. Chronic hypokalemia, characteristic of some tubulopathies, impairs growth by mechanisms that are not well known. Association with growth hormone deficiency has been reported in patients with Bartter's or Gitelman's syndrome. Tissue-specific alterations of growth hormone and insulin-like growth factor I axis have been described in experimental models of potassium depletion. Hypokalemic rats gain less body length and weight than pair-fed normokalemic animals and, by contrast, develop renal hypertrophy. These rats have low circulating concentrations of insulin-like growth factor I, depressed messenger ribonucleic acid (mRNA) levels of this peptide in the tibial growth plate, and they are resistant to the longitudinal growth-promoting effects of exogenous growth hormone. The reason for this resistance remains to be defined. No alterations in the intracellular signaling for growth hormone have been found in the liver of hypokalemic rats. However, treatment with high doses of growth hormone is unable to normalize hypertrophy of the epiphyseal cartilage chondrocytes, which are severely disturbed in potassium depletion and likely play an important role in the pathogenia of growth impairment in this condition.
Hakami, Osamah; Ahmad, Maswood M.; Al Johani, Naji
Thyrotoxic periodic paralysis (TPP) is a potentially lethal complication of hyperthyroidism characterized by recurrent muscle weakness and hypokalemia. It has been commonly reported in non-Asian populations. Four cases were reported in Saudis so far, and one had a life-threatening arrhythmia. We describe an additional case of a 28-year-old apparently healthy Saudi male patient, who presented with acute paraparesis associated with hypokalemia (K: 2.0 mmol/L), complicated by ventricular tachycardia and cardiac arrest. He was successfully resuscitated and his hypokalemia was corrected. A diagnosis of Graves’ disease associated with TPP was made. He was initially treated with carbimazole and β-blockers and then given a definitive therapy with radioactive iodine, which showed a good response. This case highlights the importance of early recognition and prompt treatment of TPP as a differential diagnosis for muscle weakness. A brief review of TPP and associated arrhythmia is included. PMID:26843815
Silva, Jonathan R.
In skeletal muscle, slow inactivation (SI) of NaV1.4 voltage-gated sodium channels prevents spontaneous depolarization and fatigue. Inherited mutations in NaV1.4 that impair SI disrupt activity-induced regulation of channel availability and predispose patients to hyperkalemic periodic paralysis. In our companion paper in this issue (Silva and Goldstein. 2013. J. Gen. Physiol. http://dx.doi.org/10.1085/jgp.201210909), the four voltage sensors in NaV1.4 responsible for activation of channels over microseconds are shown to slowly immobilize over 1–160 s as SI develops and to regain mobility on recovery from SI. Individual sensor movements assessed via attached fluorescent probes are nonidentical in their voltage dependence, time course, and magnitude: DI and DII track SI onset, and DIII appears to reflect SI recovery. A causal link was inferred by tetrodotoxin (TTX) suppression of both SI onset and immobilization of DI and DII sensors. Here, the association of slow sensor immobilization and SI is verified by study of NaV1.4 channels with a hyperkalemic periodic paralysis mutation; L689I produces complex changes in SI, and these are found to manifest directly in altered sensor movements. L689I removes a component of SI with an intermediate time constant (∼10 s); the mutation also impedes immobilization of the DI and DII sensors over the same time domain in support of direct mechanistic linkage. A model that recapitulates SI attributes responsibility for intermediate SI to DI and DII (10 s) and a slow component to DIII (100 s), which accounts for residual SI, not impeded by L689I or TTX. PMID:23401572
Lucas, Brooke; Ammar, Tarek; Khogali, Shiemaa; DeJong, Danica; Barbalinardo, Michael; Nishi, Cameron; Hayward, Lawrence J; Renaud, Jean-Marc
Hyperkalemic periodic paralysis (HyperKPP) is characterized by myotonic discharges that occur between episodic attacks of paralysis. Individuals with HyperKPP rarely suffer respiratory distress even though diaphragm muscle expresses the same defective Na(+) channel isoform (NaV1.4) that causes symptoms in limb muscles. We tested the hypothesis that the extent of the HyperKPP phenotype (low force generation and shift toward oxidative type I and IIA fibers) in muscle is a function of 1) the NaV1.4 channel content and 2) the Na(+) influx through the defective channels [i.e., the tetrodotoxin (TTX)-sensitive Na(+) influx]. We measured NaV1.4 channel protein content, TTX-sensitive Na(+) influx, force generation, and myosin isoform expression in four muscles from knock-in mice expressing a NaV1.4 isoform corresponding to the human M1592V mutant. The HyperKPP flexor digitorum brevis muscle showed no contractile abnormalities, which correlated well with its low NaV1.4 protein content and by far the lowest TTX-sensitive Na(+) influx. In contrast, diaphragm muscle expressing the HyperKPP mutant contained high levels of NaV1.4 protein and exhibited a TTX-sensitive Na(+) influx that was 22% higher compared with affected extensor digitorum longus (EDL) and soleus muscles. Surprisingly, despite this high burden of Na(+) influx, the contractility phenotype was very mild in mutant diaphragm compared with the robust abnormalities observed in EDL and soleus. This study provides evidence that HyperKPP phenotype does not depend solely on the NaV1.4 content or Na(+) influx and that the diaphragm does not depend solely on Na(+)-K(+) pumps to ameliorate the phenotype. Copyright © 2014 the American Physiological Society.
Paninka, Rolf Matias; Carlos-Lima, Estevão; Lindsey, Susan C; Kunii, Ilda S; Dias-da-Silva, Magnus R; Arcisio-Miranda, Manoel
Inward rectifying potassium - Kir - channels drive the resting potential to potassium reversal potential and, when disrupted, might be related to muscular diseases. Recently, Thyrotoxic Periodic Paralysis (TPP) has emerged as a channelopathy related to mutations in KCNJ18 gene, which encodes Kir2.6 channel. TPP is a neuromuscular disorder characterized by a triad of muscle weakness, hypokalemia, and thyrotoxicosis, the latter being essential for the crisis. Direct sequencing revealed two heterozygous mutations - D252N and R386C - in two TPP patients. KCNJ18 cDNAs were cloned into mammalian expression plasmids and transiently expressed in HEK 293T cells to investigate the functional effects of Kir2.6 mutations. Patch-clamp and confocal laser scanning microscopy experiments were carried out, comparing the WT channel to its mutants. D252N mutation down-regulates the Kir2.6 activity, decreasing the K(+) current density (∼34%) when compared to the WT channel; whereas the mutation R386C shows no significant changes from WT. The mutant D252N Kir2.6 channel also showed a substantial reduction of ∼51% in membrane abundance relative to WT channel. Our study describes the functional consequences of a single amino acid change in Kir2.6 channel. Further analysis regarding hormonal conditions and Kir channel expression are required to provide new clues about the TPP pathophysiology.
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Reddy, Sashank; Redett, Richard
Facial paralysis can have devastating physical and psychosocial consequences. These are particularly severe in children in whom loss of emotional expressiveness can impair social development and integration. The etiologies of facial paralysis, prospects for spontaneous recovery, and functions requiring restoration differ in children as compared with adults. Here we review contemporary management of facial paralysis with a focus on special considerations for pediatric patients.
Iwamura, Hitoshi; Kondo, Kenji; Sawamura, Hiromasa; Baba, Shintaro; Yasuhara, Kazuo; Yamasoba, Tatsuya
The association between congenital facial paralysis and visual development has not been thoroughly studied. Of 27 pediatric cases of congenital facial paralysis, we identified 3 patients who developed amblyopia, a visual acuity decrease caused by abnormal visual development, as comorbidity. These 3 patients had facial paralysis in the periocular region and developed amblyopia on the paralyzed side. They started treatment by wearing an eye patch immediately after diagnosis and before the critical visual developmental period; all patients responded to the treatment. Our findings suggest that the incidence of amblyopia in the cases of congenital facial paralysis, particularly the paralysis in the periocular region, is higher than that in the general pediatric population. Interestingly, 2 of the 3 patients developed anisometropic amblyopia due to the hyperopia of the affected eye, implying that the periocular facial paralysis may have affected the refraction of the eye through yet unspecified mechanisms. Therefore, the physicians who manage facial paralysis should keep this pathology in mind, and when they see pediatric patients with congenital facial paralysis involving the periocular region, they should consult an ophthalmologist as soon as possible. © 2016 S. Karger AG, Basel.
I have been Editor-in-Chief for about 10 months now. Over that period of time, I have processed hundreds of manuscripts and considered hundreds of reviews. In doing so, I have noticed an emphasis on analysis at the expense of a better understanding of the ecological system under study. I mention this not to belittle statistical advances made within various disciplines...
Sawant, Neena S; Parkar, Shubhangi R; Tambe, Ravindra
Sleep paralysis (SP) is a cardinal symptom of narcolepsy. However, little is available in the literature about isolated sleep paralysis. This report discusses the case of a patient with isolated sleep paralysis who progressed from mild to severe SP over 8 years. He also restarted drinking alcohol to be able to fall asleep and allay his anxiety symptoms. The patient was taught relaxation techniques and he showed complete remission of the symptoms of SP on follow up after 8 months.
Ukaonu, Chinwe; Hill, D Ashley; Christensen, Franklyn
We present a case of severe hypokalemic myopathy during pregnancy caused by clay ingestion. A multigravida presented with fatigue, muscle weakness, and a 3-day history of extremity pain. Serum potassium levels were 1.5 mEq/L, requiring intravenous potassium replacement. The initial evaluation was unrewarding for the cause of the patient's hypokalemia until a family member reported that the patient frequently ate large quantities of clay. Discontinuation of clay ingestion led to normalization of potassium levels. Pica, the persistent ingestion of nonnutritive substances, can cause a number of medical problems. Pica of clay, called geophagia, can bind potassium in the intestine, leading to severe hypokalemic myopathy. Clinicians caring for pregnant women with fatigue, muscle weakness, and hypokalemia should consider geophagia as a possible cause.
Primary hyperaldosteronism is found in up to 13% of patients with hypertension. This article describes a patient with hypokalemia, hypertension, and periodic paralysis that were caused by primary hyperaldosteronism. Plasma aldosterone concentration to plasma renin activity ratio is a common screening test, and adrenal vein sampling can be performed to determine which gland is overproducing aldosterone. Treatment with mineralocorticoid receptor antagonists or adrenalectomy gives similar reductions in BP.
Evers, S.; Engelien, A.; Karsch, V.; Hund, M.
Besides the hereditary hyperkalaemic paralysis, a secondary form exists which often mimicks Guillain-Barre syndrome. A 62year old patient is reported on who developed severe hyperkalaemic paralysis on the basis of mild renal failure and additive spironolactone intake. Neurophysiological examinations disclosed normal muscle fibre activity but delayed nerve conduction velocities indicating that the mechanism underlying secondary hyperkalaemic paralysis is different from channelopathies. Haemodialysis led to complete recovery. Review of the medical literature showed that spironolactone intake is the most common cause of secondary hyperkalaemic paralysis. Typical symptoms are flaccid tetraplegia sparing the cranial nerves with only mild or lacking sensory impairment. Symptoms promptly resolve after haemodialysis or after glucose and insulin infusion. Only three out of 18 patients reviewed died, because of cardiopulmonary complications. Thus the prognosis of secondary hyperkalaemic paralysis is good. PMID:9489541
The management of facial paralysis is one of the most complex areas of reconstructive surgery. Given the wide variety of functional and cosmetic deficits in the facial paralysis patient, the reconstructive surgeon requires a thorough understanding of the surgical techniques available to treat this condition. This review article will focus on surgical management of facial paralysis and the treatment options available for acute facial paralysis (<3 weeks duration), intermediate duration facial paralysis (3 weeks to 2 yr) and chronic facial paralysis (>2 yr). For acute facial paralysis, the main surgical therapies are facial nerve decompression and facial nerve repair. For facial paralysis of intermediate duration, nerve transfer procedures are appropriate. For chronic facial paralysis, treatment typically requires regional or free muscle transfer. Static techniques of facial reanimation can be used for acute, intermediate, or chronic facial paralysis as these techniques are often important adjuncts to the overall management strategy. PMID:19434284
Hayashi, K; Hayashi, R; Maruyama, K; Yanagisawa, N
Histopathologic studies and magnetic resonance images of the leg muscles were conducted in two patients with glycyrrhizin-induced hypokalemic myopathy (GHM). Muscle biopsy showed myopathic changes and vacuolated fibers with light microscopy, and dilatation of the sarcoplasmic reticulum, various types of vacuoles and myofibrillar degeneration with electron microscopy. High signal intensities in T2-weighted images obtained during severe muscle weakness were widely distributed in the leg muscles, especially the pretibial and soleus muscles. These high signal intensities disappeared after full recovery of muscle weakness. We suggest that high signal intensity in T2-weighted images can be seen and correspond to histopathologic changes in the muscles of GHM patients.
Taniguchi, Koichiro; Okino, Iwao; Yamamoto, Nobuaki; Matsumoto, Shinichi; Tachibana, Naoko; Hamano, Toshiaki
We reported two women (78 and 85 years of age) with dropped head syndrome caused by hypokalemic myopathy restricted to the posterior cervical muscles. Both presented with relatively rapid onset of severe neck extensor weakness. Needle EMG demonstrated myogenic changes in the cervical paraspinal muscles and there were high intensity signals in the posterior cervical muscles on the neck MRI. Dropped head syndrome resolved in both patients as potassium normalized. One of the patients relapsed 11 months later with recurrent hypokalemia, but recovered rapidly with supplementation of potassium. Focal myopathy localized in the posterior cervical muscles due to hypokalemia should be considered as one of the possible causes of dropped head syndrome.
Gregg, J R; Labosky, D; Harty, M; Lotke, P; Ecker, M; DiStefano, V; Das, M
Ten cases of isolated, complete paralysis of the serratus anterior muscle were diagnosed in young athletes during a three-year period. One patient had recurrent partial paralysis of the serratus anterior muscle, the first such case reported. From studies on cadavera and clinical observations, we concluded that paralysis of the serratus anterior muscle results from a traction injury to the long thoracic nerve of Bell. Since full recovery usually occurs in an average of nine months, surgical methods of treatment should be reserved for patients in whom function fails to return after a two-year period. Non-strenuous use of the involved extremity with avoidance of the precipitating activity, followed by exercises designed to maintain the range of motion of the shoulder and to increase the strength of associated muscles, is advocated for treatment of acute or repetitive injuries to the long thoracic nerve of Bell.
Alves-Filho, José C; Spiller, Fernando; Cunha, Fernando Q
Sepsis develops when the initial host response is unable to contain the primary infection, resulting in widespread inflammation and multiple organ dysfunction. The impairment of neutrophil migration into the infection site, also termed neutrophil paralysis, is a critical hallmark of sepsis, which is directly related to the severity of the disease. Although the precise mechanism of this phenomenon is not fully understood, there has been much advancement in the understanding of this field. In this review, we highlight the recent insights into the molecular mechanisms of neutrophil paralysis during sepsis.
Wu, Chuifen; Xin, Jun; Xin, Minghua; Zou, Hai; Jing, Lie; Zhu, Caoyong; Lei, Wenhui
Primary aldosteronism (PA) is a rare disorder. The majority of patients with PA present with typical features and are easily diagnosed. This disorder is usually diagnosed with hypokalemia, hypertension or an adrenal mass. However, patients with atypical symptoms may present a challenge for diagnosis and treatment. In the present study, a case of PA is described that presented with hypokalemic myopathy simulating polymyositis. The patient was a 44-year-old woman who presented with weakness and difficulty walking. The patient was initially suspected to have PM and was treated with methylprednisolone. The patient was found to have hypokalemia which persisted despite high-dose supplementation of potassium. Adrenal computed tomography revealed a right adrenal mass. Surgical adrenalectomy was conducted. The final pathological diagnosis was benign adrenocortical adenoma. The serum tests remained normal and the patient's symptoms were resolved during the 8-month follow-up. PMID:28101185
Razfar, Ali; Lee, Matthew K; Massry, Guy G; Azizzadeh, Babak
Facial nerve paralysis is a devastating condition arising from several causes with severe functional and psychological consequences. Given the complexity of the disease process, management involves a multispecialty, team-oriented approach. This article provides a systematic approach in addressing each specific sequela of this complex problem.
... Tests Sleep paralysis can be a symptom of narcolepsy . But if you do not have other symptoms of narcolepsy, there is usually no need to have sleep ... 2012:chap 43. Read More Muscle function loss Narcolepsy Review Date 4/13/2015 Updated by: Allen ...
Penn, N E; Kripke, D F; Scharff, J
Sleep paralysis is a sensation of an inability to speak or move other muscles when falling asleep or awakening. Sleep paralysis by itself has been reported as occurring infrequently and many clinicians are uncertain of its significance. In contrast, sleep paralysis in conjunction with sleep attacks has been reported as a concomitant of narcolepsy. To further examine the incidence of sleep paralysis, the responses of 80 first-year medical students, 16.25% had experienced predormital, postdormital, or both types of sleep paralysis. These episodes occurred infrequently--only once or twice for most of these students. Reports of sleep paralysis were not associated with sleep attacks or cataplexy. These results support two previous studies which found that sleep paralysis alone occurs frequently among normals.
Whole genome and exome sequencing realignment supports the assignment of KCNJ12, KCNJ17, and KCNJ18 paralogous genes in thyrotoxic periodic paralysis locus: functional characterization of two polymorphic Kir2.6 isoforms.
Paninka, Rolf M; Mazzotti, Diego R; Kizys, Marina M L; Vidi, Angela C; Rodrigues, Hélio; Silva, Silas P; Kunii, Ilda S; Furuzawa, Gilberto K; Arcisio-Miranda, Manoel; Dias-da-Silva, Magnus R
Next-generation sequencing (NGS) has enriched the understanding of the human genome. However, homologous or repetitive sequences shared among genes frequently produce dubious alignments and can puzzle NGS mutation analysis, especially for paralogous potassium channels. Potassium inward rectifier (Kir) channels are important to establish the resting membrane potential and regulating the muscle excitability. Mutations in Kir channels cause disorders affecting the heart and skeletal muscle, such as arrhythmia and periodic paralysis. Recently, a susceptibility muscle channelopathy-thyrotoxic periodic paralysis (TPP)-has been related to Kir2.6 channel (KCNJ18 gene). Due to their high nucleotide sequence homology, variants found in the potassium channels Kir2.6 and Kir2.5 have been mistakenly attributable to Kir2.2 polymorphisms or mutations. We aimed at elucidating nucleotide misalignments by performing realignment of whole exome sequencing (WES) and whole genome sequencing (WGS) reads to specific Kir2.2, Kir2.5, and Kir2.6 cDNA sequences using BWA-MEM/GATK pipeline. WES/WGS reads correctly aligned 26.9/43.2, 37.6/31.0, and 35.4/25.8 % to Kir2.2, Kir2.5, and Kir2.6, respectively. Realignment was able to reduce over 94 % of misalignments. No putative mutations of Kir2.6 were identified for the three TPP patients included in the cohort of 36 healthy controls using either WES or WGS. We also distinguished sequences for a single Kir2.2, a single Kir2.5 sequence, and two Kir2.6 isoforms, which haplotypes were named RRAI and QHEV, based on changes at 39, 40, 56, and 249 residues. Electrophysiology records on both Kir2.6_RRAI and _QHEV showed typical rectifying currents. In our study, the reduction of misalignments allowed the elucidation of paralogous gene sequences and two distinct Kir2.6 haplotypes, and pointed the need for checking the frequency of these polymorphisms in other populations with different genetic background.
Cox, Ann M
Sleep paralysis is a relatively new term to describe what for hundreds of years many believed to be a visitation by a malevolent creature which attacked its victims as they slept. The first clinical description of sleep paralysis was published in 1664 in a Dutch physician's case histories, where it was referred to as, 'Incubus or the Night-Mare [sic]'. In 1977, it was discovered more than 100 previously healthy people from various South East Asian communities had died mysteriously in their sleep. The individuals affected were dying at a rate of 92/100,000 from Sudden Unexplained Nocturnal Death Syndrome. No underlying cause was ever found, only that subsequent studies revealed a high rate of sleep paralysis and belief in the dab tsog (nightmare spirit) amongst members of the community. The nightmare/succubus is descended from Lilith. The earliest reference to Lilith is found in the Sumerian King list of 2400 BC known as Lilitu or she-demon, she bore children from her nocturnal unions with men. In other derivations, she was Adam's first wife who rather than 'obey' became a demon that preyed on women during childbirth. In modern Middle Eastern maternity wards, some women still wear amulets for protection. Today, clinical cause of these disturbances is sleep paralysis due to the unsuitable timing of REM sleep. During the 'Nightmare' episode, the sleeper becomes partially conscious during REM cycle, leaving the individual in a state between dream and wakefulness. For some, culture and the tradition of the nightmare is explanation enough.
Sleep paralysis is a relatively new term to describe what for hundreds of years many believed to be a visitation by a malevolent creature which attacked its victims as they slept. The first clinical description of sleep paralysis was published in 1664 in a Dutch physician’s case histories, where it was referred to as, ‘Incubus or the Night-Mare [sic]’. In 1977, it was discovered more than 100 previously healthy people from various South East Asian communities had died mysteriously in their sleep. The individuals affected were dying at a rate of 92/100,000 from Sudden Unexplained Nocturnal Death Syndrome. No underlying cause was ever found, only that subsequent studies revealed a high rate of sleep paralysis and belief in the dab tsog (nightmare spirit) amongst members of the community. The nightmare/succubus is descended from Lilith. The earliest reference to Lilith is found in the Sumerian King list of 2400 BC known as Lilitu or she-demon, she bore children from her nocturnal unions with men. In other derivations, she was Adam’s first wife who rather than ‘obey’ became a demon that preyed on women during childbirth. In modern Middle Eastern maternity wards, some women still wear amulets for protection. Today, clinical cause of these disturbances is sleep paralysis due to the unsuitable timing of REM sleep. During the ‘Nightmare’ episode, the sleeper becomes partially conscious during REM cycle, leaving the individual in a state between dream and wakefulness. For some, culture and the tradition of the nightmare is explanation enough. PMID:28008370
Goel, Neha; Bhambhwani, Vishaal; Jain, Pooja; Ghosh, Basudeb
To describe an unusual retinal manifestation of dengue fever in an endemic region. A 35 year old male presenting with acute onset decreased vision in his right eye, was found to have a massive retinal pigment epithelial detachment (PED) extending up to the vascular arcades. He had been diagnosed with acute hypokalemic quadriparesis in dengue fever in the preceding week, which had resolved following treatment. The patient was managed conservatively. At three months follow up, there was spontaneous flattening of the PEDs with improvement in visual acuity. Dengue fever complicated by acute hypokalemic quadriparesis can be associated with PED, which can be large. The condition resolves spontaneously and bears a good prognosis.
Gubran, Christopher; Narain, Rajay; Malik, Luqmaan; Saeed, Saad Aldeen
Thyrotoxic periodic paralysis (TPP) is a rare metabolic disorder characterised by muscular weakness and paralysis in predisposed thyrotoxic patients. Although patients with TPP are almost uniformly men of Asian descent, cases have been reported in Caucasian and other ethnic populations. The rapid increase in ethnic diversity in Western and European nations has led to increase in TPP reports, where it was once considered exceedingly rare. Correcting the hypokalaemic and hyperthyroid state tends to reverse the paralysis. However, failure to recognise the condition may lead to delay in diagnosis and serious consequences including respiratory failure and death. We describe a young man who was diagnosed with hyperthyroidism who presented with acute paralysis. The clinical characteristics, pathophysiology and management of TTP are reviewed. PMID:22927268
Rehabilitation takes an important part in the treatment of facial paralysis, especially when these are severe. It aims to lead the recovery of motor activity and prevent or reduce sequelae like synkinesis or spasms. It is preferable that it be proposed early in order to set up a treatment plan based on the results of the assessment, sometimes coupled with an electromyography. In case of surgery, preoperative work is recommended, especially in case of hypoglossofacial anastomosis or lengthening temporalis myoplasty (LTM). Our proposal is to present an original technique to enhance the sensorimotor loop and the cortical control of movement, especially when using botulinum toxin and after surgery.
Hufford, David J
This article presents an overview of the sleep paralysis experience from both a cultural and a historical perspective. The robust, complex phenomenological pattern that represents the subjective experience of sleep paralysis is documented and illustrated. Examples are given showing that, for a majority of subjects, sleep paralysis is taken to be a kind of spiritual experience. This is, in part, because of the very common perception of a non-physical 'threatening presence' that is part of the event. Examples from various cultures, including mainstream contemporary America which has no widely known tradition about sleep paralysis, are used to show that the complex pattern and spiritual interpretation are not dependent on cultural models or prior learning. This is dramatically contrary to conventional explanations of apparently 'direct' spiritual experiences, explanations that are summed up as the 'Cultural Source Hypothesis.' This aspect of sleep paralysis was not recognized through most of the twentieth century. The article examines the way that conventional modern views of spiritual experience, combined with medical ideas that labeled 'direct' spiritual experiences as psychopathological, and mainstream religious views of such experiences as heretical if not pathological, suppressed the report and discussion of these experiences in modern society. These views have resulted in confusion in the scientific literature on sleep paralysis with regard to its prevalence and core features. The article also places sleep paralysis in the context of other 'direct' spiritual experiences and offers an 'Experiential Theory' of cross-culturally distributed spiritual experiences.
Kao, K C; Tsai, Y H; Lin, M C; Huang, C C; Tsao, C Y; Chen, Y C
A 34-year-old male was admitted to the emergency department with the development of quadriparesis and respiratory failure due to hypokalemia after prolonged glue sniffing. The patient was subsequently given mechanical ventilatory support for respiratory failure. He was weaned from the ventilator 4 days later after potassium replacement. Toluene is an aromatic hydrocarbon found in glues, cements, and solvents. It is known to be toxic to the nervous system, hematopoietic system, and causes acid-base and electrolyte disorders. Acute respiratory failure with hypokalemia and rhabdomyolysis with acute renal failure should be considered as potential events in a protracted glue sniffing.
Law, Samuel; Kirmayer, Laurence J
Traditional and contemporary Inuit concepts of sleep paralysis were investigated through interviews with elders and young people in Iqaluit, Baffin Island. Sleep paralysis was readily recognized by most respondents and termed uqumangirniq (in the Baffin region) or aqtuqsinniq (Kivalliq region). Traditional interpretations of uqumangirniq referred to a shamanistic cosmology in which the individual's soul was vulnerable during sleep and dreaming. Sleep paralysis could result from attack by shamans or malevolent spirits. Understanding the experience as a manifestation of supernatural power, beyond one's control, served to reinforce the experiential reality and presence of the spirit world. For contemporary youth, sleep paralysis was interpreted in terms of multiple frameworks that incorporated personal, medical, mystical, traditional/shamanistic, and Christian views, reflecting the dynamic social changes taking place in this region.
Bennett, Cleaves M.
The urine-concentrating mechanism was studied in chronic hypokalemia (seven dogs given a low K+, high NaCl diet plus injections of deoxycorticosterone acetate [DOCA]) and chronic hypercalcemia (seven dogs given vitamin D). In the potassium-depleted dogs, muscle, serum, and urine K+ fell markedly, but glomerular filtration rate (GFR) and body weight varied little. Maximum urine osmolality fell in all dogs (mean decrease = 45%); however, solute-free water reabsorption (TCH2O) at high rates of solute excretion remained normal in three of four dogs. Free water excretion (CH2O) increased normally or supranormally as a function of increasing Na+ delivery to Henle's loop in six dogs so tested. Hypercalcemia of several weeks duration caused a decrease in both GFR (mean 36%) as well as in maximum urine osmolality (mean 57%). Maximum TCH2O was not invariably depressed; in fact, when the values were adjusted for the reduced number of functioning nephrons (TCH2O/CIn), four of seven studies were normal. CH20/CIn increased normally (or supranormally) with increasing fractional Na delivery to Henle's loop in four of five dogs. I conclude that the lowered maximum urine osmolality in these hypokalemic and hypercalcemic dogs was not related to abnormal water reabsorption from the collecting ducts. Although not specifically measured in this study, it is very likely that solute accumulation in the renal medulla was reduced. This probably was not caused by abnormal delivery of sodium to, nor reabsorption of sodium from Henle's loop. It is likely that a more subtle defect exists in the countercurrent mechanisms for establishing a steep concentration gradient in the renal medulla. In the few hypercalcemic dogs in whom GFR was very low, I believe that injury to, and blockage of medullary tubules could account for most of the reduction in maximum UOsm. Although not specifically ruled out, there is no evidence here to suggest that high serum Ca+ or low serum K+ per se causes a defect in
Grotegut, Chad A; Dandolu, Vani; Katari, Sunita; Whiteman, Valerie E; Geifman-Holtzman, Ossie; Teitelman, Melissa
We report a case of baking soda pica in a woman at 31 weeks of pregnancy causing severe hypokalemic metabolic alkalosis and rhabdomyolysis. A multigravida at 31 weeks of gestation presented with weakness and muscle pain. She was found to have severe hypokalemic metabolic alkalosis and rhabdomyolysis, with elevation in serum transaminases and hypertension. We initially thought the patient had an atypical presentation of preeclampsia until it was realized that she was ingesting 1 full box of baking soda (454 g sodium bicarbonate) per day. Symptoms and abnormal laboratory findings resolved with discontinuation of the patient's pica practices. Pica is a common but often overlooked practice that can potentially lead to life-threatening disorders. A thorough evaluation of a patient's dietary intake is extremely important, especially in the setting of atypical presentations of disease in pregnancy.
Alar, Timucin; Degirmenci, Yildiz; Ozisik Karaman, Handan Isin
Lightning injury is the second most common cause of weather-related deaths in the United States. Despite the several neurological complications such as polyneuropathy, myelopathy, spinal cord injury, motor neuron disease due to the lightning-induced injury, there is no documented case of unilateral diaphragmatic paralysis. We describe the case of a patient with a history of lightning strike at childhood period, prior the onset of isolated, diaphragmatic paralysis, unilaterally. Clinical and electrophysiological findings suggest an injury restricted to the phrenic nerve, unilaterally. PMID:24765394
Ferrazzoli, Davide; Sabetta, Annarita; Palamara, Grazia; Caremani, Luca; Capobianco, Marina; Balbi, Pietro; Frazzitta, Giuseppe
To report a rare case of hypokalemic rhabdomyolysis induced by the heavy and prolonged ingestion of cola-based beverages, and its uneventful recovery after kalemia normalization. We report a 38-year-old Caucasian male presented in our emergency room with a recent and progressive weakness of the lower limbs proximal muscles. A dietary history revealed a prolonged ingestion of cola-based beverages. Blood tests showed severe hypokalemia and marked increase in serum creatine phosphokinase. The analysis of cerebrospinal fluid resulted normal. Electromyography was suggestive for a myopathy. The clinical, laboratory and neurophysiological data were evocative for a cola-induced hypokalemic rhabdomyolysis. After kalemia normalization, the improvements of the electromyographic findings paralleled the clinical recovery. Chronic consumption of large amount of cola-based soft drinks may result in severe symptomatic hypokalemia, eventually leading in turn to myopathy. To our knowledge, this is the first description of the electromyographic findings of the cola-induced hypokalemic rhabdomyolysis. An early diagnosis and a prompt treatment appear to be crucial for a benign clinical course.
Ferrazzoli, Davide; Sabetta, Annarita; Palamara, Grazia; Caremani, Luca; Capobianco, Marina; Balbi, Pietro; Frazzitta, Giuseppe
Objective: To report a rare case of hypokalemic rhabdomyolysis induced by the heavy and prolonged ingestion of cola-based beverages, and its uneventful recovery after kalemia normalization. Methods: We report a 38-year-old Caucasian male presented in our emergency room with a recent and progressive weakness of the lower limbs proximal muscles. Results: A dietary history revealed a prolonged ingestion of cola-based beverages. Blood tests showed severe hypokalemia and marked increase in serum creatine phosphokinase. The analysis of cerebrospinal fluid resulted normal. Electromyography was suggestive for a myopathy. The clinical, laboratory and neurophysiological data were evocative for a cola-induced hypokalemic rhabdomyolysis. After kalemia normalization, the improvements of the electromyographic findings paralleled the clinical recovery. Conclusion: Chronic consumption of large amount of cola-based soft drinks may result in severe symptomatic hypokalemia, eventually leading in turn to myopathy. To our knowledge, this is the first description of the electromyographic findings of the cola-induced hypokalemic rhabdomyolysis. An early diagnosis and a prompt treatment appear to be crucial for a benign clinical course. PMID:28321307
Dutta, D; Fischler, M; McClung, A
Secondary hyperkalaemic paralysis is a rare condition often mimicking the Guillain-Barré syndrome. There have been a few case reports of hyperkalaemia caused by renal failure, trauma, and drugs where the presentation has been with muscle weakness. A case of hyperkalaemic paralysis caused by an angiotensin converting enzyme inhibitor is reported. Keywords: hyperkalaemia; paralysis; ACE inhibitors PMID:11161080
Deem, Samuel; Davis, Cordell R; Tierney, James P
Laparoscopic radical prostatectomy (LARP) has been accepted as first line therapy for clinically localized prostate cancer. Complications have been low and outcomes are comparable to that of open surgery with potential benefits including shorter hospital stay, less pain and quicker return to normal activity. Unexplained paralysis following LARP is a rare entity with no reported cases in the current literature. We report a case of complete motor paralysis following LARP. An extensive multidisciplinary evaluation did not definitively establish a diagnosis. Aggressive multimodality treatment led to a complete recovery. Our understanding of this phenomena with the possible etiology and treatment is discussed.
Rubin, David; Fusfeld, Robert D.
Herpes zoster may, in some instances, cause motor paralysis as well as the usual sensory and cutaneous manifestations. It is suggested that the presence of electromyographic denervation potentials be used as the criterion of muscle paresis in order to avoid mistaking atrophy of disuse for true lower motor neuron disease. Use of the proper physical therapy procedures hastens the recovery of function and may serve to retard denervation atrophy and fibrosis in patients with muscle paralysis. ImagesFigure 1 (Case 1).Figure 1 (Case 1). PMID:5828175
Lorenz, Daniel S.; Reiman, Michael P.; Walker, John C.
Background: Clinicians are constantly faced with the challenge of designing training programs for injured and noninjured athletes that maximize healing and optimize performance. Periodization is a concept of systematic progression—that is, resistance training programs that follow predictable patterns of change in training variables. The strength training literature is abundant with studies comparing periodization schemes on uninjured, trained, and untrained athletes. The rehabilitation literature, however, is scarce with information about how to optimally design resistance training programs based on periodization principles for injured athletes. The purpose of this review is to discuss relevant training variables and methods of periodization, as well as periodization program outcomes. A secondary purpose is to provide an anecdotal framework regarding implementation of periodization principles into rehabilitation programs. Evidence Acquisition: A Medline search from 1979 to 2009 was implemented with the keywords periodization, strength training, rehabilitation, endurance, power, hypertrophy, and resistance training with the Boolean term AND in all possible combinations in the English language. Each author also undertook independent hand searching of article references used in this review. Results: Based on the studies researched, periodized strength training regimens demonstrate improved outcomes as compared to nonperiodized programs. Conclusions: Despite the evidence in the strength training literature supporting periodization programs, there is a considerable lack of data in the rehabilitation literature about program design and successful implementation of periodization into rehabilitation programs. PMID:23015982
Imaizumi, Mitsuyoshi; Tani, Akiko; Ogawa, Hiroshi; Omori, Koichi
Parotid lymphangioma is a relatively rare disease that is usually detected in infancy or early childhood, and which has typical features. Clinical reports of facial nerve paralysis caused by lymphangioma, however, are very rare. Usually, facial nerve paralysis in a child suggests malignancy. Here we report a very rare case of parotid lymphangioma associated with facial nerve paralysis. A 7-year-old boy was admitted to hospital with a rapidly enlarging mass in the left parotid region. Left peripheral-type facial nerve paralysis was also noted. Computed tomography and magnetic resonance imaging also revealed multiple cystic lesions. Open biopsy was undertaken in order to investigate the cause of the facial nerve paralysis. The histopathological findings of the excised tumor were consistent with lymphangioma. Prednisone (40 mg/day) was given in a tapering dose schedule. Facial nerve paralysis was completely cured 1 month after treatment. There has been no recurrent facial nerve paralysis for eight years.
Rika-Heke, Tamara; Kelman, Mark; Ward, Michael P
The aim of this study was to describe the association between climate, weather and the occurrence of canine tick paralysis, feline tick paralysis and canine parvovirus in Australia. The Southern Oscillation Index (SOI) and monthly average rainfall (mm) data were used as indices for climate and weather, respectively. Case data were extracted from a voluntary national companion animal disease surveillance resource. Climate and weather data were obtained from the Australian Government Bureau of Meteorology. During the 4-year study period (January 2010-December 2013), a total of 4742 canine parvovirus cases and 8417 tick paralysis cases were reported. No significant (P ≥ 0.05) correlations were found between the SOI and parvovirus, canine tick paralysis or feline tick paralysis. A significant (P < 0.05) positive cross-correlation was found between parvovirus occurrence and rainfall in the same month (0.28), and significant negative cross-correlations (-0.26 to -0.36) between parvovirus occurrence and rainfall 4-6 months previously. Significant (P < 0.05) negative cross-correlations (-0.34 to -0.39) were found between canine tick paralysis occurrence and rainfall 1-3 months previously, and significant positive cross-correlations (0.29-0.47) between canine tick paralysis occurrence and rainfall 7-10 months previously. Significant positive cross-correlations (0.37-0.68) were found between cases of feline tick paralysis and rainfall 6-10 months previously. These findings may offer a useful tool for the management and prevention of tick paralysis and canine parvovirus, by providing an evidence base supporting the recommendations of veterinarians to clients thus reducing the impact of these diseases. Copyright © 2015 Elsevier Ltd. All rights reserved.
Takeuchi, T; Miyasita, A; Sasaki, Y; Inugami, M; Fukuda, K
We elicited isolated sleep paralysis (ISP) from normal subjects by a nocturnal sleep interruption schedule. On four experimental nights, 16 subjects had their sleep interrupted for 60 minutes by forced awakening at the time when 40 minutes of nonrapid eye movement (NREM) sleep had elapsed from the termination of rapid eye movement (REM) sleep in the first or third sleep cycle. This schedule produced a sleep onset REM period (SOREMP) after the interruption at a high rate of 71.9%. We succeeded in eliciting six episodes of ISP in the sleep interruptions performed (9.4%). All episodes of ISP except one occurred from SOREMP, indicating a close correlation between ISP and SOREMP. We recorded verbal reports about ISP experiences and recorded the polysomnogram (PSG) during ISP. All of the subjects with ISP experienced inability to move and were simultaneously aware of lying in the laboratory. All but one reported auditory/visual hallucinations and unpleasant emotions. PSG recordings during ISP were characterized by a REM/W stage dissociated state, i.e. abundant alpha electroencephalographs and persistence of muscle atonia shown by the tonic electromyogram. Judging from the PSG recordings, ISP differs from other dissociated states such as lucid dreaming, nocturnal panic attacks and REM sleep behavior disorders. We compare some of the sleep variables between ISP and non-ISP nights. We also discuss the similarities and differences between ISP and sleep paralysis in narcolepsy.
Iheonunekwu, N C; Ibrahim, T M; Davies, D; Pickering, K
This paper reports the case of a 21-year-old Afro-Caribbean pregnant woman with hyperthyroidism and hypokalaemic quadriparesis and reviews the literature on the topic. Thyrotoxic periodic paralysis is a very rare condition in the Caribbean. This case reminds West Indian physicians to consider this rare condition in any patient that presents with paralysis.
Ciorba, Andrea; Corazzi, Virginia; Conz, Veronica; Bianchini, Chiara; Aimoni, Claudia
Facial nerve palsy is a condition with several implications, particularly when occurring in childhood. It represents a serious clinical problem as it causes significant concerns in doctors because of its etiology, its treatment options and its outcome, as well as in little patients and their parents, because of functional and aesthetic outcomes. There are several described causes of facial nerve paralysis in children, as it can be congenital (due to delivery traumas and genetic or malformative diseases) or acquired (due to infective, inflammatory, neoplastic, traumatic or iatrogenic causes). Nonetheless, in approximately 40%-75% of the cases, the cause of unilateral facial paralysis still remains idiopathic. A careful diagnostic workout and differential diagnosis are particularly recommended in case of pediatric facial nerve palsy, in order to establish the most appropriate treatment, as the therapeutic approach differs in relation to the etiology. PMID:26677445
Billue, J S
Patients with Bell's palsy, or idiopathic facial paralysis, present sporadically in the primary care setting. New evidence implicates reactivated herpes simplex virus (HSV) as the etiologic agent in greater than 70% of cases diagnosed as Bell's palsy. Careful evaluation of the patient with facial paralysis, including history, physical examination, and diagnostic assessment, may mandate the expeditious treatment of facial paralysis to prevent faulty nerve regeneration during the recovery period. Using the results of an objective tool for grading resting facial symmetry, symmetry of voluntary movement, and synkinesis can provide a quantitative measurement for decision making. These data are also useful in documenting progression or regression of the patient's facial paralysis. Administration of acyclovir with prednisone improves the recovery of complete facial functioning following an episode of Bell's palsy. During the acute and convalescent stages, the eye on the affected side must be protected until function is restored to the facial nerve. Residual effects of Bell's palsy lasting more than 6 months may indicate another diagnosis and the need to refer the patient to a specialist.
Diels, H J; Combs, D
Neuromuscular retraining is an effective method for rehabilitating facial musculature in patients with facial paralysis. This nonsurgical therapy has demonstrated improved functional outcomes and is an important adjunct to surgical treatment for restoring facial movement. Treatment begins with an intensive clinical evaluation and incorporates appropriate sensory feedback techniques into a patient-specific, comprehensive, home therapy program. This article discusses appropriate patients, timelines for referral, and basic treatment practices of facial neuromuscular retraining for restoring function and expression to the highest level possible.
Fukumoto, Megumi; Yamashiro, Nobuo; Kobayashi, Fumikazu; Nagasaka, Takamura; Takiyama, Yoshihisa
A 49-year-old man subacutely developed muscle weakness in four extremities over a few days. He had no past or family history of muscle weakness. His blood tests showed significant hypokalemia without endocrinological abnormalities. With the diagnosis of hypokalemic myopathy, potassium was administered orally, and his symptoms improved. The patient had been drinking a beverage containing green tea extract too much two weeks before the symptoms developed, in addition to taking a cold remedy for ten years. Thus, hypokalemia is considered to be induced by the excessive intake of caffeine that accompanies the excessive consumption of the beverage and cold remedy.
Tolins, J P; Hostetter, M K; Hostetter, T H
Chronic potassium deficiency results in progressive tubulointerstitial injury, associated with augmented renal ammoniagenesis. We investigated the role of elevated renal ammonia levels and the interaction of ammonia with the complement system in this injury. Potassium deficiency was induced in rats by feeding a low potassium diet. Experimental animals received 150 mM NaHCO3 or equimolar NaCl, as drinking water. After 3 wk, NaHCO3 supplemented rats demonstrated decreased ammonia production, less renal hypertrophy, less histologic evidence of injury, and less proteinuria. In in vitro studies on normal cortical tubular fragments, the addition of ammonia to serum in concentrations comparable to renal cortical levels in potassium-deficient animals significantly increased tubular deposition of C3 as quantitated by a radiolabeled antibody binding technique. Thus, alkali supplementation reduced chronic tubulointerstitial disease in a rat model of hypokalemic nephropathy. We propose that increased cortical ammonia levels contribute to hypokalemic nephropathy through ammonia-mediated activation of the alternative complement pathway.
Girard, Todd A; Cheyne, J Allan
The objective of this prospective naturalistic field study was to determine the distribution of naturally occurring sleep-paralysis (SP) episodes over the course of nocturnal sleep and their relation to bedtimes. Regular SP experiencers (N = 348) who had previously filled out a screening assessment for SP as well as a general sleep survey were recruited. Participants reported, online over the World Wide Web, using a standard reporting form, bedtimes and subsequent latencies of spontaneous episodes of SP occurring in their homes shortly after their occurrence. The distribution of SP episodes over nights was skewed to the first 2 h following bedtime. Just over one quarter of SP episodes occurred within 1 h of bedtime, although episodes were reported throughout the night with a minor mode around the time of normal waking. SP latencies following bedtimes were moderately consistent across episodes and independent of bedtimes. Additionally, profiles of SP latencies validated self-reported hypnagogic, hypnomesic, and hypnopompic SP categories, as occurring near the beginning, middle, and end of the night/sleep period respectively. Results are consistent with the hypothesis that SP timing is controlled by mechanisms initiated at or following sleep onset. These results also suggest that SP, rather than uniquely reflecting anomalous sleep-onset rapid eye movement (REM) periods, may result from failure to maintain sleep during REM periods at any point during the sleep period. On this view, SP may sometimes reflect the maintenance of REM consciousness when waking and SP hallucinations the continuation of dream experiences into waking life.
Cha, H E; Baek, M K; Yoon, J H; Yoon, B K; Kim, M J; Lee, J H
To evaluate the causes, treatment modalities and recovery rate of paediatric facial nerve paralysis. We analysed 24 cases of paediatric facial nerve paralysis diagnosed in the otolaryngology department of Gachon University Gil Medical Center between January 2001 and June 2006. The most common cause was idiopathic palsy (16 cases, 66.7 per cent). The most common degree of facial nerve paralysis on first presentation was House-Brackmann grade IV (15 of 24 cases). All cases were treated with steroids. One of the 24 cases was also treated surgically with facial nerve decompression. Twenty-two cases (91.6 per cent) recovered to House-Brackmann grade I or II over the six-month follow-up period. Facial nerve paralysis in children can generally be successfully treated with conservative measures. However, in cases associated with trauma, radiological investigation is required for further evaluation and treatment.
Beyer, A B; Grossman, M
A free-ranging male red wolf (Canis rufus) in North Carolina (USA), exhibiting paresis, anorexia and heavy tick infection was diagnosed with tick paralysis. The wolf recovered completely following the removal of all ticks. This is the first record of tick paralysis in the red wolf.
Facial paralysis has been a recognized condition since Antiquity, and was mentionned by Hippocratus. In the 17th century, in 1687, the Dutch physician Stalpart Van der Wiel rendered a detailed observation. It was, however, Charles Bell who, in 1821, provided the description that specified the role of the facial nerve. Facial nerve surgery began at the end of the 19th century. Three different techniques were used successively: nerve anastomosis, (XI-VII Balance 1895, XII-VII, Korte 1903), myoplasties (Lexer 1908), and suspensions (Stein 1913). Bunnell successfully accomplished the first direct facial nerve repair in the temporal bone, in 1927, and in 1932 Balance and Duel experimented with nerve grafts. Thanks to progress in microsurgical techniques, the first faciofacial anastomosis was realized in 1970 (Smith, Scaramella), and an account of the first microneurovascular muscle transfer published in 1976 by Harii. Treatment of the eyelid paralysis was at the origin of numerous operations beginning in the 1960s; including palpebral spring (Morel Fatio 1962) silicone sling (Arion 1972), upperlid loading with gold plate (Illig 1968), magnets (Muhlbauer 1973) and transfacial nerve grafts (Anderl 1973). By the end of the 20th century, surgeons had at their disposal a wide range of valid techniques for facial nerve surgery, including modernized versions of older techniques.
Bahl, Sunil; Khera, Ajay; Sutter, Roland W.
Diphtheritic polyneuropathy is a vaccine-preventable illness caused by exotoxin-producing strains of Corynebacterium diphtheriae. We present a retrospective convenience case series of 15 children (6 girls) <15 years of age (mean age 5.2 years, case-fatality rate 53%, and 1 additional case-patient who was ventilator dependent at the time of last follow-up; median follow-up period 60 days) with signs and symptoms suggestive of diphtheritic polyneuropathy. All cases were identified through national acute flaccid paralysis surveillance, which was designed to detect poliomyelitis in India during 2002–2008. We also report data on detection of diphtheritic polyneuropathy compared with other causes of acute flaccid paralysis identified by this surveillance system. PMID:23965520
Deeley, Quinton; Oakley, David A; Toone, Brian; Bell, Vaughan; Walsh, Eamonn; Marquand, Andre F; Giampietro, Vincent; Brammer, Michael J; Williams, Steven C R; Mehta, Mitul A; Halligan, Peter W
Suggestions of limb paralysis in highly hypnotically suggestible subjects have been employed to successfully model conversion disorders, revealing similar patterns of brain activation associated with attempted movement of the affected limb. However, previous studies differ with regard to the executive regions involved during involuntary inhibition of the affected limb. This difference may have arisen as previous studies did not control for differences in hypnosis depth between conditions and/or include subjective measures to explore the experience of suggested paralysis. In the current study we employed functional magnetic resonance imaging (fMRI) to examine the functional anatomy of left and right upper limb movements in eight healthy subjects selected for high hypnotic suggestibility during (i) hypnosis (NORMAL) and (ii) attempted movement following additional left upper limb paralysis suggestions (PARALYSIS). Contrast of left upper limb motor function during NORMAL relative to PARALYSIS conditions revealed greater activation of contralateral M1/S1 and ipsilateral cerebellum, consistent with the engagement of these regions in the completion of movements. By contrast, two significant observations were noted in PARALYSIS relative to NORMAL conditions. In conjunction with reports of attempts to move the paralysed limb, greater supplementary motor area (SMA) activation was observed, a finding consistent with the role of SMA in motor intention and planning. The anterior cingulate cortex (ACC, BA 24) was also significantly more active in PARALYSIS relative to NORMAL conditions - suggesting that ACC (BA 24) may be implicated in involuntary, as well as voluntary inhibition of prepotent motor responses.
Seirafian, Shiva; Shafie, Mohammad; Abedini, Amin; Pakzad, Bahram; Roomizadeh, Peyman
We herein report the case of a 64-year old woman with recurrent attacks of hypokalemic quadriparesis which resulted from distal renal tubular acidosis (dRTA) secondary to Sjögren syndrome. The patient presented with sudden onset quadriparesis. A physical examination showed symmetric weakness of all four limbs. Severe hypokalemia (1.8 mEq/L), accompanied by normal anion gap metabolic acidosis, a positive urine anion gap and an inappropriately high urine pH pointed toward the diagnosis of dRTA. Further investigations disclosed primary Sjögren syndrome, which had not previously been recognized. On the basis of the current report and a review of the literature we suggest investigating the possibility of Sjögren syndrome in all patients with clinically unexplained dRTA.
Maturo, Stephen; Brennan, Joseph
We present in this case report the return to flying duty of a pilot with vocal cord paralysis secondary to removal of a thymoma. We discuss the importance of glottic function as it pertains to the unique aviation environment. We also discuss the anatomy and physiology of the glottis, the evaluation for vocal cord paralysis, and surgical approaches for paralyzed vocal cords. Although the incidence of recurrent laryngeal nerve paralysis is low in the military aviation community, it is important to recognize that its sequelae can be managed so that the aviator may return to flight duties.
Robla-Costales, David; Robla-Costales, Javier; Socolovsky, Mariano; di Masi, Gilda; Fernández, Javier; Campero, Álvaro
Facial palsy is a relatively common condition, from which most cases recover spontaneously. However, each year, there are 127,000 new cases of irreversible facial paralysis. This condition causes aesthetic, functional and psychologically devastating effects in the patients who suffer it. Various reconstructive techniques have been described, but there is no consensus regarding their indication. While these techniques provide results that are not perfect, many of them give a very good aesthetic and functional result, promoting the psychological, social and labour reintegration of these patients. The aim of this article is to describe the indications for which each technique is used, their results and the ideal time when each one should be applied.
This preliminary report, of a longitudinal study, looks at the relationship between geomagnetic activity and the incidence of isolated sleep paralysis over a 23.5-mo. period. The author, who has frequently and for the last 24 years experienced isolated sleep paralysis was the subject. In addition, incidence of lucid dreaming, vivid dreams, and total dream frequency were looked at with respect to geomagnetic activity. The data were in the form of dream-recall frequency recorded in a diary. These frequency data were correlated with geomagnetic activity k-index values obtained from two observatories. A significant correlation was obtained between periods of local geomagnetic activity and the incidence of isolated sleep paralysis. Specifically, periods of relatively quiet geomagnetic activity were significantly associated with an increased incidence of episodes.
Achour, I; Chakroun, A; Ayedi, S; Ben Rhaiem, Z; Mnejja, M; Charfeddine, I; Hammami, B; Ghorbel, A
Idiopathic facial palsy is the most common cause of facial nerve palsy in children. Controversy exists regarding treatment options. The objectives of this study were to review the epidemiological and clinical characteristics as well as the outcome of idiopathic facial palsy in children to suggest appropriate treatment. A retrospective study was conducted on children with a diagnosis of idiopathic facial palsy from 2007 to 2012. A total of 37 cases (13 males, 24 females) with a mean age of 13.9 years were included in this analysis. The mean duration between onset of Bell's palsy and consultation was 3 days. Of these patients, 78.3% had moderately severe (grade IV) or severe paralysis (grade V on the House and Brackmann grading). Twenty-seven patients were treated in an outpatient context, three patients were hospitalized, and seven patients were treated as outpatients and subsequently hospitalized. All patients received corticosteroids. Eight of them also received antiviral treatment. The complete recovery rate was 94.6% (35/37). The duration of complete recovery was 7.4 weeks. Children with idiopathic facial palsy have a very good prognosis. The complete recovery rate exceeds 90%. However, controversy exists regarding treatment options. High-quality studies have been conducted on adult populations. Medical treatment based on corticosteroids alone or combined with antiviral treatment is certainly effective in improving facial function outcomes in adults. In children, the recommendation for prescription of steroids and antiviral drugs based on adult treatment appears to be justified. Randomized controlled trials in the pediatric population are recommended to define a strategy for management of idiopathic facial paralysis. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Wang, Sheng-Qiang; Yu, Su; Wang, Jian-Ping
Articles on acupuncture for peripheral facial paralysis were picked up from CNKI database. The retrieved original studies were evaluated and summarized. The problems of acupuncture for peripheral facial paralysis were analyzed, and concrete solutions were proposed. Problems that differential diagnosis, prognosis, treatment of severe facial paralysis, and identification of sequelae and compliation were not embasized in clinical treatment of facial paralysis. Consequently, the effectiveness of acupuncture for peripheral facial paralysis will be improved by sloving above problems.
failing to comply with a collection of information if it does not display a currently valid OMB control number. PLEASE DO NOT RETURN YOUR FORM TO...eye blink in patients with unilateral facial nerve paralysis. The system will electrically stimulate the paretic eyelid when EMG electrodes detect...thermal discharge. 15. SUBJECT TERMS facial paralysis, neuroprosthetics, functional electrical stimulation, medical device, Bell’s Palsy 16
Richardson, Brent E; Bastian, Robert W
Vocal fold paralysis is regarded as a sign of other pathologic findings until investigation has proven that there is no lesion to explain the paralysis. We have outlined a cost-effective and time- and labor-efficient method for the clinical evaluation of vocal fold paralysis, including a focused history; vocal capability assessment to find deficits in the function of palate,pharynx, and larynx: and, finally, an intense examination under topical anesthesia to demonstrate these deficits. In essence, it is the endoscopic version of a radiographic study from the skull base through the aortic arch. This method is streamlined as compared with prior protocols for evaluation of vocal fold paralysis, because it directs the necessary further workup according to the likely site of the lesion as indicated by the extended physical examination and can be conducted entirely in the physician's office. Radiographic workup should include CT of the skull base through the upper mediastinum if solely a recurrent nerve paralysis is present; it should include MRI of the skull base if high vagal signs and symptoms are present. If MRI is negative, CT may also be needed for complete evaluation. Neurologic signs that are not all ipsilateral require MRI of the brain and consultation with a neurologist. Esophageal obstruction combined with vocal fold paralysis mandates evaluation via esophagoscopy or an esophagram.
Birbaumer, Niels; Gallegos-Ayala, Guillermo; Wildgruber, Moritz; Silvoni, Stefano; Soekadar, Surjo R
Despite considerable growth in the field of brain-computer or brain-machine interface (BCI/BMI) research reflected in several hundred publications each year, little progress was made to enable patients in complete locked-in state (CLIS) to reliably communicate using their brain activity. Independent of the invasiveness of the BCI systems tested, no sustained direct brain control and communication was demonstrated in a patient in CLIS so far. This suggested a more fundamental theoretical problem of learning and attention in brain communication with BCI/BMI, formulated in the extinction-of-thought hypothesis. While operant conditioning and goal-directed thinking seems impaired in complete paralysis, classical conditioning of brain responses might represent the only alternative. First experimental studies in CLIS using semantic conditioning support this assumption. Evidence that quality-of-life in locked-in-state is not as limited and poor as generally believed draise doubts that "patient wills" or "advanced directives"signed long-before the locked-in-state are useful. On the contrary, they might be used as an excuse to shorten anticipated long periods of care for these patients avoiding associated financial and social burdens. Current state and availability of BCI/BMI systems urge a broader societal discourse on the pressing ethical challenges associated with the advancements in neurotechnology and BCI/BMI research.
Liu, Xu-Long; Hong, Wen-Xue; Liu, Jie-Min
This paper presented a novel approach to objective assessment of facial nerve paralysis based on infrared thermography and formal concept analysis. Sixty five patients with facial nerve paralysis on one side were included in the study. The facial temperature distribution images of these 65 patients were captured by infrared thermography every five days during one-month period. First, the facial thermal images were pre-processed to identify six potential regions of bilateral symmetry by using image segmentation techniques. Then, the temperature differences on the left and right sides of the facial regions were extracted and analyzed. Finally, the authors explored the relationships between the statistical averages of those temperature differences and the House-Brackmann score for objective assessment degree of nerve damage in a facial nerve paralysis by using formal concept analysis. The results showed that the facial temperature distribution of patients with facial nerve paralysis exhibited a contralateral asymmetry, and the bilateral temperature differences of the facial regions were greater than 0.2 degrees C, whereas in normal healthy individuals these temperature differences were less than 0.2 degrees C. Spearman correlation coefficient between the bilateral temperature differences of the facial regions and the degree of facial nerve damage was an average of 0.508, which was statistically significant (p < 0.05). Furthermore, if one of the temperature differences of bilateral symmetry on facial regions was greater than 0.2 degrees C, and all were less than 0.5 degrees C, facial nerve paralysis could be determined as for the mild to moderate; if one of the temperature differences of bilateral symmetry was greater than 0.5 degrees C, facial nerve paralysis could be determined as for serious. In conclusion, this paper presents an automated technique for the computerized analysis of thermal images to objectively assess facial nerve related thermal dysfunction by
Lindner, K; Hitzenberger, P; Drlicek, M; Grisold, W
A 47 year old male was admitted in a comatose state. CT scan showed a haemorrhage in the right pulvinar thalamus descending into the right part of the lamina quadrigemina. He presented with anisocoria, prompt bilateral pupillary light reaction, and unilateral convergence paralysis contralateral to the lesion in combination with upward gaze palsy. During an observation period of two months, the convergence reaction returned to normal. MRI showed a lacunar lesion ventral to superior right colliculus. Angiography revealed an arteriovenous malformation (right posterior cerebral artery--sinus rectus) as the possible cause of the haemorrhage. Images PMID:1527550
Cojan, Yann; Waber, Lakshmi; Carruzzo, Alain; Vuilleumier, Patrik
Brain mechanisms underlying hysterical conversion symptoms are still poorly known. Recent hypotheses suggested that activation of motor pathways might be suppressed by inhibitory signals based on particular emotional situations. To assess motor and inhibitory brain circuits during conversion paralysis, we designed a go-nogo task while a patient underwent functional magnetic resonance imaging (fMRI). Preparatory activation arose in right motor cortex despite left paralysis, indicating preserved motor intentions, but with concomitant increases in vmPFC regions that normally mediate motivational and affective processing. Failure to execute movement on go trials with the affected left hand was associated with activations in precuneus and ventrolateral frontal gyrus. However, right frontal areas normally subserving inhibition were activated by nogo trials for the right (normal) hand, but not during go trials for the left hand (affected by conversion paralysis). By contrast, a group of healthy controls who were asked to feign paralysis showed similar activation on nogo trials and left-go trials with simulated weakness, suggesting that distinct inhibitory mechanisms are implicated in simulation and conversion paralysis. In the patient, right motor cortex also showed enhanced functional connectivity with the posterior cingulate cortex, precuneus, and vmPFC. These results suggest that conversion symptoms do not act through cognitive inhibitory circuits, but involve selective activations in midline brain regions associated with self-related representations and emotion regulation.
Nagao, Namiko; Kaneko, Takaho; Hikawa, Yoshio; Yanagihara, Satoko
We report a case of an 8-year-old boy with laryngeal edema and vocal cord paralysis due to lithium battery ingestion. He had ingested a lithium battery of a television remote controller, and was admitted to our hospital. He was suffering from wheezing and retractive respiration with crying. The foreign body was removed under general anesthesia about two hours after the ingestion. It was a 3 volt lithium battery of 20 millimeters in diameter. Endoscopy showed chemical burn of the postcricoid area and severe edema of the laryngeal arytenoids. Twelve days later we confirmed healing of edema and extubated the tracheal tube, but endoscopy showed bilateral vocal fold paralysis. He had no difficulty in breathing and eating but the vocal cord paralysis remained. Lithium batteries ingestion may cause severe airway injury in a short period because of their large size and high voltage. Immediate removal and careful management are required.
Sanghvi, D; Goyal, C; Mani, J
We present an uncommon case of clinically diagnosed window period stroke subsequently recognised on diffusion - perfusion MRI as ictal paralysis due to focal inhibitory seizures or negative motor seizures. This case highlights the importance of MRI with perfusion imaging in establishing the diagnosis of stroke mimics and avoiding unnecessary thrombolysis.
Sanghvi, D; Goyal, C; Mani, J
We present an uncommon case of clinically diagnosed window period stroke subsequently recognised on diffusion – perfusion MRI as ictal paralysis due to focal inhibitory seizures or negative motor seizures. This case highlights the importance of MRI with perfusion imaging in establishing the diagnosis of stroke mimics and avoiding unnecessary thrombolysis. PMID:27763486
Schwartsmann, Carlos Roberto; Ruschel, Paulo Henrique; Huyer, Rodrigo Guimarães
Paralysis or nerve injury associated with fractures of forearm bones fracture is rare and is more common in exposed fractures with large soft-tissue injuries. Ulnar nerve paralysis is a rare condition associated with closed fractures of the forearm. In most cases, the cause of paralysis is nerve contusion, which evolves with neuropraxia. However, nerve lacerations and entrapment at the fracture site always need to be borne in mind. This becomes more important when neuropraxia appears or worsens after reduction of a closed fracture of the forearm has been completed. The importance of diagnosing this injury and differentiating its features lies in the fact that, depending on the type of lesion, different types of management will be chosen.
Al-Ibrahim, Alia; Al-Harbi, Mosa; Al-Musallam, Sulaiman
Carbonic anhydrase II (CAII) deficiency is an autosomal recessive disorder manifest by osteopetrosis, renal tubular acidosis, and cerebral calcification. Other features include growth failure and mental retardation. Complications of the osteopetrosis include frequent bone fractures, cranial nerve compression, and dental mal-occlusion. A hyper-chloremic metabolic acidosis, sometimes with hypokalemia, occurs due to renal tubular acidosis that may be proximal, distal, or more commonly, the combined type. Such patients may present with global hypotonia, muscle weakness or paralysis. We report a case of CA II deficiency with recurrent attacks of acute paralysis which was misdiagnosed initially as Guillian-Barre syndrome.
Chi, John J
The preoperative assessment of the eye in facial paralysis is a critical component of surgical management. The degree of facial nerve paralysis, lacrimal secretion, corneal sensation, and lower eyelid position must be assessed accurately. Upper eyelid loading procedures are standard management of lagophthalmos. Lower eyelid tightening repositions the lower eyelid and helps maintain the aqueous tear film. Eyelid reanimation allows an aesthetic symmetry with blinking and restores protective functions vital to ocular preservation. Patients often have multiple nervous deficits, including corneal anesthesia. Other procedures include tarsorrhaphy, spring implantation, and temporalis muscle transposition; associated complications have rendered them nearly obsolete.
Kwon, Oh Jin; Park, Jung Je; Kim, Jin Pyeong; Woo, Seung Hoon
Foreign bodies in the oral cavity and pharynx are commonly encountered in the emergency room and outpatient departments, and the most frequently observed of these foreign bodies are fish bones. Among the possible complications resulting from a pharyngeal foreign body, vocal cord fixation is extremely rare, with only three cases previously reported in the English literature. The mechanisms of vocal cord fixation can be classified into mechanical articular fixation, direct injury of the recurrent laryngeal nerve, or recurrent laryngeal nerve paralysis secondary to inflammation. The case discussed here is different from previous cases. We report a rare case of vocal cord paralysis caused by the venom of a stingray tail in the hypopharynx.
Naeini, Alireza Emami; Ghazavi, Mohamadreza; Moghim, Sharareh; Sabaghi, Amirhosein; Fadaei, Reza
Background: Poliomyelitis is still an endemic disease in many areas of the world including Africa and South Asia. Iran is polio free since 2001. However, due to endemicity of polio in neighboring countries of Iran, the risk of polio importation and re-emergence of wild polio virus is high. Case definition through surveillance system is a well-defined method for maintenance of polio eradication in polio free countries. Methods: In a cross-sectional survey from 2007 to 2013, we reviewed all the records of under 15 years old patients reported to Acute Flaccid Paralysis Committee (AFPC) in Isfahan province, Iran. All cases were visited by members of the AFPC. Three stool samples were collected from each reported case within 2 weeks of onset of paralysis and sent to National Polio Laboratory in Tehran, Iran, for poliovirus isolation. Data were analyzed by SSPS software (version 22). Student's t-test and Chi-square was used to compare variables. Statistical significance level was set at P < 0.05. Results: In this 6-year period 85 cases were analyzed, 54 patients were male (63.5%) and 31 were female (36.5%). The mean age of patients was 5.7 ± 3.9 years. The most common cause of paralysis among these patients was Guillian–Barré syndrome (83.5%). We did not found any poliomyelitis caused by wild polio virus. Only one case of vaccine associated poliomyelitis was reported. Conclusion: Since 1992, Iran has a routine and high percent coverage of polio vaccination program for infants (>94%), with six doses of oral polio vaccine (OPV). Accurate surveillance for poliomyelitis is essential for continuing eradication. PMID:26015925
Ahmad Bhat, Manzoor; Ahmad Laway, Bashir; Mustafa, Farhat; Shafi Kuchay, Mohammad; Mubarik, Idrees; Ahmad Palla, Nazir
Distal renal tubular acidosis is a syndrome of abnormal urine acidification and is characterized by hyperchloremic metabolic acidosis, hypokalemia, hypercalciurea, nephrocalcinosis and nephrolithiasis. Despite the presence of persistent hypokalemia, acute muscular paralysis is rarely encountered in males. Here, we will report an eighteen year old male patient who presented with flaccid quadriparesis and was subsequently found to have rhabdomyolysis, severe short stature, skeletal deformities and primary distal renal tubular acidosis. PMID:25250276
Yetter, M F; Ogren, F P; Moore, G F; Yonkers, A J
Bell's Palsy is not synonymous with facial nerve paralysis. While it is a common cause of facial nerve paralysis, it is a diagnosis of exclusion and other causes of facial nerve paralysis should be ruled out by appropriate evaluation and follow-up. A case report is presented of a patient with a facial nerve paralysis, which was initially diagnosed as Bell's Palsy, but which was found to be a poorly differentiated parotid malignancy causing facial nerve paralysis. A review and discussion of Bells Palsy, evaluation and treatment is presented.
de Jong, Joop T V M
Sleep paralysis is one of the lesser-known and more benign forms of parasomnias. The primary or idiopathic form, also called isolated sleep paralysis, is illustrated by showing how patients from different cultures weave the phenomenology of sleep paralysis into their clinical narratives. Clinical case examples are presented of patients from Guinea Bissau, the Netherlands, Morocco, and Surinam with different types of psychopathology, but all accompanied by sleep paralysis. Depending on the meaning given to and etiological interpretations of the sleep paralysis, which is largely culturally determined, patients react to the event in specific ways.
Chavez, Magdalena; Williams, Jeffrey
Hypokalemia can cause reactions from mild muscular cramping to life-threatening paralysis and cardiac dysrhythmias. This article describes a patient whose unusual, recurrent muscular symptoms and electrolyte abnormalities were eventually identified as Gitelman syndrome, a rare genetic disorder resulting in severe refractory hypokalemia.
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So, Edmund Cheung
Cervical traction is a frequently used treatment in rehabilitation clinics for cervical spine problems. This modality works, in principle, by decompressing the spinal cord or its nerve roots by applying traction on the cervical spine through a harness placed over the mandible (Olivero et al., Neurosurg Focus 2002;12:ECP1). Previous reports on treatment complications include lumbar radicular discomfort, muscle injury, neck soreness, and posttraction pain (LaBan et al., Arch Phys Med Rehabil 1992;73:295-6; Lee et al., J Biomech Eng 1996;118:597-600). Here, we report the first case of unilateral facial nerve paralysis developed after 4 wks of intermittent cervical traction therapy. Nerve conduction velocity examination revealed a peripheral-type facial nerve paralysis. Symptoms of facial nerve paralysis subsided after prednisolone treatment and suspension of traction therapy. It is suspected that a misplaced or an overstrained harness may have been the cause of facial nerve paralysis in this patient. Possible causes were (1) direct compression by the harness on the right facial nerve near its exit through the stylomastoid foramen; (2) compression of the right external carotid artery by the harness, causing transient ischemic injury at the geniculate ganglion; or (3) coincidental herpes zoster virus infection or idiopathic Bell's palsy involving the facial nerve.
Allen, David; Dunn, Louisa
The most common disorder of the facial nerve is acute idiopathic facial paralysis or Bell's palsy and there may be significant morbidity or incomplete recovery associated with severe cases. To assess the efficacy of aciclovir or similar agents for treating Bell's palsy. We searched the Cochrane Neuromuscular Disease Group register (searched April 2003), MEDLINE (from January 1966 to April 2003), EMBASE (from January 1980 to April 2003) and LILACS (from January 1982 to April 2003). We also contacted authors of identified trials. Randomised or quasi-randomised trials of aciclovir or valaciclovir therapy, alone or in combination with any other drug, in patients with Bell's palsy. We identified six randomised trials. Three studies met our inclusion criteria, including 246 patients. One study evaluated aciclovir with corticosteroid versus corticosteroid alone, another study evaluated aciclovir alone versus corticosteroid and a further study evaluated valaciclovir with corticosteroid versus corticosteroid alone or versus placebo alone. Incomplete recovery after one year: data were not available. An analysis was performed on data reported at the end of the study period in each trial. The results from one study four months after the start of treatment significantly favoured the treatment group, whilst the results of the study three months after the start of treatment significantly favoured the control group. The results from the second study at four months showed no statistically significant difference between the three groups.Adverse events: relevant data were not reported in any of the three trials.Complete facial paralysis six months after start of treatment: only one patient had complete paralysis upon entering one of the studies. This patient was assigned to the control group and the level of recovery attained was not reported.Motor synkinesis or crocodile tears one year after start of treatment: data were available up to a maximum of four months after onset of
Guernier, Vanina; Milinovich, Gabriel J; Bezerra Santos, Marcos Antonio; Haworth, Mark; Coleman, Glen; Soares Magalhaes, Ricardo J
Tick paralysis, resultant from envenomation by the scrub-tick Ixodes holocyclus, is a serious threat for small companion animals in the eastern coast of Australia. We hypothesise that surveillance systems that are built on Internet search queries may provide a more timely indication of high-risk periods more effectively than current approaches. Monthly tick paralysis notifications in dogs and cats across Australia and the states of Queensland (QLD) and New South Wales (NSW) were retrieved from Disease WatchDog surveillance system for the period 2011-2013. Internet search terms related to tick paralysis in small companion animals were identified using Google Correlate, and corresponding search frequency metrics were downloaded from Google Trends. Spearman's rank correlations and time series cross correlations were performed to assess which Google search terms lead or are synchronous with tick paralysis notifications. Metrics data were available for 24 relevant search terms at national level, 16 for QLD and 18 for NSW, and they were all significantly correlated with tick paralysis notifications (P < 0.05). Among those terms, 70.8, 56.3 and 50 % showed strong Spearman's correlations, at national level, for QLD, and for NSW respectively, and cross correlation analyses identified searches which lead notifications at national or state levels. This study demonstrates that Internet search metrics can be used to monitor the occurrence of tick paralysis in companion animals, which would facilitate early detection of high-risk periods for tick paralysis cases. This study constitutes the first application of the rapidly emerging field of Internet-based surveillance to veterinary science.
Bettinelli, A; Vezzoli, G; Colussi, G; Bianchetti, M G; Sereni, F; Casari, G
phenotypic and genotypic data, we propose a clinical-pathophysiological and molecular approach to diagnose the different tubulopathies associated with hypokalemic metabolic alkalosis.
Zhang, Xiaoge; Feng, Ling; Du, Liang; Zhang, Anxiang; Tang, Tian
BACKGROUND: Facial paralysis is defined as severe or complete loss of facial muscle motor function. OBJECTIVE: The study was undertaken to explore a bibliometric approach to quantitatively assess the research on clinical treatment of facial paralysis using rehabilitation, physiotherapy and acupuncture using Web of Science from 1992 to 2011. DESIGN: Bibliometric approach. DATA RETRIEVAL: A bibliometric analysis based on the publications on Web of Science was performed using key words such as “facial paralysis”, “rehabilitation”, “physiotherapy” and “acupuncture”. INCLUSIVE CRITERIA: (1) Research articles on the clinical treatment of facial paralysis using acupuncture or physiotherapy (e.g. exercise, electro-stimulation) and other rehabilitation methods; (2) researches on human and animal fundamentals, clinical trials and case reports; (3) Article types: article, review, proceedings paper, note, letter, editorial material, discussion, book chapter. (4) Publication year: 1992–2011 inclusive. Exclusion criteria: (1) Articles on the causes and diagnosis on facial paralysis; (2) Type of articles: correction; (3) Articles from following databases: all databases related to social science and chemical databases in Web of Science. MAIN OUTCOME MEASURES: (1) Overall number of publications; (2) number of publications annually; (3) number of citations received annually; (4) top cited paper; (5) subject categories of publication; (6) the number of countries in which the article is published; (7) distribution of output in journals. RESULTS: Overall population stands at 3 543 research articles addressing the clinical treatment of facial paralysis in Web of Science during the study period. There is also a markedly increase in the number of publications on the subject “facial paralysis treatments using rehabilitation” during the first decade of the 21st century, except in 2004 and 2006 when there are perceptible drops in the number of articles published. The
Ohki, Masafumi; Komiyama, Sakurako; Tayama, Niro
Pharyngeal tuberculosis is a rare disease, and its commonly reported symptoms include sore throat, dysphagia, and throat discomfort. The dysphagia in pharyngeal tuberculosis cases is not due to pharyngolaryngeal paralysis but due to odynophagia. Herein, we describe the first case of dysphagia caused by pharyngolaryngeal paralysis secondary to pharyngeal tuberculosis. An irregular mass at the right nasopharynx was detected in a 57-year-old female patient, along with dysphagia and hoarseness. She had poor right soft palate elevation, inadequate right velopharyngeal closure, poor constrictor pharyngus muscle contraction, and an immobilized right vocal cord, which collectively indicate right pharyngolaryngeal paralysis. Pathological examination and culture testing revealed pharyngeal tuberculosis. She was diagnosed with pharyngolaryngeal paralysis secondary to pharyngeal tuberculosis. The pharyngolaryngeal paralysis resolved after beginning anti-tuberculous treatment. Right pharyngolaryngeal paralysis was attributed to glossopharyngeal and vagus nerve impairment in the parapharyngeal space. Prior reports indicate that peripheral nerve paralysis, including recurrent laryngeal nerve paralysis caused by tuberculous lymphadenitis, often recovers after anti-tuberculous treatment. Pharyngeal tuberculosis rarely causes dysphagia and hoarseness attributable to pharyngolaryngeal paralysis. The neuropathy may recover after anti-tuberculous treatment. Pharyngeal tuberculosis is a new potential differential diagnosis in pharyngolaryngeal paralysis.
Crilly, James Patrick; Rzechorzek, Nina; Scott, Philip
Paresis and paralysis are uncommon problems in sheep but are likely to prompt farmers to seek veterinary advice. A thorough and logical approach can aid in determining the cause of the problem and highlighting the benefit of veterinary involvement. While this may not necessarily alter the prognosis for an individual animal, it can help in formulating preventive measures and avoid the costs – both in economic and in welfare terms – of misdirected treatment. Distinguishing between central and peripheral lesions is most important, as the relative prognoses are markedly different, and this can often be achieved with minimal equipment. This article describes an approach to performing a neurological examination of the ovine trunk and limbs, the ancillary tests available and the common and important causes of paresis and paralysis in sheep. PMID:26752801
Mansat, M; Bonnevialle, P; Fine, X; Guiraud, B; Testut, M F
Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralysis are emphasized. A very prolonged symptom free interval, a rapid onset and a severe involvement. The ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are notable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal procedure of the neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury.
Chiang, Wen-Fang; Yeh, Fu-Chiang; Lin, Shih-Hua
Unilateral paralysis is rarely reported to be primary presentation of severe hypokalemia. We describe a 24-year-old woman who presented to the emergency department with sudden onset of right-sided weakness. Neurologic examination revealed diminished muscle strength and tendon reflexes over the right limbs. Computed tomography of the brain showed no organic brain lesion. However, laboratory data showed hypokalemia (K+ 2.0 mmol/L) with metabolic acidosis (HCO3 − 19 mmol/L). She needed a total of 260 mmol K+ to achieve complete recovery of muscle strength at a serum K+ level of 3.2 mmol/L and was proved to have distal renal tubular acidosis. Severe hypokalemia must be kept in mind as a cause of acute unilateral paralysis without organic lesions to avoid unnecessary examination and potentially life-threatening complications.
Sozzo, S; Carratù, P; Damiani, M F; Falcone, V A; Palumbo, A; Dragonieri, S; Resta, O
A 57-year-old woman underwent an enucleoresection of her right kidney angiomyolipoma. Two weeks later she was admitted to our hospital because of dyspnea at rest with orthopnea. The chest x-ray showed the elevation of both hemidiaphragms and the measurement of the sniff transdiaphragmatic pressure confirmed the diagnosis of bilateral diaphragmatic paralysis. A diaphragm paralysis can be ascribed to several causes, i.e. trauma, compressive events, inflammations, neuropathies, or it can be idiopathic. In this case, it was very likely that the patient suffered from post-surgery neuralgic amyotrophy. To our knowledge, there are only a few reported cases of neuralgic amyotrophy, also known as Parsonage-Turner Syndrome, which affects only the phrenic nerve as a consequence of a surgery in an anatomically distant site.
Ennafiri, Meryem; Elotmani, Wafae; Awab, Almahdi; El Moussaoui, Rachid; El Hijri, Ahmed; Alilou, Mustapha; Azzouzi, Abderrahim
Les polymyosites sont des maladies inflammatoires des muscles striés, d’étiologie inconnue. Le déficit musculaire, qui se résume généralement à une fatigabilité, évolue de façon bilatérale, symétrique et non sélective avec prédominance sur les muscles proximaux. L'intensité de la faiblesse musculaire est variable d'un sujet à un autre, de la simple gêne fonctionnelle à un état grabataire. Nous rapportons l'observation d'un cas de polymyosite particulièrement sévère avec paralysie musculaire complète, touchant tous les muscles de l'organisme, d’évolution favorable sous immunoglobulines intraveineuses et nous discutons les facteurs favorisant la paralysie musculaire. PMID:26185559
Wang, Yanjun; Cui, Linhua; Yuan, Jun; He, Li; Xie, Zhanqing; Xue, Weihua; Li, Mei; Zhang, Zhenwei; Gao, Yuchun; Kang, Suobin
To introduce professor Gao Yuchun's clinical experience and treating characteristics of facial paralysis treated with acupuncture and moxibustion. Professor Gao pays attention to yangming when he selects acupoints for clinical syndrome, and directs acupoints selection based on syndrome differentiation in different levels of jingjin, meridians and zangfu; he praises opposing needling technique and reinforcing the deficiency and reducing the excess highly; the acupuncture manipulation is gentle,shallow and slow for reducing the healthy side and reinforcing the affected side, and through losing its excess to complement its deficiency; besides, he stresses needle retaining time and distinguishes reinforcing and reducing. Facial paralysis is treated with key factors such as acupoints selecting based on yangming, acupuncture manipulation, needle retaining time, etc. And the spleen and stomach is fine and good at transportation and transformation; the meridians is harmonious; the qi and blood is smooth. The clinical efficacy is enhanced finally.
Khalil, Mahmoud A; Abdel Tawab, Hazem M
BACKGROUND Bilateral abductor vocal fold paralysis can lead to respiratory distress and dyspnea. OBJECTIVES To assess the efficacy of CO2 laser unilateral posterior cordotomy in cases with bilateral abductor paralysis as regards improvement of dyspnea with preservation of satisfactory voice and swallowing after the operation. METHODS A prospective study was done on 18 patients with bilateral abductor vocal fold paralysis (10 females and 8 males) from November 2010 to December 2012 with their ages ranging from 32 to 64 years. RESULTS All patients showed improvement of dyspnea after the operation, most of the patients suffered from mild to moderate dyspnea in the immediate post-operative period, and two patients needed another intervention to solve it. All the patients had satisfactory results of their voice after the operation, and one patient only suffered from temporary aspiration. CONCLUSION Unilateral CO2 laser posterior cordotomy is an easy and effective procedure to solve the dyspnea after bilateral vocal fold abductor paralysis without aspiration or significant voice alteration. PMID:25057244
Sarıman, Nesrin; Koca, Öncel; Boyacı, Zerrin; Levent, Ender; Soylu, Akın Cem; Alparslan, Sümeyye; Saygı, Attila
Vocal cord paralysis is a rare cause of obstructive sleep apnea syndrome (OSAS). Recurrent laryngeal nerve injury after thyroid gland surgery is one of the leading causes of acquired vocal cord paralysis. A 46-year-old woman with OSAS due to bilateral abductor vocal cord paralysis was presented. She had thyroidectomy 30 years ago and had a weak, breathy voice. She had been referred with a history of high-pitched snoring, apnea witnessed by her spouse, and excessive daytime sleepiness for the last 5 years. Full-night polysomnography revealed that her apnea-hypopnea index was 72/h and minimal oxygen saturation level was 81%. There was no REM and deep sleep periods. Ear-nose-throat consultation offered an endoscopic bilateral posterior cordotomy operation via microscopic suspension laryngoscopy (MLS) as a treatment option. Instead of using a nasal positive airway pressure (nCPAP) device, she was treated surgically. Her OSAS resolved completely within 5 months of the surgery. Her phonation was preserved, and symptoms such as snoring and hypersomnolance disappeared. In OSAS patients with bilateral vocal cord paralysis, MLS-associated bilateral posterior cordotomy can be a choice of treatment as an alternative to nCPAP application.
Galimberti, Carlo Andrea; Ossola, Maria; Colnaghi, Silvia; Arbasino, Carla
Sleep paralysis (SP) is a common parasomnia. The diagnostic criteria for SP, as reported in the International Classification of Sleep Disorders, are essentially clinical, as electroencephalography (EEG)-polysomnography (PSG) is not mandatory. We describe a subject whose sleep-related events fulfilled the diagnostic criteria for SP, even though her visual hallucinations were elementary, repetitive and stereotyped, thus differing from those usually reported by patients with SP. Video/EEG-PSG documented the focal epileptic nature of the SP-like episodes.
Sünram, F; Hippe, P
An isolated paralysis of the radial nerve in a newborn was reported. The displaced growth of the histologically proved angioleiomyoma caused a circumferential compression with subsequent atrophy of the nerve (Fig. 4). During operative treatment of the tumor, the damaged part of the nerve was resected, too. In a second stage the defect in the nerve was closed by suralis grafts. Possibly due to scar adhesions a good result was not obtained.
Gaudin, Robert A; Jowett, Nathan; Banks, Caroline A; Knox, Christopher J; Hadlock, Tessa A
Bilateral facial palsy is a rare clinical entity caused by myriad disparate conditions requiring different treatment paradigms. Lyme disease, Guillain-Barré syndrome, and leukemia are several examples. In this article, the authors describe the cause, the initial diagnostic approach, and the management of long-term sequelae of bilateral paralysis that has evolved in the authors' center over the past 13 years. A chart review was performed to identify all patients diagnosed with bilateral paralysis at the authors' center between January of 2002 and January of 2015. Demographics, signs and symptoms, diagnosis, initial medical treatment, interventions for facial reanimation, and outcomes were reviewed. Of the 2471 patients seen at the authors' center, 68 patients (3 percent) with bilateral facial paralysis were identified. Ten patients (15 percent) presented with bilateral facial paralysis caused by Lyme disease, nine (13 percent) with Möbius syndrome, nine (13 percent) with neurofibromatosis type 2, five (7 percent) with bilateral facial palsy caused by brain tumor, four (6 percent) with Melkersson-Rosenthal syndrome, three (4 percent) with bilateral temporal bone fractures, two (3 percent) with Guillain-Barré syndrome, one (2 percent) with central nervous system lymphoma, one (2 percent) with human immunodeficiency virus infection, and 24 (35 percent) with presumed Bell palsy. Treatment included pharmacologic therapy, physical therapy, chemodenervation, and surgical interventions. Bilateral facial palsy is a rare medical condition, and treatment often requires a multidisciplinary approach. The authors outline diagnostic and therapeutic algorithms of a tertiary care center to provide clinicians with a systematic approach to managing these complicated patients.
Larralde, Margarita; Santos-Muñoz, Andrea; Rutiman, Ricardo
Kawasaki disease (KD) is a multisystem disorder with varying clinical expression. We describe an instance of facial nerve paralysis in a patient with KD. A 5-month-old boy developed fever, irritability, and diarrhea, treated 8 days later with cefaclor and ibuprofen. Three days later a confluent, erythematous and papular rash appeared, his lips were reddened and swollen, and his white blood count and platelet count were 20,900/mm(3) and 558,000/mm(3), respectively. He was admitted to the hospital with a diagnosis of KD, and an echocardiogram showed a right coronary aneurysm. The patient then developed an acute, right-sided, facial nerve peripheral paralysis that resolved over the next 6 weeks. He was treated with intravenous immune globulin (IVIG) 2 g/kg and aspirin 100 mg/kg/day with improvement of signs and symptoms. This report documents facial nerve paralysis as an uncommon complication of KD and points out that it may be a marker of increased risk of cardiovascular disease in this disorder.
Lowe, James B; Sen, Subhro K; Mackinnon, Susan E
After studying this article, the participant should be able to: 1. Identify all potential points of radial nerve compression and other likely causes of radial nerve injury. 2. Accurately diagnose both surgical and nonsurgical causes of radial nerve paralysis. 3. Define a safe and effective approach to the surgical release and reconstruction of the radial nerve. Radial nerve paralysis, which can result from a complex humerus fracture, direct nerve trauma, compressive neuropathies, neuritis, or (rarely) from malignant tumor formation, has been reported throughout the literature, with some controversy regarding its diagnosis and management. The appropriate management of any radial nerve palsy depends primarily on an accurate determination of its cause, severity, duration, and level of involvement. The radial nerve can be injured as proximally as the brachial plexus or as distally as the posterior interosseous or radial sensory nerve. This article reviews the etiology, prognosis, and various treatments available for radial nerve paralysis. It also provides a new classification system and treatment algorithm to assist in the management of patients with radial nerve palsies, and it offers a simple, five-step approach to radial nerve release in the forearm.
Sánchez Segura, A; Ramos Pérez, P L; Rodríguez Sánchez, A; Aguirre Sánchez, J J; Gutiérrez Díez, J A; Alvarez Domínguez, J
We display the study performed to a female patient affected of laryngeal paralysis to become, based in clinical and radiologic criteria, to diagnose her cerebellar atrophy. We justify our work because of how infrequently this illness heredodegenerative of the central nervous system begins with cranial pairs paralysis. We emphasize the importance that the new methods of explorations specially TAC and IRM, have to guess the possible etiologies of central originated paralysis.
Hall-Mendelin, S; Craig, S B; Hall, R A; O’Donoghue, P; Atwell, R B; Tulsiani, S M; Graham, G C
Ticks are obligate haematophagous ectoparasites of various animals, including humans, and are abundant in temperate and tropical zones around the world. They are the most important vectors for the pathogens causing disease in livestock and second only to mosquitoes as vectors of pathogens causing human disease. Ticks are formidable arachnids, capable of not only transmitting the pathogens involved in some infectious diseases but also of inducing allergies and causing toxicoses and paralysis, with possible fatal outcomes for the host. This review focuses on tick paralysis, the role of the Australian paralysis tick Ixodes holocyclus, and the role of toxin molecules from this species in causing paralysis in the host. PMID:21396246
Mitchison, N. A.
The quantitative dose requirements for induction of paralysis by BSA in mice has been the subject of further study. Parallel studies have been made with lysozyme, ovalbumin, diphtheria toxoid and ribonuclease, in which similar paralysing and immunizing procedures were used, and similar direct binding tests applied to measurement of the response. In normal adults all the antigens tested induced high-zone paralysis and concomitant immunization, but BSA alone induced low-zone paralysis. With irradiation, with courses of injection commencing at birth, and with paralysis-maintaining treatment, all the antigens tested induced paralysis in a zone quantitatively similar to the low zone detectable in normal adults with BSA. Neither irradiation, treatment with cortisol, nor thymectomy affected the rate of induction of paralysis in the low zone. On the other hand the minimum dose required for immunization varied markedly from one antigen to another. The ability of BSA to induce low-zone paralysis in normal adults can, therefore, be attributed to the failure of low doses of this antigen to immunize. The consistency of paralysis threshold, in contrast to the variability for immunization, is interpreted as evidence of an additional step of complexity involved in immunization that is not required for paralysis. PMID:5696262
Ohaeri, J U; Odejide, A O; Ikuesan, B A; Adeyemi, J D
In a cross-sectional study of the patterns of isolated sleep paralysis among 164 Nigerian medical students, 26.1% admitted having experienced this phenomenon. About 31% of the females and 20% of the males had had this experience. Of those with sleep paralysis, 32.6% had hypnogenic hallucinations during the episode, mainly visual. Sleep paralysis was not significantly associated with psychosocial distress or differences in personality profile. Although the rate differs across cultures, the myths associated with sleep paralysis are similar.
Sharpless, Brian A; Barber, Jacques P
To determine lifetime prevalence rates of sleep paralysis. Keyword term searches using "sleep paralysis", "isolated sleep paralysis", or "parasomnia not otherwise specified" were conducted using MEDLINE (1950-present) and PsychINFO (1872-present). English and Spanish language abstracts were reviewed, as were reference lists of identified articles. Thirty five studies that reported lifetime sleep paralysis rates and described both the assessment procedures and sample utilized were selected. Weighted percentages were calculated for each study and, when possible, for each reported subsample. Aggregating across studies (total N=36,533), 7.6% of the general population, 28.3% of students, and 31.9% of psychiatric patients experienced at least one episode of sleep paralysis. Of the psychiatric patients with panic disorder, 34.6% reported lifetime sleep paralysis. Results also suggested that minorities experience lifetime sleep paralysis at higher rates than Caucasians. Sleep paralysis is relatively common in the general population and more frequent in students and psychiatric patients. Given these prevalence rates, sleep paralysis should be assessed more regularly and uniformly in order to determine its impact on individual functioning and better articulate its relation to psychiatric and other medical conditions. Copyright © 2011. Published by Elsevier Ltd.
Song, Sung Hyuk; Lee, Kyeong Hwan
Limb paralysis can develop for various reasons. We found a 13-year-old patient who became paralyzed in her lower extremities after laparoscopic appendectomy. Some tests, including electrodiagnostic studies and magnetic resonance imaging, were performed to evaluate the cause of lower limb paralysis. None of the tests yielded definite abnormal findings. We subsequently decided to explore the possibility of psychological problems. The patient was treated with simultaneous rehabilitation and psychological counseling. Paralysis of the patient's lower extremity improved gradually and the patient returned to normal life. Our findings indicate that psychological problems can be related to limb paralysis without organ damage in patients who have undergone laparoscopic surgical procedures. PMID:25426280
Khairunnisaa, Aida; Basah, Shafriza Nisha; Yazid, Haniza; Basri, Hassrizal Hassan; Yaacob, Sazali; Chin, Lim Chee
The diagnostic process of facial paralysis requires qualitative assessment for the classification and treatment planning. This result is inconsistent assessment that potential affect treatment planning. We developed a facial-paralysis diagnostic system based on 3D reconstruction of RGB and depth data using a standard structured-light camera - Kinect 360 - and implementation of Active Appearance Models (AAM). We also proposed a quantitative assessment for facial paralysis based on triangular model. In this paper, we report on the design and development process, including preliminary experimental results. Our preliminary experimental results demonstrate the feasibility of our quantitative assessment system to diagnose facial paralysis.
Karabiber, Hamza; Ozkan, K Ugur; Garipardic, Mesut; Parmaksiz, Gonul
Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can be overlooked if thorough examination isn't done. We present a two-weeks-old baby with a birth weight of 3800 grams who had a left-sided brachial plexus palsy and torticollis with an undiagnosed left diaphragmatic paralysis even though he was examined by different physicians several times. The role of physical examination, the chest x-rays of patients with brachial paralysis and the treatment modalities of diaphragmatic paralysis due to obstetrical factors are discussed.
Armour, Brian S; Courtney-Long, Elizabeth A; Fox, Michael H; Fredine, Heidi; Cahill, Anthony
To estimate the prevalence and causes of functional paralysis in the United States. We used the 2013 US Paralysis Prevalence & Health Disparities Survey to estimate the prevalence of paralysis, its causes, associated sociodemographic characteristics, and health effects among this population. Nearly 5.4 million persons live with paralysis. Most persons with paralysis were younger than 65 years (72.1%), female (51.7%), White (71.4%), high school graduates (64.8%), married or living with a partner (47.4%), and unable to work (41.8%). Stroke is the leading cause of paralysis, affecting 33.7% of the population with paralysis, followed by spinal cord injury (27.3%), multiple sclerosis (18.6%), and cerebral palsy (8.3%). According to the functional definition, persons living with paralysis represent a large segment of the US population, and two thirds of them are between ages 18 and 64 years. Targeted health promotion that uses inclusion strategies to account for functional limitations related to paralysis can be undertaken in partnership with state and local health departments.
Molinero, Marco R; Varon, Daniel; Holden, Kenton R; Sladky, John T; Molina, Ida B; Cleaves, Francisco
The objective of this study was to investigate the incidence of acute flaccid paralysis in the pediatric population of Honduras over an 11-year period, determine what percentage of acute flaccid paralysis was Guillain-Barré syndrome, and identify the epidemiologic features of Guillain-Barré syndrome. There were 546 childhood cases of acute flaccid paralysis seen between January 1989 and December 1999 at the Hospital Escuela Materno-Infantil in Tegucigalpa, Honduras. Of these cases with acute flaccid paralysis, 394 (72.2%) were diagnosed with Guillain-Barré syndrome. Our incidence of Guillain-Barré syndrome in the Honduran pediatric population (1.37/100,000 per year) is higher than that shown in other studies. There was a significantly higher incidence of Guillain-Barré syndrome in younger children (ages 1-4 years), a significant preponderance of cases from rural areas, and a mild predominance in boys but a typical clinical presentation. The Honduran pediatric Guillain-Barré syndrome population had an increased mortality rate. Guillain-Barré syndrome has become the leading cause of childhood paralysis in Honduras. A better understanding of the population at highest risk and opportunities for earlier intervention with more effective therapeutic modalities may permit reducing the mortality among Honduran children who develop Guillain-Barré syndrome.
Ladalardo, Thereza C.; Brugnera, Aldo, Jr.; Takamoto, Marcia; Pinheiro, Antonio L. B.; Campos, Roberto A. d. C.; Castanho Garrini, Ana E.; Bologna, Elisangela D.; Settanni, Flavio
This clinical case report relates to a total of 4 patients, carriers of idiopathic facial paralysis, treated with Low Level Laser Therapy using a Gallium-Aluminum-Arsenide diode laser of 780 nm, 50 mW, continuous wave emission, spot size 3 mm2 and total dosage of 20 joules per session distributed to the peripheral trajectory of the injured nerve in a point by point contact mode. Altogether 24 treatment sessions were performed in a period of 12 consecutive weeks twice a week All treated patients presented recovery signs from the initial degree of paralysis.
Molsberger, Friedrich; Raak, C; Teuber, M
The case study reports on the effect of pharmacological, complementary, and alternative medicine including YNSA, Applied Kinesiology, and respiratory exercises in a 9-year-old boy with facial paralysis. The boy suffered from borreliosis and one-sided facial paralysis that occurred 3.5 weeks after being bitten by a tick and persisted despite 4 weeks of medication with antibiotics. In the first treatment, muscle function as assessed by the coachman׳s test was normalized, and improvement in the facial paralysis was observed. Within 8 additional treatments over a period of 2 months, the boy showed complete recovery. The case shows a multimodal approach to facial paralysis integrating pharmacological treatment and CAM including YNSA, Applied Kinesiology, and breathing exercises. Copyright © 2016. Published by Elsevier Inc.
Joseph, Shannon S; Joseph, Andrew W; Douglas, Raymond S; Massry, Guy G
Facial paralysis can result in serious ocular consequences. All patients with orbicularis oculi weakness in the setting of facial nerve injury should undergo a thorough ophthalmologic evaluation. The main goal of management in these patients is to protect the ocular surface and preserve visual function. Patients with expected recovery of facial nerve function may only require temporary and conservative measures to protect the ocular surface. Patients with prolonged or unlikely recovery of facial nerve function benefit from surgical rehabilitation of the periorbital complex. Current reconstructive procedures are most commonly intended to improve coverage of the eye but cannot restore blink.
Reiter, R; Hoffmann, T K; Rotter, N; Pickhard, A; Scheithauer, M O; Brosch, S
Etiology of vocal fold paralysis is broad: e. g. iatrogenic/traumatic, associated with neoplasms or with systemic diseases. The cause of idiopathic paralysis is unknown. The main symptom of unilateral vocal fold paralysis is hoarseness because of a remaining glottic gap during phonation. Patients with bilateral vocal fold paralysis typically have no impairment of the voice but dyspnea. Examination of patients with an idopathic vocal fold paralysis is a CT of the vagal nerve and recurrent laryngeal nerve from skull base to neck and mediastinum. Serological tests are not obligatory. Differential diagnosis of vocal fold immobility is vocal fold paralysis/neurological causes and arthrogene causes such as arytenoid subluxation, interarytenoid adhesion and vocal fold fixation in laryngeal carcinomas. Voice therapy is a promising approach for patients with unilateral vocal fold paralysis, but not all patients benefit sufficiently. Temporary vocal fold augmentation by injection medialization results in satisfactory voice quality that is comparable with a thyroplasty. Patients with bilateral vocal fold immobility show typically dyspnea requiring immediate therapy such as temporary tracheotomy or reversible laterofixation of the paralyzed vocal chord. If the paralysis persists a definitive enlargement of the glottic airway by eg. arytenoidectomy needs to be performed.
When describing how they experience moments of not-knowing, youth workers often talk about a sense of paralysis, as though their uncertainty becomes physically constraining. This chapter describes the first of five themes associated with youth workers' experiences of not knowing what to do: the paralysis of stuckness. In addition to describing and…
When describing how they experience moments of not-knowing, youth workers often talk about a sense of paralysis, as though their uncertainty becomes physically constraining. This chapter describes the first of five themes associated with youth workers' experiences of not knowing what to do: the paralysis of stuckness. In addition to describing and…
Wang, Xia; Xu, Yaosheng
Pus overflow from patent's fistula belew the left face near mandibular angle 2 years agowith a little pain. Symptoms relieved after oral antibiotics. This symptom frequently occurred in the past six months. Postoperative facial paralysis occurred after surgery, and recovered after treatment. It was diagnosed as the postoperative facial paralysis after first branchial fistula surgery.
Davis, Nancy J.
Discusses three classroom climates that are often encountered in teaching about inequality and social stratification: resistance, paralysis, and rage. Describes resistance as denying the existence or importance of inequality. Defines paralysis as classes that see little chance of overcoming inequality. Suggests that the enraged class is unable to…
Lidia, Zawadzka-Glos; Magdalena, Frackiewicz; Mieczyslaw, Chmielik
Vocal cords paralysis is the second most frequent cause of laryngeal stridor in children. Symptoms of congenital vocal cords paralysis can occur shortly after birth or later. Vocal cords paralysis can be unilateral or bilateral. Symptoms of unilateral paralysis include hoarse weeping or stridor during a deep inhalation. In children unilateral vocal cords paralysis often retreats spontaneously or can be completely compensated. Children with bilateral vocal cords paralysis present mainly breathing disorders while phonation is normal. Symptoms are different, starting from complete occlusion of respiratory tracts and ending on small symptoms connected with the lack of effort tolerance. When symptoms are severe, patients from this group require a tracheotomy. The lack of restoration of normal function of vocal cords or lack of complete compensation and maintenance of symptoms are an indication for surgical treatment. The aim of this study is to present results of the treatment of bilateral vocal cords paralysis in children using the endoscopic method of laterofixation of vocal cords. In the Pediatric ENT Department between 1998 and 2009 sixty four children with dyspnoea and/or phonation disorders caused by vocal cords paralysis were treated. In ten cases laterofixation of vocal cords was performed, in most cases with good result. In this article the authors present the method of endoscopic laterofixation and achieved results. Endoscopic laterofixation of vocal cords in children is a safe and an easy method of surgical treatment of bilateral vocal cords paralysis. This method can be used as a first and often as a one stage treatment of vocal cords paralysis. In some cases this procedure is insufficient and has to be completed with other methods. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.
Zhang, Xiaoge; Feng, Ling; Du, Liang; Zhang, Anxiang; Tang, Tian
Facial paralysis is defined as severe or complete loss of facial muscle motor function. The study was undertaken to explore a bibliometric approach to quantitatively assess the research on clinical treatment of facial paralysis using rehabilitation, physiotherapy and acupuncture using Web of Science from 1992 to 2011. Bibliometric approach. A bibliometric analysis based on the publications on Web of Science was performed using key words such as "facial paralysis", "rehabilitation", "physiotherapy" and "acupuncture". (1) Research articles on the clinical treatment of facial paralysis using acupuncture or physiotherapy (e.g. exercise, electro-stimulation) and other rehabilitation methods; (2) researches on human and animal fundamentals, clinical trials and case reports; (3) Article types: article, review, proceedings paper, note, letter, editorial material, discussion, book chapter. (4) Publication year: 1992-2011 inclusive. (1) Articles on the causes and diagnosis on facial paralysis; (2) Type of articles: correction; (3) Articles from following databases: all databases related to social science and chemical databases in Web of Science. (1) Overall number of publications; (2) number of publications annually; (3) number of citations received annually; (4) top cited paper; (5) subject categories of publication; (6) the number of countries in which the article is published; (7) distribution of output in journals. Overall population stands at 3 543 research articles addressing the clinical treatment of facial paralysis in Web of Science during the study period. There is also a markedly increase in the number of publications on the subject "facial paralysis treatments using rehabilitation" during the first decade of the 21(st) century, except in 2004 and 2006 when there are perceptible drops in the number of articles published. The only other year during the study period saw such a drop is 1993. Specifically, there are 192 published articles on facial paralysis treated
Potter, Ryan; Havlioglu, Necat; Thomopoulos, Stavros
Mechanical stimuli are required for the proper development of the musculoskeletal system. Removal of muscle forces during fetal or early post-natal timepoints impairs the formation of bone, tendon, and their attachment (the enthesis). The goal of the current study was to examine the capacity of the shoulder to recover after a short duration of neonatal rotator cuff paralysis, a condition mimicking the clinical condition neonatal brachial plexus palsy. We asked if reapplication of muscle load to a transiently paralyzed muscle would allow for full recovery of tissue properties. CD-1 mice were injected with botulinum toxin A to paralyze the supraspinatus muscle from birth through 2 weeks and subsequently allowed to recover. The biomechanics of the enthesis was determined using tensile testing and the morphology of the shoulder joint was determined using microcomputed tomography and histology. A recovery period of at least 10 weeks was required to achieve control properties, demonstrating a limited capacity of the shoulder to recover after only two weeks of muscle paralysis. Although care must be taken when extrapolating results from an animal model to the human condition, the results of the current study imply that treatment of neonatal brachial plexus palsy should be aggressive, as even short periods of paralysis could lead to long-term deficiencies in enthesis biomechanics and shoulder morphology.
Sharpless, Brian A.; McCarthy, Kevin S.; Chambless, Dianne L.; Milrod, Barbara L.; Khalsa, Shabad-Ratan; Barber, Jacques P.
Isolated sleep paralysis (ISP) has received scant attention in clinical populations, and there has been little empirical consideration of the role of fear in ISP episodes. To facilitate research and clinical work in this area, the authors developed a reliable semistructured interview (the Fearful Isolated Sleep Paralysis Interview) to assess ISP and their proposed fearful ISP (FISP) episode criteria in 133 patients presenting for panic disorder treatment. Of these, 29.3% met lifetime ISP episode criteria, 20.3% met the authors’ lifetime FISP episode criteria, and 12.8% met their recurrent FISP criteria. Both ISP and FISP were associated with minority status and comorbidity. However, only FISP was significantly associated with posttraumatic stress disorder, body mass, anxiety sensitivity, and mood and anxiety disorder symptomatology. PMID:20715166
Sharpless, Brian A; McCarthy, Kevin S; Chambless, Dianne L; Milrod, Barbara L; Khalsa, Shabad-Ratan; Barber, Jacques P
Isolated sleep paralysis (ISP) has received scant attention in clinical populations, and there has been little empirical consideration of the role of fear in ISP episodes. To facilitate research and clinical work in this area, the authors developed a reliable semistructured interview (the Fearful Isolated Sleep Paralysis Interview) to assess ISP and their proposed fearful ISP (FISP) episode criteria in 133 patients presenting for panic disorder treatment. Of these, 29.3% met lifetime ISP episode criteria, 20.3% met the authors' lifetime FISP episode criteria, and 12.8% met their recurrent FISP criteria. Both ISP and FISP were associated with minority status and comorbidity. However, only FISP was significantly associated with posttraumatic stress disorder, body mass, anxiety sensitivity, and mood and anxiety disorder symptomatology.
Barber, Jacques P.
Objective To determine lifetime prevalence rates of sleep paralysis. Data Sources Keyword term searches using “sleep paralysis”, “isolated sleep paralysis”, or “parasomnia not otherwise specified” were conducted using MEDLINE (1950-present) and PsychINFO (1872-present). English and Spanish language abstracts were reviewed, as were reference lists of identified articles. Study Selection Thirty five studies that reported lifetime sleep paralysis rates and described both the assessment procedures and sample utilized were selected. Data Extraction Weighted percentages were calculated for each study and, when possible, for each reported subsample. Data Synthesis Aggregating across studies (total N = 36533), 7.6% of the general population, 28.3% of students, and 31.9% of psychiatric patients experienced at least one episode of sleep paralysis. Of the psychiatric patients with panic disorder, 34.6% reported lifetime sleep paralysis. Results also suggested that minorities experience lifetime sleep paralysis at higher rates than Caucasians. Conclusions Sleep paralysis is relatively common in the general population and more frequent in students and psychiatric patients. Given these prevalence rates, sleep paralysis should be assessed more regularly and uniformly in order to determine its impact on individual functioning and better articulate its relation to psychiatric and other medical conditions. PMID:21571556
Cabin, Jonathan A; Massry, Guy G; Azizzadeh, Babak
Complete flaccid facial paralysis, as well as the synkinetic and hyperkinetic sequelae of partial recovery, has significant impact on quality of life. Patients suffer from functional deficiencies, cosmetic deformity, discomfort and social consequences leading to emotional distress. Despite an extensive and sophisticated array of available interventions for facial reanimation, most patients have persistent issues that require consistent follow-up. In long-term management, botulinum toxin (BT) injection remains a critical tool in the treatment of the facial paralysis patient, particularly in the case of synkinesis, hyperkinesis and imbalance. We review the recent scientific literature and highlight key principles and developments in the use of BT in the management of facial paralysis, including less common applications for acute facial paralysis, hyperlacrimation and pseudoptosis. We reviewed the literature for the latest advances in the use of BT in facial paralysis, including applications and technique, as well as measurement tools and adjunct exercises. We also share our experience in treating our own patient population. BT continues to be a well tolerated and effective tool in the long-term management of facial paralysis, specifically in treating synkinesis, imbalance and hyperkinesis, as well as hyperlacrimation and pseudoptosis. Consistent measurement tools and adjunct neuromuscular retraining are crucial in the successful deployment of BT. Controversy exists as to whether BT should be used to manage facial paralysis during the acute phase, and whether BT application to the nonparalyzed face can improve long-term recovery in the paralyzed side.
Cakarer, Sirmahan; Can, Taylan; Cankaya, Burak; Erdem, Mehmet Ali; Yazici, Sinem; Ayintap, Emre; Özden, Ali Veysel; Keskin, Cengizhan
Peripheral facial nerve paralysis (PFNP) after mandibular interventions has been reported in the literature. In most cases, paralysis begins immediately after the injection of the mandibular anesthesia, and duration of facial weakness is less than 12 hours. However, there are few documented cases of PFNP after maxillary dental or surgical procedures. A variety of mechanisms have been associated to PFNP, including viral reactivation, demyelination, edema, vasospasm, and trauma. The purpose of this presentation was to report a rare case of facial paralysis that occurred after an upper third molar extraction. The cause of the PFNP and the importance of the multidisciplinary approach in the management are emphasized.
Edgerton, V. Reggie; Roy, Roland R.
Considerable evidence now demonstrates that extensive functional and anatomical reorganization following spinal cord injury occurs in centers of the brain that have some input into spinal motor pools. This is very encouraging, given the accumulating evidence that new connections formed across spinal lesions may not be initially functionally useful. The second area of advancement in the field of paralysis recovery is in the development of effective interventions to counter axonal growth inhibition. A third area of significant progress is the development of robotic devices to quantify the performance level of motor tasks following spinal cord injury and to 'teach' the spinal cord to step and stand. Advances are being made with robotic devices for mice, rats and humans.
Patti, A M; Santi, A L; Ciapetti, C; Fiore, L; Novello, F; Vellucci, L; De Stefano, F; Fara, G M
The goal of World Health Organization is to reach the global eradication of poliomyelitis during the first decade of the third millennium. To achieve the certification of the eradication of the disease the main strategy is the Acute Flaccid Paralysis (AFP) surveillance. In Italy the active AFP surveillance was performed at national level since 1997. In the Latium region the active surveillance was performed since January 1997 by the laboratory of virology of Institute of Hygiene G Sanarelli which established a regional hospital network. During the years of survey 7 cases were found in 1997 (0.87/100,000), 4 in 1998 (0.5/100,000), 2 in 1999 (0.25/100,000) and 2 in 2000. No wild polioviruses were detected.
Edgerton, V. Reggie; Roy, Roland R.
Considerable evidence now demonstrates that extensive functional and anatomical reorganization following spinal cord injury occurs in centers of the brain that have some input into spinal motor pools. This is very encouraging, given the accumulating evidence that new connections formed across spinal lesions may not be initially functionally useful. The second area of advancement in the field of paralysis recovery is in the development of effective interventions to counter axonal growth inhibition. A third area of significant progress is the development of robotic devices to quantify the performance level of motor tasks following spinal cord injury and to 'teach' the spinal cord to step and stand. Advances are being made with robotic devices for mice, rats and humans.
Undabeitia, Jose; Liu, Brian; Pendleton, Courtney; Nogues, Pere; Noboa, Roberto; Undabeitia, Jose Ignacio
Although traumatic injury of the facial nerve is a relatively common condition in neurosurgical practice, bilateral lesions related to fracture of temporal bones are seldom seen. We report the case of a 38-year-old patient admitted to Intensive Care Unit after severe head trauma requiring ventilatory support (Glasgow Coma Scale of 7 on admission). A computed tomography (CT) scan confirmed a longitudinal fracture of the right temporal bone and a transversal fracture of the left. After successful weaning from respirator, bilateral facial paralysis was observed. The possible aetiologies for facial diplegia differ from those of unilateral injury. Due to the lack of facial asymmetry, it can be easily missed in critically ill patients, and both the high resolution CT scan and electromyographic studies can be helpful for correct diagnosis.
Sharpless, Brian Andrew; Grom, Jessica Lynn
Relatively little is known about isolated sleep paralysis (ISP), and no empirically supported treatments are available. This study aims to determine: the clinical impact of ISP, the techniques used to prevent or disrupt ISP, and the effectiveness of these techniques. 156 undergraduates were assessed with lifetime ISP using a clinical interview. 75.64% experienced fear during ISP, and 15.38% experienced clinically significant distress/interference, while 19.23% attempted to prevent ISP, and 79.31% of these believed their methods were successful. Regarding disruption, 69.29% made attempts, but only 54.12% reported them effective. Disruption was more common than prevention, but several techniques were useful. Encouraging individuals to utilize these techniques and better monitor their symptoms may be an effective way to manage problematic ISP.
Maccherini, M; Davoli, G; Sani, G; Rossi, P; Giani, S; Lisi, G; Mazzesi, G; Toscano, M
Since January 1992, we adopted a new method of myocardial protection: warm blood cardioplegia with continuous ante-retrograde combined delivery during normothermic cardiopulmonary bypass, (CPB) instead of cold blood intermittent cardioplegia plus topical ice slush in hypothermic CPB. We have compared postoperative chest X-rays of 50 patients who underwent elective coronary artery bypass with normothermic CPB to postoperative chest X-rays, of 50 patients operated upon with hypothermia. In the cold group transitory diaphragmatic paralysis, as well as pleural effusions and thoracentesis related to the hypothermia, and topical cooling, were statistically increased over that of warm group. The data suggest that topical cooling with slush ice is responsible for phrenic nerve injury and that warm heart surgery has no associated incidence of diaphragmatic injury.
Steinmann, Scott P; Wood, Michael B
Serratus anterior paralysis can result in winging of the scapula and weakness of arm elevation. The etiology of the condition is injury to the long thoracic nerve. There are many proposed causes of long thoracic nerve injury including acute trauma, Parsonage-Turner syndrome, or viral illness. The long length of the long thoracic nerve makes it prone to compression injury along the chest wall. Most patients recover nerve function with conservative treatment. In those in whom nerve function fails to recover, surgical treatment involving pectoralis major transfer may be beneficial. In this study 9 patients underwent pectoralis major transfer with a fascia lata extension graft. The symptoms of most were improved, with correction of the winging and improved movement in the affected shoulder.
Hirst, G. D. S.; Wood, D. R.
1. The effects of procaine on neuromuscular transmission in the rat phrenic nerve diaphragm preparation have been examined using intracellular recording techniques. 2. The paralysis produced by procaine resembled that produced by tubocurarine and it is concluded that this effect of procaine results from a change in post-junctional sensitivity to transmitter; at low rates of stimulation procaine did not depress the transmitter release. 3. During high frequency stimulation of the phrenic nerve a distinct form of prejunctional failure was observed. It is suggested that this depression results from a combination of local anaesthesia and anoxia and that it would explain reports of a reduction in the amount of transmitter released when assayed in a conventional manner. PMID:4396131
Warner, Sarah E.; Sanford, David A.; Becker, Blair A.; Bain, Steven D.; Srinivasan, Sundar; Gross, Ted S.
The means by which muscle function modulates bone homeostasis is poorly understood. To begin to address this issue, we have developed a novel murine model of unilateral transient hindlimb muscle paralysis using botulinum toxin A (Botox). Female C57BL/6 mice (16 weeks) received IM injections of either saline or Botox (n = 10 each) in both the quadriceps and calf muscles of the right hindleg. Gait dysfunction was assessed by multi-observer inventory, muscle alterations were determined by wet mass, and bone alterations were assessed by micro-CT imaging at the distal femur, proximal tibia, and tibia mid-diaphysis. Profound degradation of both muscle and bone was observed within 21 days despite significant restoration of weight bearing function by 14 days. The muscle mass of the injected quadriceps and calf muscles was diminished −47.3% and −59.7%, respectively, vs. saline mice (both P < 0.001). The ratio of bone volume to tissue volume (BV/TV) within the distal femoral epiphysis and proximal tibial metaphysis of Botox injected limbs was reduced −43.2% and −54.3%, respectively, while tibia cortical bone volume was reduced −14.6% (all P < 0.001). Comparison of the contralateral non-injected limbs indicated the presence of moderate systemic effects in the model that were most probably associated with diminished activity following muscle paralysis. Taken as a whole, the micro-CT data implied that trabecular and cortical bone loss was primarily achieved by bone resorption. These data confirm the decisive role of neuromuscular function in mediating bone homeostasis and establish a model with unique potential to explore the mechanisms underlying this relation. Given the rapidly expanding use of neuromuscular inhibitors for indications such as pain reduction, these data also raise the critical need to monitor bone loss in these patients. PMID:16185943
Pappenheimer, Alwin M.; Dunn, Leslie C.; Cone, Vernon
1. Fowl paralysis (neurolymphomatosis gallinarum) is a disease entity, with characteristic clinical and pathological features. 2. The disease occurs in all parts of the United States, Holland, Austria and probably South America. 3. The disease appears to be endemic in certain foci. Having once appeared, the disease tends to persist through successive years. 4. It occurs with about equal frequency in both sexes; all common breeds may be affected. 5. Symptoms appear between the 3rd and 18th months. Typical clinical cases have not been observed outside of these limits. 6. The conspicuous symptoms are (a) asymmetrical, partial and progressive paralysis of the wings and both legs, and rarely of neck muscles; (b) occasional grey discoloration of iris, with blindness. Nutrition is usually preserved. 7. The duration is variable; the outcome is usually fatal, but spontaneous recovery may rarely occur. 8. The principal pathological changes are found in the nervous system. In the peripheral nerves, the essential feature is an intense infiltration of lymphoid, plasma cells, and large mononuclears. This is accompanied by a myelin degeneration in the more advanced lesions, but the cellular infiltrations appear to precede the degenerative changes. In brain, cord and meninges, there are similar infiltrations predominantly perivascular. Infiltrations of the iris with lymphoid and plasma cells are found in the cases showing gross discoloration of the iris. Visceral lymphomata, originating usually in the ovary, are associated in a certain percentage of the cases. Evidence is presented in favor of the view that this association is not accidental, and that the lymphomata are a manifestation of the disease. 9. Infiltrations of the spinal cord and brain, rarely of the peripheral nerves, are frequently present in birds showing no clinical symptoms. These are interpreted as mild cases of the same disease. 10. No microorganisms of etiological significance have been demonstrated in the
known to be triggered by β-blockers or β-blocker withdrawal including myasthenia gravis, periodic hypokalemic paralysis , pheochromocytoma and...Veterans Affairs Hospital, Birmingham, Alabama, USA 4Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, University of California, San
Cheyne, J A
Sleep paralysis (SP) entails a period of paralysis upon waking or falling asleep and is often accompanied by terrifying hallucinations. Two situational conditions for sleep paralysis, body position (supine, prone, and left or right lateral decubitus) and timing (beginning, middle, or end of sleep), were investigated in two studies involving 6730 subjects, including 4699 SP experients. A greater number of individuals reported SP in the supine position than all other positions combined. The supine position was also 3-4 times more common during SP than when normally falling asleep. The supine position during SP was reported to be more prevalent at the middle and end of sleep than at the beginning suggesting that the SP episodes at the later times might arise from brief microarousals during REM, possibly induced by apnea. Reported frequency of SP was also greater among those consistently reporting episodes at the beginning and middle of sleep than among those reporting episodes when waking up at the end of sleep. The effects of position and timing of SP on the nature of hallucinations that accompany SP were also examined. Modest effects were found for SP timing, but not body position, and the reported intensity of hallucinations and fear during SP. Thus, body position and timing of SP episodes appear to affect both the incidence and, to a lesser extent, the quality of the SP experience.
Eckley, C A; Sataloff, R T; Hawkshaw, M; Spiegel, J R; Mandel, S
Evaluation of Physiologic Frequency Range (PFR) and Musical Frequency Range (MRP) of Phonation was performed on 56 adults (singers and nonsingers) presenting with superior laryngeal nerve (SLN) paresis or paralysis confirmed by laryngeal electromyography. The most common etiology was neuritis (69.7%), followed by iatrogenic and unknown causes,each accounting for 10.2% of cases, and finally trauma (8.9%). Both female and male singers with SLN paresis or paralysis had significantly higher PFR and MPR than nonsingers. Female classical singers presented PFR and MPR of up to 10 semitones (ST) higher than nonclassical singers and nonsingers. The lowest PFR and musical ranges were found in patients with SLN paresis associated with recurrent laryngeal nerve paresis or paralysis. The authors suggest that voice range measurement is a useful parameter for analyzing the effects of SLN paresis or paralysis on voice and that it may also assist in measuring outcome following voice therapy.
Kitshoff, Adriaan M; Van Goethem, Bart; Stegen, Ludo; Vandekerckhov, Peter; de Rooster, Hilde
Laryngeal paralysis is the effect of an inability to abduct the arytenoid cartilages during inspiration, resulting in respiratory signs consistent with partial airway obstruction. The aetiology of the disease can be congenital (hereditary laryngeal paralysis or congenital polyneuropathy), or acquired (trauma, neoplasia, polyneuropathy, endocrinopathy). The most common form of acquired laryngeal paralysis (LP) is typically seen in old, large breed dogs and is a clinical manifestation of a generalised peripheral polyneuropathy recently referred to as geriatric onset laryngeal paralysis polyneuropathy. Diagnosing LP based on clinical signs, breed and history has a very high sensitivity (90%) and can be confirmed bylaryngeal inspection. Prognosis after surgical correction depends on the aetiology: traumatic cases have a good prognosis, whereas tumour-induced or polyneuropathy-induced LP has a guarded prognosis. Acquired idiopathic LP is a slow progressive disease, with dogs reaching median survival times of 3-5 years after surgical correction.
... pioneering work involving four-dimensional imaging of the cardiovascular system using magnetic resonance imaging (MRI). His current research focuses on integrated imaging and predictive biomechanical modeling of coronary atherosclerotic disease. Is paralysis a major health problem? Yes, it ...
Norton, Michael I; Mason, Malia F; Vandello, Joseph A; Biga, Andrew; Dyer, Rebecca
We explore the existence and underlying neural mechanism of a new norm endorsed by both black and white Americans for managing interracial interactions: "racial paralysis', the tendency to opt out of decisions involving members of different races. We show that people are more willing to make choices--such as who is more intelligent, or who is more polite-between two white individuals (same-race decisions) than between a white and a black individual (cross-race decisions), a tendency which was evident more when judgments involved traits related to black stereotypes. We use functional magnetic resonance imaging to examine the mechanisms underlying racial paralysis, to examine the mechanisms underlying racial paralysis, revealing greater recruitment of brain regions implicated in socially appropriate behavior (ventromedial prefrontal cortex), conflict detection (anterior cingulate cortex), deliberative processing (dorsolateral prefrontal cortex), and inhibition (ventrolateral prefrontal cortex). We also discuss the impact of racial paralysis on the quality of interracial relations.
Dragu, A; Horch, R E; Wirth, S; Ingianni, G
Whereas cases of unilateral obstetric brachial plexus paralysis have been sufficiently described and discussed in the literature cases of bilateral obstetric brachial plexus paralysis are extremely rare and so far have not been mentioned and discussed satisfactorily. We present a case of bilateral obstetric brachial plexus paralysis in an 8-months-old white boy. We performed a neurotisation of the Nervus suprascapularis with the Nervus accessorius and an Oberlin procedure on both sides in two operative steps. In an early follow-up 6 months after the second operation and intensive physiotherapy the little patient was able to crawl with the active help of both arms. Bilateral obstetric brachial plexus paralysis is a very rare incidence in infants. An interdisciplinary approach including paediatrics, plastic surgeons, neurosurgeons, neurologists, radiologists and physiotherapists is essential for the success of treatment strategies in such cases.
A flaccid paralysis results from damage to any part of the lower motor neurone, from destruction of the anterior horn cell by poliomyelitis to injury of the peripheral axon by trauma or disease. Reconstructive surgery can do much to alleviate the residual paralysis. The indications and timing for surgery are considered. Certain well-tried operative techniques are described, from tendon transplantation to arthrodeses of joints, and the relative merits of each procedure are evaluated and placed in perspective. PMID:7092088
da Fonseca Filho, Gentil Gomes; de Medeiros Cirne, Gabriele Natane; Cacho, Roberta Oliveira; de Souza, Jane Carla; Nagem, Danilo; Cacho, Enio Walker Azevedo; Moran, Cristiane Aparecida; Abreu, Bruna; Pereira, Silvana Alves
Facial paralysis in newborns can leave functional sequelae. Determining the evolution and amount of functional losses requires consistent evaluation methods that measure, quantitatively, the evolution of clinical functionality. This paper reports an innovative method of facial assessment for the case of a child 28 days of age with unilateral facial paralysis. The child had difficulty breast feeding, and quickly responded to the physical therapy treatment.
Hsu, Amy K; Rosow, David E; Wallerstein, Robert J; April, Max M
True vocal fold (TVF) paralysis is a common cause of neonatal stridor and airway obstruction, though bilateral TVF paralysis is seen less frequently. Rare cases of familial congenital TVF paralysis have been described with implied genetic origin, but few genetic abnormalities have been discovered to date. The purpose of this study is to describe a novel chromosomal translocation responsible for congenital bilateral TVF immobility. The charts of three patients were retrospectively reviewed: a 35 year-old woman and her two children. The mother had bilateral TVF paralysis at birth requiring tracheotomy. Her oldest child had a similar presentation at birth and also required tracheotomy, while the younger child had laryngomalacia without TVF paralysis. Standard karyotype analysis was done using samples from all three patients and the parents of the mother, to assess whether a chromosomal abnormality was responsible. Karyotype analysis revealed the same balanced translocation between chromosomes 5 and 14, t(5;14) (p15.3, q11.2) in the mother and her two daughters. No other genetic abnormalities were identified. Neither maternal grandparent had the translocation, which appeared to be a spontaneous mutation in the mother with autosomal dominant inheritance and variable penetrance. A novel chromosomal translocation was identified that appears to be responsible for familial congenital bilateral TVF paralysis. While there are other reports of genetic abnormalities responsible for this condition, we believe this is the first describing this particular translocation. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Deshpande, Jagdish; Ram, Madhav; Durrani, Sunita; Wenger, Jay
Accurate surveillance for polio is essential for eradication. Surveillance systems for polio has been developed under the guidance of the global polio eradication initiative. Surveillance of cases of acute flaccid paralysis among children less than 15 years of age is a key component for a well functioning polio surveillance system. The surveillance system works through a network of surveillance medical officers, the responsibility of them lies in assisting the health services departments of all states and maintaining a network of acute flaccid paralysis reporting sites and rapidly investigating the cases. Surveillance activities begin when a child comes in contact with a healthcare provider who in turn informs the officer in charge of acute flaccid paralysis surveillance. The goal of the polio network laboratories is to provide accurate and timely results of wild poliovirus detection in stool samples of cases of acute flaccid paralysis. Strong linkages have been established between the acute flaccid paralysis surveillance system and the laboratory network. Laboratories complete poliovirus isolation and if poliovirus is isolated, these are submitted for intratypic differentiations. Acute flaccid paralysis surveillance in India has demonstrated that the eradication activities implemented in India led to dramatic reduction and restriction in the number of cases and geographic spread of poliovirus transmission.
Denis, Dan; French, Christopher C; Gregory, Alice M
Sleep paralysis is a relatively common but under-researched phenomenon. While the causes are unknown, a number of studies have investigated potential risk factors. In this article, we conducted a systematic review on the available literature regarding variables associated with both the frequency and intensity of sleep paralysis episodes. A total of 42 studies met the inclusion criteria. For each study, sample size, study site, sex and age of participants, sleep paralysis measure, and results of analyses looking at the relationship(s) between sleep paralysis and associated variable(s) were extracted. A large number of variables were associated with sleep paralysis and a number of themes emerged. These were: substance use, stress and trauma, genetic influences, physical illness, personality, intelligence, anomalous beliefs, sleep problems and disorders (both in terms of subjective sleep quality and objective sleep disruption), symptoms of psychiatric illness in non-clinical samples (particularly anxiety symptoms), and psychiatric disorders. Sleep paralysis appears to be particularly prevalent in post-traumatic stress disorder, and to a less degree, panic disorder. Limitations of the current literature, directions for future research, and implications for clinical practice are discussed. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
McNally, Richard J; Clancy, Susan A
Sleep paralysis accompanied by hypnopompic ('upon awakening') hallucinations is an often-frightening manifestation of discordance between the cognitive/perceptual and motor aspects of rapid eye movement (REM) sleep. Awakening sleepers become aware of an inability to move, and sometimes experience intrusion of dream mentation into waking consciousness (e.g. seeing intruders in the bedroom). In this article, we summarize two studies. In the first study, we assessed 10 individuals who reported abduction by space aliens and whose claims were linked to apparent episodes of sleep paralysis during which hypnopompic hallucinations were interpreted as alien beings. In the second study, adults reporting repressed, recovered, or continuous memories of childhood sexual abuse more often reported sleep paralysis than did a control group. Among the 31 reporting sleep paralysis, only one person linked it to abuse memories. This person was among the six recovered memory participants who reported sleep paralysis (i.e. 17% rate of interpreting it as abuse-related). People rely on personally plausible cultural narratives to interpret these otherwise baffling sleep paralysis episodes.
Wyatt, H V
Death of motor neurones following invasion of the central nervous system by poliovirus may result in paralysis of specific muscles. Virulence may be tested by injection into monkeys by routes which bypass natural infection. Transmissibility is also very important, but cannot be measured, only inferred. An infection may lead to immunity or paralysis. In epidemics, the highest incidence among children 0-2 years was 2% and among those over 10 years was 25%: these figures fit a model of genetic susceptibility of homozygotes and heterozygotes with phenotypic susceptibility increasing with age. Hypogamma-globulinemics, some neonates and pregnant women are more susceptible than others. Intra-muscular injections may increase the risk of paralysis. Strenuous exercise and IM injections given when poliovirus has already reached the spinal cord can increase the severity of paralysis or convert a non-paralytic attack to paralysis. Although vaccines reduced polio in temperate countries, polio was thought to be no problem in the tropics. Since 1977 polio has been recognised as a massive problem in the third world: because it affects babies and very young children, it is properly infantile paralysis.
Zhou, Zhong-Yuan; Dai, Tie-Zhu
To compare therapeutic effects of acupuncture on complicated facial paralysis in the patient with HIV/AIDS and in the patient with no HIV/AIDS. The observation group of 31 cases of facial paralysis with positive HIV/AIDS and the control group of 30 cases of facial paralysis with negative HIV/AIDS were treated with acupuncture at Yifeng (TE 17), Xiaguan (ST 7), Jiache (ST 6), Taiyang (EX-HN 5), Dicang (ST 4), Yuyao (EX-HN 4), Cuanzhu (BL 2), Yingxiang (LI 20), etc. and with individual treatment according to different periods of disease. The difference of therapeutic effects between the two groups were observed. The effective rate was 83.9% in the observation group and 96.7% in the control group, with no significant difference between the two groups; while the cured rate was 9.7% in the observation group and 73.3% in the control group with a very significant difference between the two groups (P < 0.01). Acupuncture with individual treatment has a satisfactory therapeutic effect on complicated facial paralysis in the patient of HIV/AIDS.
Greig, Sarah L
Oral dichlorphenamide (Keveyis™) is a carbonic anhydrase inhibitor that is approved in the USA for the treatment of primary hyperkalaemic and hypokalaemic periodic paralyses and related variants. The efficacy and safety of dichlorphenamide in patients with primary periodic paralyses have been evaluated in four 9-week, randomized, double-blind, placebo-controlled, phase III trials [two parallel-group trials (HOP and HYP) and two crossover trials]. In two trials in patients with hypokalaemic periodic paralysis, dichlorphenamide was associated with a significantly (eightfold) lower paralytic attack rate and fewer patients with acute intolerable worsening compared with placebo. In two trials in patients with hyperkalaemic periodic paralysis, the attack rate was lower with dichlorphenamide than placebo, with this comparison reaching statistical significance in one trial (crossover) but not the other (HYP), although the attack rate was approximately fivefold lower with dichlorphenamide than placebo in the HYP trial. In 52-week, open-label extensions of the HOP and HYP trials, dichlorphenamide provided sustained efficacy in patients with hypokalaemic or hyperkalaemic periodic paralysis. Dichlorphenamide was generally well tolerated in all four phase III trials and during the extension trials; the most common adverse events were paraesthesia, cognitive disorders and dysgeusia. As the first agent to be approved in the USA for this indication, dichlorphenamide is a valuable treatment option for patients with primary hyperkalaemic or hypokalaemic periodic paralysis.
Terzis, Julia K; Olivares, Fatima S
Ninety-two children, the entire series of paediatric facial reanimation by a single surgeon over thirty years, are presented. The objective is to analyse the incidence and value of secondary revisions for functional and aesthetic refinements following the two main stages of reanimation. The reconstructive strategy varied according to the denervation time, the aetiology, and whether the paralysis was uni- or bilateral, complete or partial. Irrespective of these variables, 89% of the patients required secondary surgery. Post-operative videos were available in seventy-two cases. Four independent observers graded patients' videos using a scale from poor to excellent. The effect of diverse secondary procedures was measured computing a mean-percent-gain score. Statistical differences between treatment groups means were tested by the t-test and one-way ANOVA. Two-thirds of the corrective and ancillary techniques utilized granted significantly higher mean-scores post-secondary surgery. A comparison of pre- and post-operative data found valuable improvements in all three facial zones after secondary surgery. In conclusion, inherent to dynamic procedures is the need for secondary revisions. Secondary surgery builds in the potential of reanimation surgery, effectively augmenting functional faculties and aesthesis.
Barcelos, Camila Barbosa; Silveira, Paula Angélica Lorenzon; Guedes, Renata Lígia Vieira; Gonçalves, Aline Nogueira; Slobodticov, Luciana Dall'Agnol Siqueira; Angelis, Elisabete Carrara-de
Patients with unilateral vocal fold paralysis may demonstrate different degrees of voice perturbation depending on the position of the paralyzed vocal fold. Understanding the effectiveness of voice therapy in this population may be an important coefficient to define the therapeutic approach. To evaluate the voice therapy effectiveness in the short, medium and long-term in patients with unilateral vocal fold paralysis and determine the risk factors for voice rehabilitation failure. Prospective study with 61 patients affected by unilateral vocal fold paralysis enrolled. Each subject had voice therapy with an experienced speech pathologist twice a week. A multidimensional assessment protocol was used pre-treatment and in three different times after voice treatment initiation: short-term (1-3 months), medium-term (4-6 months) and long-term (12 months); it included videoendoscopy, maximum phonation time, GRBASI scale, acoustic voice analysis and the portuguese version of the voice handicap index. Multiple comparisons for GRBASI scale and VHI revealed statistically significant differences, except between medium and long term (p<0.005). The data suggest that there is vocal improvement over time with stabilization results after 6 months (medium term). From the 28 patients with permanent unilateral vocal fold paralysis, 18 (69.2%) reached complete glottal closure following vocal therapy (p=0.001). The logistic regression method indicated that the Jitter entered the final model as a risk factor for partial improvement. For every unit of increased jitter, there was an increase of 0.1% (1.001) of the chance for partial improvement, which means an increase on no full improvement chance during rehabilitation. Vocal rehabilitation improves perceptual and acoustic voice parameters and voice handicap index, besides favor glottal closure in patients with unilateral vocal fold paralysis. The results were also permanent during the period of 1 year. The Jitter value, when elevated, is
Lindsay, Robin W; Robinson, Mara; Hadlock, Tessa A
The Facial Grading Scale (FGS) is a quantitative instrument used to evaluate facial function after facial nerve injury. However, quantitative improvements in function after facial rehabilitation in people with chronic facial paralysis have not been shown. The objectives of this study were to use the FGS in a large series of consecutive subjects with facial paralysis to quantitatively evaluate improvements in facial function after facial nerve rehabilitation and to describe the management of chronic facial paralysis. The study was a retrospective review. A total of 303 individuals with facial paralysis were evaluated by 1 physical therapist at a tertiary care facial nerve center during a 5-year period. Facial rehabilitation included education, neuromuscular training, massage, meditation-relaxation, and an individualized home program. After 2 months of home exercises, the participants were re-evaluated, and the home program was tailored as necessary. All participants were evaluated with the FGS before the initiation of facial rehabilitation, and 160 participants were re-evaluated after receiving treatment. All participants underwent the initial evaluation at least 4 months after the onset of facial paralysis; for 49 participants, the evaluation took place more than 3 years after onset. Statistically significant increases in FGS scores were seen after treatment (P<.001, t test). The average initial score was 56 (SD=21, range=13-98), and the average score after treatment was 70 (SD=18, range=25-100). A limitation of this study was that evaluations were performed by only 1 therapist. For 160 patients with facial paralysis, statistically significant improvements after facial rehabilitation were shown; the improvements appeared to be long lasting with continued treatment. The improvements in the FGS scores indicated that patients can successfully manage symptoms with rehabilitation and underscored the importance of specialized therapy in the management of facial paralysis.
Sharpless, Brian A
This review summarizes the empirical and clinical literature on sleep paralysis most relevant to practitioners. During episodes of sleep paralysis, the sufferer awakens to rapid eye movement sleep-based atonia combined with conscious awareness. This is usually a frightening event often accompanied by vivid, waking dreams (ie, hallucinations). When sleep paralysis occurs independently of narcolepsy and other medical conditions, it is termed "isolated" sleep paralysis. Although the more specific diagnostic syndrome of "recurrent isolated sleep paralysis" is a recognized sleep-wake disorder, it is not widely known to nonsleep specialists. This is likely due to the unusual nature of the condition, patient reluctance to disclose episodes for fear of embarrassment, and a lack of training during medical residencies and graduate education. In fact, a growing literature base has accrued on the prevalence, risk factors, and clinical impact of this condition, and a number of assessment instruments are currently available in both self-report and interview formats. After discussing these and providing suggestions for accurate diagnosis, differential diagnosis, and patient selection, the available treatment options are discussed. These consist of both pharmacological and psychotherapeutic interventions which, although promising, require more empirical support and larger, well-controlled trials.
Crausman, Robert S; Summerhill, Eleanor M; McCool, F Dennis
Idiopathic diaphragm paralysis is probably more common and responsible for more morbidity than generally appreciated. Bell's palsy, or idiopathic paralysis of the seventh cranial nerve, may be seen as an analogous condition. The roles of zoster sine herpete and herpes simplex have increasingly been recognized in Bell's palsy, and there are some data to suggest that antiviral therapy is a useful adjunct to steroid therapy. Thus, we postulated that antiviral therapy might have a positive impact on the course of acute idiopathic diaphragm paralysis which is likely related to viral infection. Three consecutive patients with subacute onset of symptomatic idiopathic hemidiaphragm paralysis were empirically treated with valacyclovir, 1,000 mg twice daily for 1 week. Prior to therapy, diaphragmatic function was assessed via pulmonary function testing and two-dimensional B-mode ultrasound, with testing repeated 1 month later. Diaphragmatic function pre- and post-treatment was compared to that of a historical control group of 16 untreated patients. All three subjects demonstrated ultrasound recovery of diaphragm function 4-6 weeks following treatment with valacyclovir. This recovery was accompanied by improvements in maximum inspiratory pressure (PI(max)) and vital capacity (VC). In contrast, in the untreated cohort, diaphragm recovery occurred in only 11 subjects, taking an average of 14.9 +/- 6.1 months (mean +/- SD). The results of this small, preliminary study suggest that antiviral therapy with valacyclovir may be helpful in the treatment of idiopathic diaphragm paralysis induced by a viral infection.
Valença, M M; Valença, L P; Lima, M C
The objective of this study was to analyze some clinical and epidemiologic aspects, as well as the follow up of 180 patients with Bell's palsy. In the study population there was a predominance of female (66.7%). Two peaks of incidence in the age distribution were identified: third-fourth and sixth decades of life. In the group of 180 patients there were 198 events of facial paralysis, 17 recurrences and in one patient the paralysis was bilateral at the onset. In 15 patients (8.3%) there were recurrences of the facial paralysis, in 12 cases (70.6%) the recurrences were ipsilateral. The left side of the face was involved in 55.6% of the cases. In eight patients the paralysis occurred during pregnancy (n=5) or puerperium (n=3). As associated conditions we found: arterial hypertension (11.7%), diabetes mellitus (11.1%), pregnancy or puerperium (4.4%; 6.7% in the women), and neurocysticercosis (1.1%). In 72.8% of the cases no association with such conditions was found. In 22.8% of the patients some kind of sequelae were identified: hemifacial spasm (12.8%), partial recovery of the motor deficit (10.6%), syndrome of the crocodile tears (3.3%), sincinetic contraction (2.8%), and the Marcus Gunn inverse phenomenon (1.1%). In conclusion, this study shows that the idiopathic facial paralysis may lead to important sequelae in more than 20% of the patients.
Mattioli, Francesco; Bettini, Margherita; Botti, Cecilia; Busi, Giulia; Tassi, Sauro; Malagoli, Andrea; Molteni, Gabriele; Trebbi, Marco; Luppi, Maria Pia; Bergamini, Giuseppe; Presutti, Livio
To analyze the long-term objective, perceptive, and subjective outcomes after endoscopic polydimethylsiloxane (PDMS) injection laryngoplasty in unilateral vocal fold paralysis. A retrospective study carried out between January 2008 and January 2012. Head and Neck Department, University Hospital of Modena, Modena, Italy. This was a retrospective analysis of 26 patients with unilateral vocal fold paralysis who underwent endoscopic injection of PDMS under general anesthesia. A voice evaluation protocol was performed for all patients, which included videolaryngostroboscopy, maximum phonation time, fundamental frequency, analysis of the harmonic structure of the vowel /a/ and the word /aiuole/, Grade of Dysphonia, Instability, Roughness, Breathiness, Asthenia, and Strain scale, and Voice Handicap Index. The protocol was performed before surgery, in the immediate postoperative period, and at least 3 years after surgery. The mean follow-up period was 73 months (range 39-119 months). The statistical analysis showed a significant improvement (P < 0.01) for all of the objective, perceptive, and subjective parameters by comparison between the preoperative and long-term follow-up data; moreover, no statistically significant difference was found between the postoperative and long-term follow-up data. This indicates that injection laryngoplasty with PDMS guarantees long-lasting effects over time. No complications were reported in our series. Injection laryngoplasty with PDMS can be considered to be a minimally invasive and safe technique for the treatment of unilateral vocal fold paralysis. Moreover, it allows very good and stable results to be obtained over time, avoiding repeated treatments and improving the quality of life of the patients. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Palii, Sergiu P.; Contreras, Cesar S.; Steill, Jeffrey D.; Palii, Stela S.; Oomens, Jos; Eyler, John R.
Triuret (also known as carbonyldiurea, dicarbamylurea, or 2,4-diimidotricarbonic diamide) is a byproduct of purine degradation in living organisms. An abundant triuret precursor is uric acid, whose level is altered in multiple metabolic pathologies. Triuret can be generated via urate oxidation by peroxynitrite, the latter being produced by the reaction of nitric oxide radical with superoxide radical anion. From this standpoint, an excess production of superoxide radical anions could indirectly favor triuret formation; however very little is known about the potential in vivo roles of this metabolite. Triuret’s structure is suggestive of its ability to adopt various conformations and act as a flexible ligand for metal ions. In the current study, HPLC-MS/MS, energy-resolved mass spectrometry, selected ion monitoring, collision-induced dissociation, IRMPD spectroscopy, Fourier transform-ion cyclotron resonance mass spectrometry and computational methods were employed to characterize the structure of triuret and its metal complexes, to determine the triuret-alkali metal binding motif, and to evaluate triuret affinity toward alkali metal ions, as well as its affinity for Na+ and K+ relative to other organic ligands. The most favored binding motif was determined to be a bidentate chelation of triuret with the alkali metal cation involving two carbonyl oxygens. Using the complexation selectivity method, it was observed that in solution triuret has an increased affinity for potassium ions, compared to sodium and other alkali metal ions. We propose that triuret may act as a potential hypokalemic agent under pathophysiological conditions conducive to its excessive formation and thus contribute to electrolyte disorders. The collision- or photo-induced fragmentation channels of deprotonated and protonated triuret, as well as its alkali metal adducts, are likely to mimic the triuret degradation pathways in vivo. PMID:20371222
Weissenburger, J; Davy, J M; Chézalviel, F; Ertzbischoff, O; Poirier, J M; Engel, F; Lainée, P; Penin, E; Motté, G; Cheymol, G
that QT-dependent arrhythmogenic effects of drugs can be reliably evaluated in conscious hypokalemic dogs with complete atrioventricular block.
Ness, R C
This paper describes a syndrome of psychological and physical symptoms involving body paralysis and hallucinations traditionally interpreted in Newfoundland as an attack of 'Old Hag'. Folk theories of cause and treatment are outlined based on 13 months of field research in a community on the northeast coast of Newfoundland. Data derived from the responses of 69 adults to the Cornell Medical Index (CMI) indicate that there are no significant differences in psychological or physical illness complaints between adults who have experienced the Old Hag and adults who have not had this experience. The striking similarity between the Old Hag experience and a clinical condition called sleep paralysis is analyzed, and the implications of viewing the Old Hag as sleep paralysis are discussed within the context of current theoretical issues in transcultural psychiatry.
Cheyne, J A; Newby-Clark, I R; Rueffer, S D
The Waterloo Sleep Experiences Scale was developed to assess the prevalence of sleep paralysis and a variety of associated hypnagogic and hypnopompic hallucinoid experiences: sensed presence, felt pressure, floating sensations, auditory and visual hallucinations, and fear. Consistent with results of recent surveys, almost 30% of 870 university students reported at least one experience of sleep paralysis. Approximately three-quarters of those also reported at least one hallucinoid experience, and slightly more than 10% experienced three or more. Fear was positively associated with hallucinoid experiences, most clearly with sensed presence. Regression analyses lend support to the hypothesis that sensed presence and fear are primitive associates of sleep paralysis and contribute to the elaboration of further hallucinoid experiences, especially those involving visual experiences.
Brach, J S; VanSwearingen, J M
Bell's palsy or idiopathic facial paralysis is the most common cause of unilateral facial paralysis. This case report describes a patient referred for physical therapy evaluation and treatment with a diagnosis of Bell's palsy. On initial presentation in physical therapy the patient had unilateral facial paralysis, ipsilateral regional facial pain and numbness, and a history of a gradual, progressive onset of symptoms. The process of evaluating this patient in physical therapy, as well as the recognition of signs and symptoms typical and atypical of Bell's palsy, are described. This report emphasizes the importance of early recognition of the signs and symptoms inconsistent with a diagnosis of Bell's palsy, and indications for prompt, appropriate referral for additional diagnostic services.
Canalis, Rinaldo F; Cino, Liliana
To provide interested scholars with a historical perspective of facial paralysis as interpreted by the ceramists of the ancient Moche culture. The authorities and curators of the Museo Arqueológico Rafael Larco Herrera, and the Museo Nacional de Arqueología, Antropología e Historia del Perú, in Lima, Perú, provided photographs of some of the more salient examples of facial paralysis in their Moche ceramic collections. Four of these were selected for inclusion in this article. Moche pathologic portraits establish a unique point of reference in the history of facial paralysis and its sequelae. They stand alone as a prehistoric record of this disorder, unsurpassed until the appearance of Bell's work and illustrations.
Schaefer, Nathan; O’Donohue, Peter; French, Heath; Griffin, Aaron; Gochee, Peter
Summary: Facial nerve paralysis because of penetrating trauma through the external auditory canal is extremely rare, with a paucity of published literature. The objective of this study is to review the literature on transtympanic facial nerve paralysis and increase physician awareness of this uncommon injury through discussion of its clinical presentation, management and prognosis. We also aim to improve patient outcomes in those that have sustained this type of injury by suggesting an optimal management plan. In this case report, we present the case of a 46-year-old white woman who sustained a unilateral facial nerve paresis because of a garfish penetrating her tympanic membrane and causing direct damage to the tympanic portion of her facial nerve. On follow-up after 12 months, her facial nerve function has largely returned to normal. Transtympanic facial nerve paralysis is a rare injury but can have a favorable prognosis if managed effectively. PMID:26090278
Lu, Mei; Zhang, Huan-huan; Zhang, Hui-fang
Professor Sun Liuhe is engaged in medical service for over 40 years. He is deeply involved in research on intractable and complicated diseases. Especially, in treating facial paralysis, he makes diagnosis and treatment based on overall analysis of symptoms and causes, differentiation of syndrome for etiology. Without confining himself to ancient treatment methods, by applying both acupuncture and Chinese medicine, selecting auxiliary acupoints according to differentiation of meridians related to illness, as well as considering anatomy. Professor Sun holds ancient and modern therapeutic methods, brings forth ideas of using new acupoints to prevent perversion based on pulse tracings, and uses cutting therapy for the cases suffering from facial paralysis for a long time. This method can shorten treatment courses, to a great extent, and achieve good therapeutic effects on intractable facial paralysis, which has revealed distinctness of acupuncture therapy.
Tamai, Kazuya; Kuramochi, Taro; Sakai, Hiroya; Iwami, Norio; Saotome, Koichi
A15-year-old girl who developed traumatic iliacus hematoma and complete paralysis of the quadriceps muscle is reported. The current case and literature review revealed that incomplete quadriceps paralysis associated with traumatic iliacus hematoma is likely to progress to complete paralysis in days or weeks as a result of increased intracompartmental pressure. However, surgical decompression of the femoral nerve could produce good results even in patients who have complete quadriceps paralysis preoperatively.
Muellbacher, W.; Artner, C.; Mamoli, B.
OBJECTIVES—The occurrence of a lingual paralysis after unilateral upper motor neuron lesions is an infrequent clinical phenomenon, and the underlying pathophysiological mechanisms are poorly understood. We studied the cortical motor representations of ipsilateral and contralateral lingual muscles in healthy controls and in a selected group of stroke patients, to clarify the variable occurrence of a lingual paralysis after recent monohemispheric ischaemia. METHODS—A special bipolar surface electrode was used to record the ipsilateral and contralateral compound muscle action potentials (CMAPs) from the lingual muscles after transcranial magnetic stimulation (TMS) of the human motor cortex and peripheral electrical stimulation (PES) of the hypoglossal nerve medial to the angle of the jaw. Four patients with a lingual paralysis (group 1) and four patients with symmetric lingual movements (group 2) after monohemispheric first ever stroke were studied and compared with 40 healthy controls. RESULTS—In controls, TMS of either hemisphere invariably produces CAMPs in the ipsilateral and contralateral lingual muscles, elicited through crossed and uncrossed central motor pathways, respectively. In the 40 healthy controls, TMS of either hemisphere elicited CMAPs of significantly greater amplitudes and shorter onset latencies from the contralateral muscles compared with the ipsilateral responses (p<0.0001). In the patient groups, TMS of the affected hemisphere failed to evoke any CMAP from either lingual side; TMS of the unsevered hemisphere always produced normal ipsilateral and contralateral responses, irrespective of whether the ipsilateral muscles were paralysed or not. CONCLUSIONS—Bilateral crossed and uncrossed corticonuclear projections are invariably existent in humans. After unilateral interruption of these pathways, some people do exhibit a lingual paralysis whereas others do not. The development of a central lingual paralysis is most likely dependent on
Abad, P; Lloret, J; Martínez Ibañez, V; Patiño, B; Boix-Ochoa, J
The phrenic nerve is the only motor nerve in the diaphragm. The injury will lead to a diaphragmatic paralysis or eventration with paradoxical movements during breathing. The aim of this review is to analyze the diagnostic criteria, surgical indications, and the patients that are not treated by surgery. We review 53 cases with diaphragmatic pathology in the last 5 years; 19 females and 20 males. One was a diaphragmatic rupture, 13 were diaphragmatic hernias, and 39 had diaphragmatic paralysis. Diaphragmatic paralysis was diagnosed by fluoroscopy in 97%, electromiography 5.1% or ultrasounds. The ethiology was 64% after cardiac surgery and 10% after thoracic oncologic surgery. The age at diagnosis was less than 1 month in 41% cases. In 29 patients the paralysis was well tolerated and were extubated between 24 h and 4 days after the diagnosis, frequently was in the first 48 h. 4 patients need a traqueostomy and 2 went to another hospital. In 5 we performed a diaphragmatic plication because the inability to be extubated or the persistence of respiratory distress. The paralysis was demonstrated by fluoroscopy. 2 patients are asymptomatic, 2 are in mechanical ventilation and 1 died (sepsis). The most frequent cause of diaphragmatic paralysis was related to cardiac or thoracic surgery. In general, is well tolerated, almost asymptomatic, the patients were extubated between 24 or 48 h. In pediatric population they are few cases that need surgical treatment. The patients that we operated on were less than 2 months old, because is at that age were the repercussion is more important. We must follow strict criteria, without precipìtation for the surgical indications.
Gerasimenko, Yury P; Lu, Daniel C; Modaber, Morteza; Zdunowski, Sharon; Gad, Parag; Sayenko, Dimitry G; Morikawa, Erika; Haakana, Piia; Ferguson, Adam R; Roy, Roland R; Edgerton, V Reggie
The present prognosis for the recovery of voluntary control of movement in patients diagnosed as motor complete is generally poor. Herein we introduce a novel and noninvasive stimulation strategy of painless transcutaneous electrical enabling motor control and a pharmacological enabling motor control strategy to neuromodulate the physiological state of the spinal cord. This neuromodulation enabled the spinal locomotor networks of individuals with motor complete paralysis for 2-6 years American Spinal Cord Injury Association Impairment Scale (AIS) to be re-engaged and trained. We showed that locomotor-like stepping could be induced without voluntary effort within a single test session using electrical stimulation and training. We also observed significant facilitation of voluntary influence on the stepping movements in the presence of stimulation over a 4-week period in each subject. Using these strategies we transformed brain-spinal neuronal networks from a dormant to a functional state sufficiently to enable recovery of voluntary movement in five out of five subjects. Pharmacological intervention combined with stimulation and training resulted in further improvement in voluntary motor control of stepping-like movements in all subjects. We also observed on-command selective activation of the gastrocnemius and soleus muscles when attempting to plantarflex. At the end of 18 weeks of weekly interventions the mean changes in the amplitude of voluntarily controlled movement without stimulation was as high as occurred when combined with electrical stimulation. Additionally, spinally evoked motor potentials were readily modulated in the presence of voluntary effort, providing electrophysiological evidence of the re-establishment of functional connectivity among neural networks between the brain and the spinal cord.
Padilla Parrado, M; Morales Puebla, J M; Díaz Sastre, M A; Caro García, M A; Cabeza Alvarez, C I; Velázquez Pérez, J M; Menéndez Loras, L M
A case of severe miastenia beginning with dyspnea, secondary to a bilateral larynx paralysis in aduction is presented. During the evolution of the severe miastenia the affectation of the larynx musculature does not result infrequent, but however, after having realized a bibliographic revision, the infrequency resulting in this disease of the beginning through a bilateral larynx paralysis in aduction was verified. A wide exposition of the clinic case, methods of exploration to obtain the diagnosis of severe miastenia, and the different treatment options actually in use to control these disease, are realized.
It is suggested that picturesque medical conditions can, at times, be encountered in literary works composed prior to their clinical delineation. This is true of sleep paralysis, of which the first scientific description was given by Silas Weir Mitchell in 1876. A quarter of a century earlier, Herman Melville, in Moby-Dick, gave a precise account of a case, including the predisposing factors and sexual connotations, all in accord with modern theory. The details of Ishmael's attack of sleep paralysis, the stresses leading up to it, and the associations causing him to recall the experience are given here.
Kang, Lianru; Zheng, Shuang
Professor GAO Weibin academically advocates, based on basic theory of TCM and theories of different schools, modern science technology should be used for the methods and principles of acupuncture and Chinese medicine for neuropathy, so as to explore and summarize the rules, characteristics and advantages of TCM for nervous system disease, especially bulbar paralysis. During the treatment of bulbar paralysis, professor GAO creatively proposes the effective acupuncture points such as Gongxue, Tunyan-1, Tunyan-2, Fayin, Tiyan and Zhifanliu from the aspects of neuroanatomy, and analyzes their anatomical structure and action mechanism.
Bahadir, Cengiz; Kalpakcioglu, Ayşe Banu; Kurtulus, Duygu
We report the case of a 73-year-old woman who complained of acute onset of pain and weakness of her left shoulder and proximal arm muscles 3 weeks after a diagnosis of herpes zoster. Electromyography revealed involvement of the C5-6 myotomes and the upper trunk of the brachial plexus. Chest X-ray and electromyographic studies documented paralysis of the left diaphragm. One year after onset, muscle strength returned to normal, but radiographic and electrophysiologic findings of diaphragm paralysis were unchanged.
Yoshimatsu, Aya; Hoshi, Takuo; Tanaka, Makoto
We report a case of a median nerve palsy. Hepatic segmentectomy and lymphnode dissection were performed in a 21-year-old man for multiple liver and retroperitoneal lymph nodes metastasis of seminoma. After surgery, patient complained of motor paralysis and hypesthesia of the left palm side of the thumb, first finger and radial half of the middle finger. He was diagnosed as having median nerve palsy. Motor paralysis and hypesthesia gradually disappeared over the two weeks after surgery. We should pay attention to appropriate positioning of the arm during surgery, and preoperative use of paclitaxel needs to be considered as etiology for perioperative peripheral nerve palsy.
Berger, Emily M; Galadari, Hassan I; Gottlieb, Alice B
Bell's palsy is an acute facial paralysis of unknown etiology. Infections including syphilis have been implicated as causes for peripheral facial paresis. The Jarisch-Herxheimer reaction is an acute worsening of skin manifestations and systemic symptoms occurring after administration of antimicrobial therapy for spirochetal infections. Although rare, neurological signs can present as part of the Jarisch-Herxheimer reaction. The authors report a case of Bell's palsy experienced by a patient shortly after treatment with penicillin for secondary syphilis and propose that this acute unilateral peripheral facial paralysis was a Jarisch-Herxheimer reaction in response to therapy.
Chan, Jason Y K; Byrne, Patrick J
Facial paralysis is a clinical entity associated with significant morbidity, which has a treatment paradigm that is continually evolving. Surgical management of the paralyzed face poses significant challenges to achieve the goal of returning patients to their premorbid states. Here we attempt to review the advances in facial reanimation, in particular with regards to chronic facial paralysis. These include recent developments in static and dynamic rehabilitation including advances like artificial muscles for eyelid reconstruction, dynamic muscle transfer for the eye, and orthodromic temporalis tendon transfer.
Zhou, Xian-Gang; Yang, Chuang; Yang, Li-Xia; Zhong, Qu
To evaluate the therapeutic effect and safety of acupoint sticking therapy for facial paralysis. Search the literatures in the whole paper databank of China figure medical library (Jan. 1994-Dec. 2004) and China Biomedical Literature Disk Databank (Jan. 1995-Dec. 2004). Meta-analysis was conducted with RevMan 4. 2. 5 software. Sixteen controlled trials involving 2 157 patients were included. Meta-analysis indicated that there was high statistically difference between the acupoint sticking therapy and simple acupuncture therapy or Western medicine therapy. The acupoint sticking therapy is effective and safe for facial paralysis.
Zimmermann, Jonas B; Jackson, Andrew
As yet, no cure exists for upper-limb paralysis resulting from the damage to motor pathways after spinal cord injury or stroke. Recently, neural activity from the motor cortex of paralyzed individuals has been used to control the movements of a robot arm but restoring function to patients' actual limbs remains a considerable challenge. Previously we have shown that electrical stimulation of the cervical spinal cord in anesthetized monkeys can elicit functional upper-limb movements like reaching and grasping. Here we show that stimulation can be controlled using cortical activity in awake animals to bypass disruption of the corticospinal system, restoring their ability to perform a simple upper-limb task. Monkeys were trained to grasp and pull a spring-loaded handle. After temporary paralysis of the hand was induced by reversible inactivation of primary motor cortex using muscimol, grasp-related single-unit activity from the ventral premotor cortex was converted into stimulation patterns delivered in real-time to the cervical spinal gray matter. During periods of closed-loop stimulation, task-modulated electromyogram, movement amplitude, and task success rate were improved relative to interleaved control periods without stimulation. In some sessions, single motor unit activity from weakly active muscles was also used successfully to control stimulation. These results are the first use of a neural prosthesis to improve the hand function of primates after motor cortex disruption, and demonstrate the potential for closed-loop cortical control of spinal cord stimulation to reanimate paralyzed limbs.
Zimmermann, Jonas B.; Jackson, Andrew
As yet, no cure exists for upper-limb paralysis resulting from the damage to motor pathways after spinal cord injury or stroke. Recently, neural activity from the motor cortex of paralyzed individuals has been used to control the movements of a robot arm but restoring function to patients' actual limbs remains a considerable challenge. Previously we have shown that electrical stimulation of the cervical spinal cord in anesthetized monkeys can elicit functional upper-limb movements like reaching and grasping. Here we show that stimulation can be controlled using cortical activity in awake animals to bypass disruption of the corticospinal system, restoring their ability to perform a simple upper-limb task. Monkeys were trained to grasp and pull a spring-loaded handle. After temporary paralysis of the hand was induced by reversible inactivation of primary motor cortex using muscimol, grasp-related single-unit activity from the ventral premotor cortex was converted into stimulation patterns delivered in real-time to the cervical spinal gray matter. During periods of closed-loop stimulation, task-modulated electromyogram, movement amplitude, and task success rate were improved relative to interleaved control periods without stimulation. In some sessions, single motor unit activity from weakly active muscles was also used successfully to control stimulation. These results are the first use of a neural prosthesis to improve the hand function of primates after motor cortex disruption, and demonstrate the potential for closed-loop cortical control of spinal cord stimulation to reanimate paralyzed limbs. PMID:24904251
Pagano, R; Morsomme, D; Camby, S; Lejeune, L; Finck, C
The purposes of this study were to assess the long-term efficacy of medialization laryngoplasty via injection of autologous fat in patients with unilateral laryngeal paralysis, and to discuss the results based on the volume of fat injected and the size of the initial glottic gap. This was a retrospective study with clinical reevaluation of 18 patients treated for unilateral laryngeal paralysis at Liège University Hospital between April 1, 2011, and December 1, 2014. The voice examination included subjective scales (GRBAS and the Voice Handicap Index), a report on acoustic and aerodynamic voice parameters, and laryngostroboscopic assessment of glottic closure and mucosal wave (T0: preoperative; T1: immediate postoperative; T2: >1 year). The median follow-up duration was 19 months. We observed a significant improvement in maximum phonation time; mean flow rate; jitter; the Voice Handicap Index; the G, R, B, and A subscales of the GRBAS-I; and glottic closure at T1. These parameters remained stable over time, without any significant difference except for shimmer and glottic closure between T1 and T2. Regardless of the volume of fat injected and the magnitude of the initial glottic gap, we did not see any significant difference from one assessment time to another. Medialization laryngoplasty by means of the injection of autologous fat is a safe, effective surgical technique for patients with unilateral laryngeal paralysis regardless of the size of the initial glottic gap. The results are maintained longer than 1 year, and no evidence of significant resorption of the fat was found in our study over a period of 12-58 months. The volume of fat injected does not seem to affect the functional results. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
Rolim, Ana Luiza R; Lindsey, Susan C; Kunii, Ilda S; Crispim, Felipe; Moisés, Regina Célia M S; Maciel, Rui M B; Dias-da-Silva, Magnus R
Thyrotoxicosis is the most common cause of the acquired flaccid muscle paralysis in adults called thyrotoxic periodic paralysis (TPP) and is characterised by transient hypokalaemia and hypophosphataemia under high thyroid hormone levels that is frequently precipitated by carbohydrate load. The sulphonylurea receptor 1 (SUR1 (ABCC8)) is an essential regulatory subunit of the β-cell ATP-sensitive K(+) channel that controls insulin secretion after feeding. Additionally, the SUR1 Ala1369Ser variant appears to be associated with insulin sensitivity. We examined the ABCC8 gene at the single nucleotide level using PCR-restriction fragment length polymorphism (RFLP) analysis to determine its allelic variant frequency and calculated the frequency of the Ala1369Ser C-allele variant in a cohort of 36 Brazilian TPP patients in comparison with 32 controls presenting with thyrotoxicosis without paralysis (TWP). We verified that the frequency of the alanine 1369 C-allele was significantly higher in TPP patients than in TWP patients (61.1 vs 34.4%, odds ratio (OR)=3.42, P=0.039) and was significantly more common than the minor allele frequency observed in the general population from the 1000 Genomes database (61.1 vs 29.0%, OR=4.87, P<0.005). Additionally, the C-allele frequency was similar between TWP patients and the general population (34.4 vs 29%, OR=1.42, P=0.325). We have demonstrated that SUR1 alanine 1369 variant is associated with allelic susceptibility to TPP. We suggest that the hyperinsulinaemia that is observed in TPP may be linked to the ATP-sensitive K(+)/SUR1 alanine variant and, therefore, contribute to the major feedforward precipitating factors in the pathophysiology of TPP.
Hontanilla, Bernardo; Marre, Diego
A patient's sex is likely to play an important role in facial paralysis reanimation, with women being superior in terms of development of brain plasticity after reanimation. The purpose of this study was to compare the rate of movement dissociation and spontaneity of men versus women reanimated with gracilis transfer neurotized to the masseteric nerve. We conducted a retrospective chart review of 27 patients who underwent facial paralysis reanimation with microvascular gracilis transplants neurotized to the ipsilateral masseteric nerve. Patients were classified by sex, comparing age at surgery, denervation time, and follow-up, as well as the rates of movement dissociation and smile spontaneity. After reanimation with gracilis to masseteric nerve, movement dissociation and spontaneity were higher in women during the first year after onset of facial movement (p=.02 and p=.01, respectively). After reanimation with masseteric nerve, women seem to be able to smile spontaneously and independently from teeth clenching earlier than men. Copyright © 2013 Wiley Periodicals, Inc.
Agutter, Paul S; Shoja, Mohammadali M; Tubbs, R Shane; Rashidi, Mohammad Reza; Khalili, Majid; Hosseini, Seyed Fazel; Ghabili, Kamyar; Cohen-Gadol, Aaron A; Loukas, Marios
Premature burial (taphophobia) is an ancient fear, but it became especially common in 18th and 19th century Europe and may have a modern-day counterpart. Examination of a well-documented case from medieval Persia reveals the importance of funeral practices in the risk of actual premature burial and sheds light on the question of why taphophobia became so prevalent in Europe during the early industrial revolution period. The medieval Persian case was attributed to hysterical paralysis (conversion). We discuss the relationship between hysterical paralysis and premature burial more generally and show that although understanding of conversion syndrome remains incomplete, modern knowledge and practices have limited the risk of any similar tragedy today.
Bode, Amy V.; Marfin, Anthony A.; Campbell, Grant L.; Pape, John; Biggerstaff, Brad J.; Petersen, Lyle R.
We report 1-year follow-up data from a longitudinal prospective cohort study of patients with West Nile virus–associated paralysis. As in the 4-month follow-up, a variety of recovery patterns were observed, but persistent weakness was frequent. Respiratory involvement was associated with considerable illness and death. PMID:16704798
Yadernuk, Lisa M.
A 13-year-old broodmare was referred for weight loss and left facial nerve paralysis. Bilateral temporohyoid osteoarthropathy was diagnosed based on proliferation of the temporohyoid joints and stylohyoid bones on radiographs and guttural pouch endoscopy. The left side was more severely affected. Treatment resulted in little or no improvement. PMID:14703087
Sharpless, Brian A
This review summarizes the empirical and clinical literature on sleep paralysis most relevant to practitioners. During episodes of sleep paralysis, the sufferer awakens to rapid eye movement sleep-based atonia combined with conscious awareness. This is usually a frightening event often accompanied by vivid, waking dreams (ie, hallucinations). When sleep paralysis occurs independently of narcolepsy and other medical conditions, it is termed “isolated” sleep paralysis. Although the more specific diagnostic syndrome of “recurrent isolated sleep paralysis” is a recognized sleep–wake disorder, it is not widely known to nonsleep specialists. This is likely due to the unusual nature of the condition, patient reluctance to disclose episodes for fear of embarrassment, and a lack of training during medical residencies and graduate education. In fact, a growing literature base has accrued on the prevalence, risk factors, and clinical impact of this condition, and a number of assessment instruments are currently available in both self-report and interview formats. After discussing these and providing suggestions for accurate diagnosis, differential diagnosis, and patient selection, the available treatment options are discussed. These consist of both pharmacological and psychotherapeutic interventions which, although promising, require more empirical support and larger, well-controlled trials. PMID:27486325
Bell, Carl C.; Shakoor, Bambade; Thompson, Belinda; Dew, Donald; Hughley, Eugene; Mays, Raymond; Shorter-Gooden, Kumea
Sleep paralysis is a state of consciousness experienced while waking from sleep or falling asleep. It is characterized by an experience of being unable to move for several seconds or minutes. This study represents the first survey to measure the incidence of this disorder in a black population of healthy subjects and psychiatric patients. PMID:6737506
Grosheva, Maria; Wittekindt, Claus; Pototschnig, Claus; Lindenthaler, Werner; Guntinas-Lichius, Orlando
To analyze the predictive value of electromyography (EMG) after peripheral vocal cord paralysis and to estimate regeneration time. Retrospective study based on electromyographic data and medical chart review of university based ENT hospitals. EMG results of 448 patients were classified into neuropraxia, axonotmesis/neurotmesis, or not classifiable and followed until final outcome. Final outcome was classified electromyographically into restitutio ad integrum, defective healing, or not classifiable. The etiology of the paralysis was thyroid gland surgery in 42.9% and other iatrogenic lesions in 11.8%. Idiopathic paralysis was found in 20.3%. Mean follow-up time was 4.8 months. Initial EMG findings were neuropraxia in 31.0%, axonotmesis/neurotmesis in 40.8%, and not classifiable in 28.1%. Restitutio ad integrum was detected by EMG in 17.6% and defective healing in 43.3%. In 39.1%, the outcome could not be classified. The positive predictive value of EMG was 97% and the negative predictive value 60%. The outcome depended significantly on the initial EMG result (P < .0001) but not on the etiology (P = .737) of the paresis. Regeneration time after neuropraxia was 4.0 months and after axonotmesis/neurotmesis 5.6 months. Laryngeal EMG has a high predictive value for acute peripheral vocal cord paralysis. The outcome can be predicted more reliably by means of EMG than by analysis of the etiology of the lesion.
de Lange, Floris P; Roelofs, Karin; Toni, Ivan
Conversion paralysis is characterized by a loss of voluntary motor functioning without an organic cause. Despite its prevalence among neurological outpatients, little is known about the neurobiological basis of this motor dysfunction. We have examined whether the motor dysfunction in conversion paralysis can be linked to inhibition of the motor system, or rather to enhanced self-monitoring during motor behavior. We measured behavioral and cerebral responses (with fMRI) in eight conversion paralysis patients with a lateralized paresis of the arm as they were engaged in imagined actions of the affected and unaffected hand. We used a within-subjects design to compare cerebral activity during imagined movements of the affected and the unaffected hand. Motor imagery of the affected hand and the unaffected hand recruited comparable cerebral resources in the motor system, and generated equal behavioral performance. However, motor imagery of the affected limb recruited additional cerebral resources in the ventromedial prefrontal cortex and superior temporal cortex. These activation differences were caused by a failure to de-activate these regions during movement imagery of the affected hand. These findings lend support to the hypothesis that conversion paralysis is associated with heightened self-monitoring during actions with the affected arm.
Lin, P T; Andersson, P-B; Distad, B J; Barohn, R J; Cho, S C; So, Y T; Katz, J S
The authors report four patients with a syndrome of painless bilateral isolated phrenic neuropathy. Electrophysiologic testing demonstrated active denervation restricted to the diaphragm. Long-term recovery was poor. The authors conclude that bilateral isolated phrenic neuropathy is a cause of painless diaphragmatic paralysis distinguishable from immune brachial plexus neuropathy and other neuromuscular disorders with similar clinical presentation.
Horner, Liana M.; Poulter, Melinda D.; Brenton, J. Nicholas
An outbreak of acute flaccid paralysis among children in the United States during summer 2014 was tentatively associated with enterovirus D68 infection. This syndrome in a child in fall 2014 was associated with enterovirus C105 infection. The presence of this virus strain in North America may pose a diagnostic challenge. PMID:26401731
To describe a patient who presented with psychopathology in the wake of sleep paralysis and hypnopompic hallucinations, and to discuss the importance of these phenomena to psychiatric diagnoses. Case report. A 25-year-old black South African woman developed paranoid beliefs and a sad and anxious mood in the wake of her first experience of sleep paralysis and hypnic hallucinations. She had no history of other sleep-related events. Reassurance, explanation of the physiological basis of her experience, and a short course of low-dose diazepam were provided. Her mood and sleep improved promptly and she no longer held paranoid beliefs. She did not experience further episodes of sleep paralysis or hypnic hallucinations and improvement was sustained at 6 months. It pays to probe for the core experiences or events that patients may be explaining by devising "delusions". Acute, nocturnal-onset, first-time psychopathology warrants inquiry for sleep paralysis and hypnic hallucinations. Sleep-related side-effects of psychotropic medications need to be studied more closely.
Hopkins, Benjamin; Khanna, Ryan; Dahdaleh, Nader S
Objective: Cruciate paralysis is a rare, poorly understood condition of the upper craniovertebral junction that allows for selective paralysis of the upper extremities while sparing the lower extremities. Reported cases are few and best treatment practices remain up for debate. The purpose of this study was to conduct a systemic literature review in an attempt to identify prognostic predictors and outcome trends associated with cases previously reported in the literature. Materials and Methods: We conducted a systematic literature review for all cases using the term “Cruciate Paralysis,” reviewing a total of 37 reported cases. All outcomes were assigned a numerical value based on examination at the last follow-up. These numerical values were further analyzed and tested for statistical significance. Results: Of the 37 cases, 78.4% were of traumatic causes. Of these, there were considerably worse outcomes associated with patients over the age of 65 years (P < 0.001). Those patients undergoing surgical treatment showed potentially worse outcomes, with a P value approaching significance at P = 0.08. Conclusion: Numerous cases of trauma-associated cruciate paralysis have been reported in the literature; however, there remains a strong need for further study of the condition. While certain risk factors can be elicited from currently reported studies, insignificant data exist to make any sound conclusion concerning whether surgical intervention is always the best method of treatment. PMID:27891037
Yardimci, Bulent; Kazancioglu, Rumeyza
Thyrotoxicosis mostly presents with tachycardia, tremor, weight loss and other hypermetabolism signs. However, there are other unusual signs of thyrotoxicosis such as paralysis. This unusual clinical presentation may postpone prompt diagnosis and treatment. In this case report, we present a 27-years-old woman, who presented with quadriparesis at the emergency department. PMID:26101516
Tang, X L; Fang, Q P
The treatment of 100 cases of acute stage peripheral facial paralysis with electro-acupuncture has indicated that, with the stimulation intensity and time interval strictly controlled, electro-acupuncture is effective. Suitable wave forms and electric intensity, as well as proper needling techniques and controlled duration of the stimulation according to experimental experience have yielded high therapeutic effects without aggravation of symptoms.
The estimated incidence of acute facial paralysis is approximately 30 patients per 100000 populations annually. Facial paralysis is an extremely frightening situation and gives extreme stress to patients because obvious disfiguring face may cause significant functional, aesthetic, and psychological disturbances. For stressful patients with acute facial paralysis, it is very important for clinicians to answer the questions like whether or not their facial function will return to normal, how much of their facial function will be recovered, and how long this is going to take. It is also important for clinicians to treat the psychological aspects by adequately explaining the prognosis, in addition to providing the appropriate medical treatment. For decades, clinicians have used various electrophysiologic tests, including the nerve excitability test, the maximal stimulation test, electroneurography, and electromyography. In particular, electroneurography is the only objective measure that is useful in early stage of acute facial paralysis. In this review article, we first discuss the pathophysiology of injured peripheral nerve. And then, we describe about various electrophysiologic tests and discuss the electroneurography extensively.
Kwon, Oh Hong; Kim, Mi-Na; Kim, Su-A; Seok, Hung Youl; Park, Seong-Mi; Kim, Byung-Jo; Kim, Chul-Hwan; Shim, Wan-Joo; Shim, Ju Sung; Lee, Min-Gu
Although the clinical presentation of myocarditis is very diverse, ranging from mild dyspnea to hemodynamic collapse, myocarditis accompanied with extracardiac myositis is extremely rare. We report a single case of fulminant myocarditis associated with orbital myositis and diaphragmatic paralysis in a 40-year-old man, which was successfully managed by immunosuppressive therapy with steroid.
The estimated incidence of acute facial paralysis is approximately 30 patients per 100000 populations annually. Facial paralysis is an extremely frightening situation and gives extreme stress to patients because obvious disfiguring face may cause significant functional, aesthetic, and psychological disturbances. For stressful patients with acute facial paralysis, it is very important for clinicians to answer the questions like whether or not their facial function will return to normal, how much of their facial function will be recovered, and how long this is going to take. It is also important for clinicians to treat the psychological aspects by adequately explaining the prognosis, in addition to providing the appropriate medical treatment. For decades, clinicians have used various electrophysiologic tests, including the nerve excitability test, the maximal stimulation test, electroneurography, and electromyography. In particular, electroneurography is the only objective measure that is useful in early stage of acute facial paralysis. In this review article, we first discuss the pathophysiology of injured peripheral nerve. And then, we describe about various electrophysiologic tests and discuss the electroneurography extensively. PMID:27144227
Marek’s Disease (MD) is a lymphoproliferative disease of domestic chickens caused by a highly cell-associated alpha herpesvirus, Marek’s disease virus (MDV). Clinical signs of MD include depression, crippling, weight loss, and transient paralysis (TP). TP is a disease of the central nervous system...
Luo, He-Ping; Lin, Tian-dong; Cai, Min; Huang, Xian-xun; Wang, Bang-bo; Gao, Wei-keng
To optimize the acupuncture treatment programs for facial paralysis. Sixty-three patients of facial paralysis were randomly divided and treated according to the table of L9 (3)4 in orthogonal test. They were treated with different combined programs of 4 factors and 3 levels, including factor A (acupuncture op portunity), B (acupoints prescription), C (quantity of stimulus) and D (time of electroacupuncture). The change of facial nerve function score was observed to choose the best acupuncture treatment program for facial paralysis from factor A (acupuncture opportunity), B (acupoints prescription), C (quantity of stimulus), D (time of electroacupuncture) and their 3 levels in each factor. B (acupoints prescription) and D (time of electroacupuncture) were significant factors (P < 0.05), and B (acupoints prescription) was the most important influential factor. B3 (alternative use of two groups of acupoints) was the best one among the 3 levels of B (acupoints prescription), and D3 (electroacupuncture in disperse-dense wave for 30 min) was the best one of D (time of electroacupuncture). Two groups of acupoints alternatively used with electroacupuncture in disperse-dense wave for 30 min is the best treatment program for facial paralysis.
Chisti, Mohammod Jobayer; Salam, Mohammed Abdus; Ashraf, Hasan; Faruque, Abu S. G.; Bardhan, Pradip Kumar; Das, Sumon Kumar; Shahunja, K. M.; Shahid, Abu S. M. S. B.; Ahmed, Tahmeed
Background Clinical signs of pneumonia are often veiled in under-five diarrheal children presenting with hypokalemia, making clinical diagnosis of pneumonia very difficult in such population. However, there is no published report that describes the influences of hypokalemia on the clinical signs of pneumonia in diarrheal children. Our objective was to assess the influences of hypokalemia, and their outcome in such children. Methods We prospectively enrolled all under-five diarrheal children (n = 180) admitted to the Special Care Ward of the Dhaka Hospital of icddr,b from September-December 2007 with radiological pneumonia who also had their serum potassium estimated. We compared the clinical features and outcome of the diarrheal children having pneumonia with (cases = 55) and without hypokalemia (controls = 125). Results The case-fatality among the cases was 2 times higher compared to the controls, but the difference was not statistically significant (p = 0.202). In logistic regression analysis, after adjusting for potential confounders such as age of the patient, clinical dehydration, severe wasting, abnormally sleepy, lower chest wall in-drawing, nasal flaring and inability to drink on admission, under-five diarrheal children with pneumonia who presented with nutritional edema had 3 times more risk to have hypokalemia compared to those without nutritional edema (OR = 2.76, 95% CI = 1.01–7.51) and these hypokalemic children were 64% less likely to present with fast breathing (OR = 0.36, 95% CI = 0.17–0.74). Conclusion and significance The results of our analysis are simple but may have great public health implications and underscore the importance of diligent assessment for pneumonia in under-five diarrheal children having risk of hypokalemia as in children with nutritional edema even in absence of fast breathing, a useful sign of pneumonia. This may help for early initiation of first dose of parental antibiotics along with
Wang, Haidong; Meeus, Ivan; Smagghe, Guy
Although it is known that Israeli acute paralysis virus (IAPV) can cause bee mortality, the symptoms of paralysis and the distribution of the virus in different body tissues and their potential to respond with an increase of the siRNA antiviral immune system have not been studied. In this project we worked with Bombus terrestris, which is one of the most numerous bumblebee species in Europe and an important pollinator for wild flowers and many crops in agriculture. Besides the classic symptoms of paralysis and trembling prior to death, we report a new IAPV-related symptom, crippled/immobilized forelegs. Reverse-transcriptase quantitative PCR showed that IAPV accumulates in different body tissues (midgut, fat body, brain and ovary). The highest levels of IAPV were observed in the fat body. With fluorescence in situ hybridization (FISH) we detected IAPV in the Kenyon cells of mushroom bodies and neuropils from both antennal and optic lobes of the brain in IAPV-infected workers. Finally, we observed an induction of Dicer-2, a core gene of the RNAi antiviral immune response, in the IAPV-infected tissues of B. terrestris workers. According to our results, tissue tropism and the induction strength of Dicer-2 could not be correlated with virus-related paralysis symptoms.
Villafañe, Jorge Hugo; Pillastrini, Paolo; Borboni, Alberto
The purpose of this case report is to describe a therapeutic intervention for peroneal nerve paralysis involving the sciatic nerve. A 24-year-old man presented with peroneal nerve paralysis with decreased sensation, severe pain in the popliteal fossa, and steppage gait, which occurred 3 days prior to the consultation. Magnetic resonance imaging and electromyography confirmed lumbar disk herniation with sciatic common peroneal nerve entrapment in the popliteal fossa. A combined treatment protocol of spinal and fibular head manipulation and neurodynamic mobilization including soft tissue work of the psoas and hamstring muscles was performed. Outcome measures were assessed at pretreatment, 1 week posttreatment, and 3-month follow-up and included numeric pain rating scale, range of motion, pressure pain threshold, and manual muscle testing. Treatment interventions were applied for 3 sessions over a period of 1 week. Results showed reduction of the patient's subjective pain and considerable improvement in range of motion, strength, and sensation in his left foot, which was restored to full function. A combined program of spinal and fibular head manipulation and neurodynamic mobilization reduced pain, increased range of motion and strength, and restored full function to the left leg in this patient who had severe functional impairment related to a compressed left common peroneal nerve.
Neufeld, J H; Machado, T; Margolin, L
Methods have been developed that permit repetitive radiographic measurement of the lumbar intervertebral disc space in a rostral-caudal direction (width) in the anesthetized laboratory rabbit. Using isolated control discs and injured discs in which narrowing has been induced for chronic and acute periods, the widths of the lumbar intervertebral disc spaces determined ratio-graphically correlate with widths determined histologically (p less than 0.000, r = 0.75). Both an increase (widening) and a decrease (narrowing) in disc width were observed using radiography after different experimental treatments. Anesthesia and lower-body paralysis (an experimentally induced inability to bear weight on and to perceive a pinch stimulus in hind limbs) caused widening of the discs: anesthesia causing a general widening throughout the lumbar spine and lower-body paralysis causing a specific widening low in the lumbar spine. Both disc injection and piercing the disc with needles to recover nucleus pulposus material caused narrowing of the discs. Acridine-orange injection induced a narrowing accompanied by osteophytosis. Experimentally induced narrowing at L4-5 (the result of injury to the disc) resulted in narrowing also at L2-3. These findings are consistent with the hypothesis that in vivo disc-width size in the young rabbit depends on both the quantity of nucleus pulposus material and the force-generating activities of the adjacent spinal muscles, and that disc injury at one level stimulates narrowing at other levels.
Stone, Jon; Perthen, Jo; Carson, Alan J
Oliver Sacks, the well known neurologist and writer, published his fourth book, 'A Leg to Stand On', in 1984 following an earlier essay 'The Leg' in 1982. The book described his recovery after a fall in a remote region of Norway in which he injured his leg. Following surgery to reattach his quadriceps muscle, he experienced an emotional period in which his leg no longer felt a part of his body, and he struggled to regain his ability to walk. Sacks attributed the experience to a neurologically determined disorder of body-image and bodyego induced by peripheral injury. In the first edition of his book Sacks explicitly rejected the diagnosis of 'hysterical paralysis' as it was then understood, although he approached this diagnosis more closely in subsequent revisions. In this article we propose that, in the light of better understanding of functional neurological symptoms, Sacks' experiences deserve to be reappraised as a unique insight in to a genuinely experienced functional/psychogenic leg paralysis following injury.
Hou, Shu-Wei; Zhang, Chang-Yun; Wang, Chang-Chun
To explore the control principles of treatment amount of acupuncture and moxibustion for peripheral facial paralysis. (1) Early stage: in this period, the selected acupoints should be few, therapy should be easy and simple, and the treatment amount should be small and basically constant, which is called constant acupoints and amount. (2) Middle stage: the treatment of this stage should be given with more acupoints and various therapies, the treatment amount should be gradually increasing and reach the peak within a certain time and keep it for an appropriate time, which is called increasing acuponts and amount. (3) Late stage: the treatment at this stage should be given with more acupoints, lesser therapies, and the treatment amount should be gradually decreasding and get the valley point within a certain time, which is called more acupoints and less amount. (4) Sequelae stage: the selection of acupoints at this stage should be focus on areas which there are the obvious symptoms, and solo type of therapy and little treatment amount is required, which is called changing acupoints and little amount. In a word, the best therapeutic effect could be achieved on condition that the control principles of treatment amount for peripheral facial paralysis are followed during the clinical practice.
[Renovascular hypertension due to unilateral renal artery stenosis with hypokalemic alkalosis, the salt-losing syndrome and reversible hyperechogenicity of the contralateral kidney. A study of 2 infants].
Castelló Girona, F; Yeste Fernández, D; Porta Ribera, R; Enríquez Cívicos, G
This report describes two infants with severe arterial hypertension secondary to unilateral renal artery stenosis which was manifested by polyuria, polydipsia, hypokalemic alkalosis, hyponatremia, increased natriuresis and increased plasma values of rennin and aldosterone. On sonographic examination, the contralateral non-stenotic kidney of both patients appeared enlarged and hyperechogenic mimicking parenchymal lesion. When the patients became normotensive, their sodium and potassium balance became normal and their contralateral non-stenotic kidney also became normal in size and echogenicity. The increase of the filtration and the natriuresis observed in the contralateral non-stenotic kidney of the patients with renovascular hypertension due to renal artery stenosis might be responsible for the hyperechogenicity. When the patients became normotensive, the filtration and excretion of sodium of the contralateral kidney also became normal and the increase of echogenicity also disappeared. The reversibility of the sonographic findings suggest a functional origin.
Weiland, F; Cox, J H; Meyer, S; Dahme, E; Reddehase, M J
Two pathogenetically distinct disease manifestations are distinguished in a murine model of primary rabies virus infection with the Evelyn-Rokitnicky-Abelseth strain, rabies virus neuritic paralysis (RVNP) and fatal encephalopathogenic rabies. RVNP develops with high incidence in immunocompetent mice after intraplantar infection as a flaccid paralysis restricted to the infected limb. The histopathologic correlate of this monoplegia is a degeneration of the myelinated motor neurons of the peripheral nerve involved. While, in this model, fatal encephalopathogenic rabies develops only after depletion of the CD4 subset of T lymphocytes and without contribution of the CD8 subset, RVNP is identified as an immunopathological process in which both the CD4 and CD8 subsets of T lymphocytes are critically implicated. Images PMID:1629964
Fukuda, K; Inamatsu, N; Kuroiwa, M; Miyasita, A
Sleep paralysis occurs in normal persons. This phenomenon had been studied psychoanalytically or in terms of the deviation of the victims' personality. This present study aimed to assess the personalities of such persons by using the MMPI and the Maudsley Personality Inventory. The subjects showed a slightly higher mean T score on the MMPI Paranoia Scale than those who did not have this experience. Although this personality difference might be related to the occurrence of the phenomenon, this difference is probably too small to take a major role. It is unlikely that the subjects developed paranoic behavior through their experiences of sleep paralysis, since their experiences were very few. Some of the subjects might have only overestimated their behavior and experiences concerning delusions and hallucinations, with the result that their Paranoia scores were higher and perhaps their kanashibari experiences exaggerated.
Fukuda, K; Miyasita, A; Inugami, M; Ishihara, K
In Japan, a set of experiences called kanashibari is considered identical with isolated sleep paralysis. We investigated this phenomenon by means of a questionnaire administered to 635 college students (390 men and 245 women). Of all subjects, about 40% had experienced at least one episode of kanashibari [subjects of K(+)]. Therefore, isolated sleep paralysis is apparently a more common phenomenon than is usually appreciated. About half of the subjects of K(+) reported that they had been under "physical or psychological stress" or in a "disturbed sleep and wakefulness cycle" immediately before the episode. Many subjects of K(+) experienced the first episode in adolescence. In the distribution of age of first attack, the peak occurred at an earlier age in women subjects than in men subjects. These findings suggest that two factors influence the occurrence of the phenomenon. One is exogenous physical or psychological load and the other is endogenous biological development.
Daniero, James J.; Garrett, C. Gaelyn; Francis, David O.
Laryngeal framework surgery is the current gold standard treatment for unilateral vocal fold paralysis. It provides a permanent solution to glottic insufficiency caused by injury to the recurrent laryngeal nerve. Various modifications to the original Isshiki type I laryngoplasty procedure have been described to improve voice and swallowing outcomes. The success of this procedure is highly dependent on the experience of the surgeon as it epitomizes the intersection of art and science in the field. The following article reviews the evidence, controversies, and complications related to laryngoplasty for unilateral vocal fold paralysis. It also provides a detailed analysis of how and when arytenoid-positioning procedures should be considered, and summarizes the literature on postoperative outcomes. PMID:24883239
Gürbüz, Melek Kezban; Erdoğan, Murat; Doğan, Nihal; Birdane, Leyla; Cingi, Cemal; Cingi, Emre
Tick-borne diseases are seen all over the world and their importance rises increasingly. It is noticeably important that disease and death rates due to tick-bites in our country in different areas increased in 2008. In Turkey, the numbers of diseases which are transmitted by ticks are considerably large and all of them are not detected. Reports of isolated facial paralysis cases due to tick infestation in the ear are infrequent in literature. The development of isolated facial paralysis due to ticks can be explained by several theories. This article reports a case report of a 3 year- old girl who was bought to our clinic with severe left ear pain and paresthesia on the left half of her face. She couldn't close her left eye and she lisped. The tick was removed from her external auditory canal surgically.
Franko, O I; Khalpey, Z; Gates, J
Phrenic nerve palsy has previously been associated with brachial plexus root avulsion; severe unilateral phrenic nerve injury is not uncommonly associated with brachial plexus injury. Brachial plexus injuries can be traumatic (gunshot wounds, lacerations, stretch/contusion and avulsion injuries) or non-traumatic in aetiology (supraclavicular brachial plexus nerve block, subclavian vein catheterisation, cardiac surgeries, or obstetric complications such as birth palsy). Despite the known association, the incidence and morbidity of a phrenic nerve injury and hemidiaphragmatic paralysis associated with traumatic brachial plexus stretch injuries remains ill-defined. The incidence of an associated phrenic nerve injury with brachial plexus trauma ranges from 10% to 20%; however, because unilateral diaphragmatic paralysis often presents without symptoms at rest, a high number of phrenic nerve injuries are likely to be overlooked in the setting of brachial plexus injury. A case report is presented of a unilateral phrenic nerve injury associated with brachial plexus stretch injury presenting with a recalcitrant left lower lobe pneumonia.
Watson, C J; Schenkman, M
This case report presents a patient who developed right shoulder pain following strenuous upper-extremity exercise. Approximately 6 weeks later his pain resolved, he noticed persistent right upper-extremity weakness. He was referred to physical therapy for evaluation and treatment. Physical therapy evaluation revealed isolated serratus anterior muscle paralysis. A long thoracic neuropathy was subsequently confirmed by electromyographic testing. The etiology, pathophysiology, and pathokinesiology of serratus anterior muscle paralysis are reviewed. A case is presented, illustrating how the clinical decision making is based on the pathokinesiology and pathophysiology. The patient was followed over the course of 17 months and has recovered full right shoulder active range of motion. His serratus anterior muscle strength has increased to Good minus, and he reports significantly improved functional use of the upper extremity.
Sautter, T; Herzog, A; Hauri, D; Schurch, B
In the last 10 years, wound botulism has increasingly been reported and nearly all of these new cases have occurred in injecting-drug abusers. After absorption into the bloodstream, botulinum toxin binds irreversibly to the presynaptic nerve endings, where it inhibits the release of acetylcholine. Diplopia, blurred vision, dysarthria, dysphagia, respiratory failure and paresis of the limbs are common symptoms of this intoxication. Surprisingly and despite the well-known blocking action of the botulinum toxin on the autonomic nerve system, little attention has been paid to changes in the lower urinary tract following acute botulinum toxin poisoning. Here we report a case of bladder paralysis following wound botulism. Early diagnosis and adequate management of bladder paralysis following botulism is mandatory to avoid urologic complications. Accordingly, the prognosis is usually favorable and the bladder recovery complete.
Szmeja, Z; Wójtowicz, J G
The method of surgical treatment of bilateral vocal cord paralysis with the use of laser CO2 is presented. This technique was used in 20 patients. The vaporization and extirpation of arytenoid cartilage was performed together with resection of 1/3 of the posterior vocal cord which was removed. Analyzing other methods of treatment of bilateral vocal cord paralysis it was emphasized that with the use of the presented method good results in preserving breathing and phonation of the operated part was archived. It was also emphasized that the fast process of healing and lack of granulation in the operated field allows for the quick recovering patient. This method allows to obtain good wide larynx lumen without the necessity to perform tracheotomy--in 17 out of 20 our patients we could perform laser arytenoidectomy without tracheotomy.
Vocal cord paralysis is a relatively common entity, usually resulting from a pathologic process of the vagus nerve or its recurrent larynegeal branch. It is rarely caused by intralargngeal lesions. Four teen patients with recurrent laryngeal nerve paralysis (RLNP) were evaluated by laryngography, computed tomography (CT), or both. In the evaluation of the paramedian cord, CT was limited in its ability to differentiate between tumor or RLNP as the cause of the fixed cord, but it yielded more information than laryngography on the structural abnormalities of the larynx and pre-epiglottic and paralaryngeal spaces. Laryngography revealed distinct features of RLNP and is the procedure of choice for evaluation of functional abnormalities of the larynx until further experience with faster CT scanners and dynamic scanning of the larynx is gained.
Zhang, Xue-Yan; Zhuo, Chun-Ping
It is generally believed that peripheral facial paralysis is mainly caused by vacancy of collaterals, invasion of pathogenic wind-cold and wind-heat to facial tendons and meridians, which lead to stagnation of qi and blood, loss of nourishment of tendons, and flaccidity of muscle. The authors belive that the main etiology and pathogenesis of facial paralysis could be deficiency of yin and blood, emptiness of Yangming and Shaoyang collaterals, lack of liver blood which all lead to loss of nourishment, which is combined with exogenous pathogenic wind-cold, that causes stagnation of meridian qi, loss of nourishment of tendons, and flaccidity of muscle. Thus, yin and yang of the Governor Vessel and the Conception Vessel should be regulated for treatment, Siguan (LR 3 and LI 4) should be always used in points selection, and moxibustion should be applied carefully.
Vayisoglu, Yusuf; Gorur, Kemal; Ozcan, Cengiz; Korlu, Savaş
Facial nerve paralysis (FNP) is a very rare complication of otitis media with effusion (OME). There are few patients with OME and FNP in the literature. A 5-year-old girl was admitted to our department with right facial weakness. Right FNP and right OME were diagnosed on the examination. After medical treatment and ventilation tube insertion, FNP completely resolved. The symptoms, signs, and management of this patient are presented.
Hamouri, Shadi; Al Shorafat, Duha
Leptomeningeal carcinomatosis is rare, and its precise incidence is unknown. It is associated with a wide spectrum of solid and hematological malignancies. To complicate its diagnosis, the clinical presentation of leptomeningeal carcinomatosis can be variable. We report a case of a 38-year-old male with bilateral facial nerve paralysis as first presentation of lung adenocarcinoma. To our knowledge, this is the only case describing bilateral facial nerve palsy as the first and only manifestation of lung adenocarcinoma. PMID:28101027
Brugnera, Aldo, Jr.; Ladalardo, Thereza C.; Bologna, Elisangela; Castanho Garrini, Ana E.; Pinheiro, Antonio L. B.; Campos, Roberto A. d. C.
This study was carried out with a 41-year-old female patient with facial paralysis as a consequence of facial nerve injury during neurosurgery. Low-reactive level laser treatment (LLLT) with a diode laser of 830 nm, 40 mw, continuous wave, spot area 3 mm2, was applied twice a week for 2 weeks, then 1 weekly session following up to 30 sessions, resulting in about 80% improvement of the motor activity.
Öztürk, Semi; Kalyoncuoğlu, Muhsin; Durmuş, Gündüz; Topçu, Adem; Can, Mehmet
A 61-year-old man underwent successful percutaneous revascularization of both lower limbs with multiple stent implantations. Paralysis of right lower limb was noticed after completion of procedure when transferring the patient from angiography table. Since hematoma compressing lumbosacral neural plexus could be a fatal complication, computed tomography (CT) image was taken. CT showed bulge of distended bladder compressing stent struts. Following placement of Foley catheter, condition improved and he was subsequently discharged uneventfully.
Tessitore, Adriana; Magna, Luis Alberto; Paschoal, Jorge Rizzato
the decrease of facial movements in peripheral facial paralysis and the resulting aesthetical sequels may have important emotional repercussions as a consequence to the functional deficit, and depending on the intensity of the clinical condition. Orofacial rehabilitation has as a purpose to favor the recovery of orofacial movements and to adequate and/or adapt orofacial functions and facial mimic. However, quantifying therapeutic results in an attempt to measure the muscle tonus is a challenge. Generally, the used forms of measurement are general and subjective. to propose the labial commissure angle as an anthropometric marker and to evaluate its reliability as an objective tool to evaluate the modification of the facial muscle tonus after rehabilitation. participants of the study were 20 patients presenting peripheral facial paralysis - level IV. The study was conducted using images from the photographical documentation taken fifteen days to one year post-onset of facial paralysis. The angle was measured by tracings determined by pre-established anthropometric facial points, such as the line between the glabella and the gnation and the crossing with the left and right chelion points determining an angle manually measured with a protractor on the photography. The average Labial Commissure Angle before treatment was of 101.70 and after rehabilitation of 93.80 (standard deviation, SD = 4.3). The statistical analysis indicated a significant difference (p < 0.001). the results obtained suggest that the Labial Commissure Angle allows the objective evaluation of facial muscle tonus modification.
Delorme, S; Knopp, M V; Kauczor, H U; Zuna, I; Trost, U; Haberkorn, U; van Kaick, G
The long and singular course of the inferior (recurrent) laryngeal nerve makes it very vulnerable to infiltration by tumors of various locations. In particular, mediastinal and pulmonary lesions must be considered in the case of left vocal chord palsy. Recurrent nerve paralysis caused by a tumor indicates advanced disease. We retrospectively reviewed the computed tomography (CT) findings in 29 patients with bronchogenic carcinoma or mediastinal tumors and recurrent nerve paralysis with respect to the site, size and extent of the tumor and the lymph node status. The review revealed a marked predominance of left upper lobe tumors with extensive lymph node metastases to the anterior mediastinum and the aortopulmonary window. The extent of mediastinal involvement exceeded the average involvement in a control group of 30 randomly selected patients with bronchogenic carcinoma at the time of presentation. In all patients CT demonstrated tumor tissue which could have caused the paralysis at one or more sites along the anatomical course of the recurrent nerve. In most cases the tumor was located at the aortic arch. The left paratracheal region, right paratracheal region and right pulmonary apex were affected in one case each. We conclude that in patients with cancer, CT is a suitable method for localizing a recurrent nerve lesion.
Ferri, E; García Purriños, F J
Several surgical procedures have been proposed for the treatment of respiratory distress secondary to bilateral vocal cord paralysis. The aim of all surgical techniques used is to restore a glottic lumen sufficient to guarantee adequate breathing through the natural airway, without tracheotomy and preserving an acceptable phonatory quality. In this study we present our experience from 1998 to 2004 concerning the use of the diode contact laser for a modified Dennis-Kashima posterior endoscopic cordectomy (extended to the false homolateral chord in 3 cases and to the homolateral arytenoid vocal process in 6 cases). 18 patients (15 male, 3 female) were treated; the age range was 35-84 years. The etiology of paralysis varied: iatrogenic post-thyroidectomy and post-thoracic surgery in 5 cases (28%), post-traumatic in 2 cases (11%), secondary to a central lesion in 11 (61%). The operation was carried out with a diode contact laser (60W; 810 nm). Follow-up was 20 months. Dyspnea improved in all patients; the 9 tracheostomized patients were decannulated within 2 months after surgery. Final voice quality was subjectively good in 16 patients (88%). None of patients had any complications after surgery. In conclusion, the endoscopic posterior cordectomy performed by contact diode laser is an effective and reliable method for the treatment of dyspnea secondary to bilateral laryngeal paralysis, guaranteing a sufficient airway without impairing swallowing and maintaining acceptable voice quality.
Chastan, Nathalie; Parain, Dominique
Psychogenic paralysis presents a real treatment challenge. Despite psychotherapy, physiotherapy, antidepressants, acupuncture, or hypnosis, the outcome is not always satisfactory with persistent symptoms after long-term follow-up. We conducted a retrospective study to assess clinical features and to propose an alternative treatment based on repetitive transcranial magnetic stimulation (rTMS). Seventy patients (44 F/26 M, mean age: 24.7 +/- 16.6 years) experienced paraparesis (57%), monoparesis (37%), tetraparesis (3%), or hemiparesis (3%). A precipitating event was observed in 42 patients, primarily as a psychosocial event or a physical injury. An average of 30 stimuli over the motor cortex contralateral to the corresponding paralysis was delivered at low frequency with a circular coil. The rTMS was effective in 89% of cases, with a significantly better outcome for acute rather than chronic symptoms. In conclusion, motor cortex rTMS seem to be very effective in patients with psychogenic paralysis and could be considered a useful therapeutic option.
Barr, Jason S; Katz, Karin A; Hazen, Alexes
In the pediatric patient population, both the pathology and the surgical managements of seventh cranial nerve palsy are complicated by the small size of the patients. Adding to the technical difficulty is the relative infrequency of the diagnosis, thus making it harder to become proficient in the management of the condition. The magnitude of the functional and aesthetic deficits these children manifest is significantly troubling to both the patient and the parents, which makes immediate attention, treatment, and functional restoration essential. A literature search using PubMed (http://www.pubmed.org) was undertaken to identify the current state of surgical management of pediatric facial paralysis. Although a multitude of techniques have been used, the ideal reconstructive procedure that addresses all of the functional and cosmetic needs of these children has yet to be described. Certainly, future research and innovative thinking will yield progressively better techniques that may, one day, emulate the native facial musculature with remarkable precision. The necessity for surgical intervention in children with facial nerve paralysis differs depending on many factors including the acute/chronic nature of the defect as well as the extent of functional and cosmetic damage. In this article, we review the surgical procedures that have been used to treat pediatric facial nerve paralysis and provide therapeutic facial reanimation. Copyright © 2011 Elsevier Inc. All rights reserved.
Tunçcan, Tuncay; Yalçın, Şinasi; Demir, Caner Feyzi; Akın, Mehmet Mustafa; Karlıdağ, Turgut; Keleş, Erol; Kaygusuz, İrfan
The aim was to investigate the efficacy of cortexin and methylprednisolone on recovery in cases of traumatic facial nerve paralysis occurring after facial nerve trauma. The study was performed on 21 healthy rabbits. The buccal branches of the left facial nerves of all the rabbits were pressed, and facial nerve paralysis occurred. The rabbits were randomly divided into three equal groups: 3 mg/day cortexin intramuscularly, 1 mg/kg/day methylprednisolone intramuscularly, and 3 mg/day saline intramuscularly were administered for 10 days in Group I (cortexin group), Group II (methylprednisolone group), and Group III (control group), respectively. Electromyography was performed on the 7th, 14th, and 21st days to evaluate their improvement. Following this, the traumatic buccal branches of the facial nerves of rabbits were extracted and subjected to histopathological examination. There was a significant difference between the cortexin and methylprednisolone groups and the control group in terms of neural fibrotic degeneration, myelin degeneration, axonal degeneration, normal myelin production, and edema. When the cortexin and methylprednisolone groups were compared with each other, there was no significant difference between them, except for an increase in collagen fibers. Cortexin significantly reduced the collagen fiber increase to a greater extent than methylprednisolone. The electromyography findings did not show any significant difference between the groups or within the groups. Our study suggests that cortexin and methylprednisolone are effective for healing traumatic facial nerve paralysis with intact nerve integrity; however, cortexin is unable to cause significant improvement, which is superior to that caused by methylprednisolone.
Otranto, Domenico; Dantas-Torres, Filipe; Tarallo, Viviana Domenica; Ramos, Rafael Antonio do Nascimento; Stanneck, Dorothee; Baneth, Gad; de Caprariis, Donato
Certain tick species including Ixodes holocyclus can inoculate neurotoxins that induce a rapid, ascending flaccid paralysis in animals. Rhipicephalus sanguineus, the most widespread tick of dogs, is recognized as a vector of several pathogens causing diseases in dogs and humans. A single report suggests its role as cause of paralysis in dogs. This study presents the clinical history of 14 young dogs heavily infested by R. sanguineus (intensity of infestation, 63-328) in an endemic area of southern Italy. During May to June of 2011, dogs were presented at the clinical examination with neurological signs of different degrees (e.g., hind limb ataxia, generalized lethargy, and difficulty in movements). All animals were treated with acaricides and by manual tick removal but ten of them died within a day, displaying neurological signs. The other 4 dogs recovered within 3 days with acaricidal and supportive treatment. Twelve dogs were positive by blood smear examination for Hepatozoon canis with a high parasitemia, two also for Babesia vogeli and two were negative for hemoparasites. Low-grade thrombocytopenia, hypoalbuminemia, and pancytopenia were the haematological alterations most frequently recorded. Other causes of neurological disease in dogs were excluded and the diagnosis of tick paralysis by R. sanguineus was confirmed (ex juvantibus) by early and complete recovery of 4 dogs following acaricidal treatment and tick removal.
Gharbaoui, Idris; Kania, Katarzyna; Cole, Patrick
As the physiologic recovery period concludes, the patient is evaluated for surgical procedures that may rebalance muscle function and correct deformity. Upper extremity function is the product of complex and highly sophisticated mechanisms working in unison, and a careful, systematic preoperative evaluation is critical. A good function of the hand cannot be achieved without adequate position of the shoulder, elbow, forearm, and wrist. The goals of surgery must be practical and clearly understood by the patient and the family. PMID:26869862
Honda, Nobumitu; Hato, Naohito; Takahashi, Hirotaka; Wakisaka, Hiroyuki; Kisaki, Hisanobu; Murakami, Shingo; Gyo, Kiyofumi
Herpes simplex virus type 1 (HSV-1) has been proven to be a cause of Bell's palsy; however, the underlying pathophysiology of the facial nerve paralysis is not fully understood. We established a mouse model with facial nerve paralysis induced by HSV-1 infection simulating Bell's palsy and investigated the pathophysiology of the facial nerve paralysis. The time course of the R1 latency in the blink reflex tests paralleled the recovery of the facial nerve paralysis well, whereas electroneurographic recovery tended to be delayed, compared to that of the paralysis; these responses are usually seen in Bell's palsy. On histopathologic analysis, intact, demyelinated, and degenerated nerves were intermingled in the facial nerve in the model. The similarity of the time course of facial nerve paralysis and the electrophysiological results in Bell's palsy and the model strongly suggest that the pathophysiological basis of Bell's palsy is a mixed lesion of various nerve injuries.
O'Hanlon, J; Murphy, M; Di Blasi, Z
Sleep paralysis (SP) is characterised by an inability to move voluntarily for a period on going to sleep or on waking. It is also associated with hallucinations, and often with fear. This study seeks to explore the experience of SP in an Irish university sample. A cross-sectional survey design was employed, with a validated scale for the assessment of SP being distributed to 2,500 students. A total of 418 responded, of whom 83 reported having experienced SP. The most commonly reported and most intense hallucinations were falling, sensed presence, visual hallucination, pressure on the body and belief might be dying. Fear was also commonly experienced. Bivariate analyses showed an association between fear and several hallucination types. SP in university students often includes experience of hallucinations. These, in turn, are associated with frequent and intense fear.
Ishida, O; Ikuta, Y
Radial deviation and limited flexion of the wrist joint and a lack of abduction of the thumb have been noticed after the Riordan's procedure. Therefore, Tsuge et al. modified the Riordan's procedure, and their procedure includes transfer of the pronator teres to the extensor carpi radialis brevis, the flexor carpi radialis (FCR) to the extensor digitorum communis (EDC), and the palmaris longus to the extensor pollicis longus, along with tenodesis of the abductor pollicis longus. We reviewed the charts of 21 patients with isolated radial nerve paralysis who were treated with the Tsuge's procedure. Mean follow-up period was 11.3 years. Postoperatively, patients showed good extension of the metacarpophalangeal joint measured at the middle finger, useful flexion of the wrist joint, and decreased radial deviation of the wrist. The FCR transfer to the EDC is an excellent procedure for extension of the fingers. However, reconstruction of active abduction of the thumb remains controversial.
Di Prisco, Gennaro; Pennacchio, Francesco; Caprio, Emilio; Boncristiani, Humberto F; Evans, Jay D; Chen, Yanping
The Israeli acute paralysis virus (IAPV) is a significant marker of honeybee colony collapse disorder (CCD). In the present work, we provide the first evidence that Varroa destructor is IAPV replication-competent and capable of vectoring IAPV in honeybees. The honeybees became infected with IAPV after exposure to Varroa mites that carried the virus. The copy number of IAPV in bees was positively correlated with the density of Varroa mites and time period of exposure to Varroa mites. Further, we showed that the mite-virus association could possibly reduce host immunity and therefore promote elevated levels of virus replication. This study defines an active role of Varroa mites in IAPV transmission and sheds light on the epidemiology of IAPV infection in honeybees.
Schneider, B; Czerny, C; Baumgartner, H; Zehetgruber, M; Bigenzahn, W
There are various reasons for paralysis of the vocal folds, which consequently imposes great demands on differential diagnostics. Angiocardiopathies are regarded as very rare cases of etiopathogenesis. In the present case, a persistent arterial duct could be identified as the reason for the paralysis of the left recurrent nerve of a 59-year-old female patient. The necessity of interdisciplinary diagnostics going beyond the field of otorhinolaryngology is emphasized, especially in cases of a paralysis of the recurrent nerve.
Lee, Haeng-Chul; Kim, Hoon-Do; Park, Wyun-Kon; Rhee, Ho-Dong; Kim, Ki-Jun
After general anesthesia, peripheral nerve paralysis is a rare complication. The frequently damaged nerves including: branches of the brachial plexus, the ulnar, radial and common peroneal nerves, and sometimes the facial nerve. The radial nerve is the most infrequently damaged one, accounting for only 3% of nerve damage. We report a case of radial nerve paralysis due to self retractor during abdominal operation, its clinical findings, and review of the literature on peripheral nerve paralysis.
Wang, Sheng-Qiang; Li, Yun; Bai, Ya-Ping
In order to have a good grasp of rules of acupuncture for severe peripheral facial paralysis, the early clinical features of severe peripheral facial paralysis (Bell's palsy) are studied and analyzed from the aspect of injury level, injury degrees, clinical syndromes and symptoms; consequently, the treatment strategies with acupuncture are proposed. The severe peripheral facial paralysis is an important research area in clinic trials which verifies the effectiveness of acupuncture treatment.
Jayawardena, Suriya; Burzyantseva, Olga; Shetty, Sanjay; Niranjan, Selvanayagam; Khanna, Ashoke
Background Hyperkalaemic paralysis due to renal failure is a rare but potentially life threatening event. Case presentation We present a patient who had sudden onset ascending flaccid paralysis. The EMS first diagnosis was acute ST-elevation myocardial infarction based on an EKG. In the emergency room (ER) due to careful history taking, serum electrolytes and repeat EKG a correct diagnosis was made and both hyperkalemia and paralysis were treated on time. Conclusion Hyperkalaemic paralysis is rare. One must keep it in the back of the mind especially in the case of renal failure patients to avoid misdiagnosing a rapidly fatal but yet completely reversible condition. PMID:18845006
Hobson, C.; Dubillot, D.; Lardy, H.; Sirinelli, D.; Saliba, E.; Lopez, E.
We report a case of a preterm neonate born at 26 weeks' of gestation diagnosed with unilateral diaphragmatic paralysis. This paralysis was a consequence of a phrenic nerve injury due to extravasation of hyperosmolar parenteral nutrition fluid in the upper thorax. Chest X-rays and ultrasonography confirmed the diagnosis. The neonate was treated with prolonged respiratory support and did not require surgical treatment. This report describes a case of hemidiaphragmatic paralysis as a complication of central venous catheter insertion. In neonates, spontaneous recovery of diaphragmatic paralysis is possible. This study concludes that recovery of extravasation injury-induced phrenic nerve palsy in the context of conservative management is possible. PMID:28405492
Denis, Dan; French, Christopher C; Rowe, Richard; Zavos, Helena M S; Nolan, Patrick M; Parsons, Michael J; Gregory, Alice M
Sleep paralysis is a relatively common but under-researched phenomenon. In this paper we examine prevalence in a UK sample and associations with candidate risk factors. This is the first study to investigate the heritability of sleep paralysis in a twin sample and to explore genetic associations between sleep paralysis and a number of circadian expressed single nucleotide polymorphisms. Analyses are based on data from the Genesis1219 twin/sibling study, a community sample of twins/siblings from England and Wales. In total, data from 862 participants aged 22-32 years (34% male) were used in the study. This sample consisted of monozygotic and dizygotic twins and siblings. It was found that self-reports of general sleep quality, anxiety symptoms and exposure to threatening events were all associated independently with sleep paralysis. There was moderate genetic influence on sleep paralysis (53%). Polymorphisms in the PER2 gene were associated with sleep paralysis in additive and dominant models of inheritance-although significance was not reached once a Bonferroni correction was applied. It is concluded that factors associated with disrupted sleep cycles appear to be associated with sleep paralysis. In this sample of young adults, sleep paralysis was moderately heritable. Future work should examine specific polymorphisms associated with differences in circadian rhythms and sleep homeostasis further in association with sleep paralysis.
McNally and Clancy [McNally, R. J., & Clancy, S. A. (2005). Sleep paralysis in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse. Journal of Anxiety Disorders, 19, 595-602.] conducted a study on sleep paralysis among adults reporting either repressed, recovered, or continuous memories of sexual abuse. I suggest that the study be replicated with a larger number of recovered memory subjects (those who believe that they have recovered memories of childhood sexual abuse) who experienced sleep paralysis, using more neutral wording in order to identify the phenomenon of sleep paralysis.
Milovancev, Milan; Townsend, Katy; Spina, Jason; Hurley, Connie; Ralphs, S Christopher; Trumpatori, Brian; Seguin, Bernard; Jermyn, Kieri
Evaluate the effect of a perioperative intravenous continuous rate infusion (CRI) of metoclopramide on the incidence of aspiration pneumonia in the short term postoperative period in dogs undergoing unilateral arytenoid lateralization. Prospective, randomized, multi-center clinical trial. 61 client-owned dogs with idiopathic laryngeal paralysis and normal preoperative thoracic radiographs. All dogs underwent unilateral arytenoid lateralization with a uniform anesthetic, analgesic, and management protocol. Dogs in the treatment group received an intravenous CRI of metoclopramide for 24 hours perioperative. All dogs were assessed for clinical signs of aspiration pneumonia based on the results of physical examination and owner interview up to the point of suture removal (10-14 days postoperative). Any dog with suspected aspiration pneumonia had thoracic radiographs performed. Six dogs developed aspiration pneumonia in the short term postoperative period (2/28 control dogs and 4/33 treated dogs), accounting for an overall frequency of 10% with no significant difference between control and treated dogs. No variables measured in the study were significantly different between control and treated dogs. Perioperative metoclopramide, at the doses used in this study, did not affect the incidence of aspiration pneumonia in the short term postoperative period in dogs with idiopathic laryngeal paralysis undergoing unilateral arytenoid lateralization. © Copyright 2016 by The American College of Veterinary Surgeons.
Ahn, Ki Young
Background and Purpose It is recommended that Botox be used within 5 hours of reconstitution, which results in substantial quantities being discarded. This is not only uneconomic, but also inconvenient for treating patients. The aim of this study was to determine the potencies of Botox used within 2 hours of reconstitution with unpreserved saline, the same Botox refrigerated (at +4℃) 72 hours after reconstitution, and during the next 4 consecutive weeks (weeks 1, 2, 3, and 4). This comparison was used to determine the length of refrigeration time during which reconstituted Botox will maintain the same efficacy as freshly reconstituted toxin. Methods Individual paralysis rates in the extensor digitorum brevis (EDB) compound muscle action potential (CMAP) amplitude and area were measured 1 week after injecting fresh reconstituted 2.5 MU of Botox on one side of the foot, and when the same quantity of Botox that had been refrigerated for a designated time (i.e., 72 h, or 1, 2, 3, or 4 weeks) into the other side of the foot. The EDB CMAP amplitude and area at 12 and 16 weeks postinjection were also measured to compare the efficacy durations in all five comparative groups. Results Ninety-four volunteers were divided into five groups according to the refrigerator storage time of the second Botox injection. The paralysis of the EDBs was significant for each injection of Botox, both fresh and refrigerated, with no statistically significant differences between them, regardless of the refrigeration time. There was a tendency toward increased CMAP amplitude and area at 12 or 16 weeks postinjection (p<0.0001). The duration of effective muscle paralysis did not differ significantly throughout the 16-week follow-up period between all five groups. Conclusions The potency of reconstituted Botox is not degraded by subsequent refrigeration for 4 weeks. However, there are definite concerns regarding its sterility, and hence its safety, since multiple withdrawals from the same vial
Kwon, Tack-Kyun; Buckmire, Robert
The purpose of this review is to provide an up-to-date review of injection laryngoplasty technique and currently available injectable materials in the management of unilateral vocal fold paralysis (UVP). Many new materials are currently available as substances for injection laryngoplasty. These materials have been developed along distinct of lines reasoning that address the inherent shortcomings of the previously available injectable substances, namely, poor tissue biocompatibility and poor persistence within the larynx. Accordingly, the past decade has seen heightened efforts toward developing implants with improved biocompatibility and longevity. The past year has witnessed publications reporting animal studies and, on occasion, human clinical trials involving the intralaryngeal injection of calcium hydroxyl-appetite, autologous fascia, particulate silicone and hyaluronic acid derivatives, and others, for managing glottic insufficiency. In recent years, the application of injection laryngoplasty to unilateral vocal fold paralysis (UVP) has regained popularity. The technique of injection laryngoplasty has several appealing qualities including relative technical ease, low cost, and wide availability in many clinical settings. A growing number of injectable substances have been developed and tested in the clinical setting of glottic insufficiency. When used to manage unilateral vocal fold paralysis, however, injection laryngoplasty has one irrefutable shortcoming: an inability to address posterior glottic insufficiency. Therefore, while injection laryngoplasty technique becomes increasingly popular for vocal fold augmentation in cases vocal fold paresis, atrophy, and scarring, its role in the treatment of UVP should be limited to cases with an appropriate glottal defect. These techniques should be considered as part of a complimentary armamentarium with framework surgery.
Behkam, Reza; Roberts, Kara E; Bierhals, Andrew J; Jacobs, M Eileen; Edgar, Julia D; Paniello, Randal C; Woodson, Gayle; Vande Geest, Jonathan P; Barkmeier-Kraemer, Julie M
Unilateral vocal fold paralysis (UVP) occurs related to recurrent laryngeal nerve (RLN) impairment associated with impaired swallowing, voice production, and breathing functions. The majority of UVP cases occur subsequent to surgical intervention with approximately 12-42% having no known cause for the disease (i.e., idiopathic). Approximately two-thirds of those with UVP exhibit left-sided injury with the average onset at ≥50 yr of age in those diagnosed as idiopathic. Given the association between the RLN and the subclavian and aortic arch vessels, we hypothesized that changes in vascular tissues would result in increased aortic compliance in patients with idiopathic left-sided UVP compared with those without UVP. Gated MRI data enabled aortic arch diameter measures normalized to blood pressure across the cardiac cycles to derive aortic arch compliance. Compliance was compared between individuals with left-sided idiopathic UVP and age- and sex-matched normal controls. Three-way factorial ANOVA test showed that aortic arch compliance (P = 0.02) and aortic arch diameter change in one cardiac cycle (P = 0.04) are significantly higher in patients with idiopathic left-sided UVP compared with the controls. As previously demonstrated by other literature, our finding confirmed that compliance decreases with age (P < 0.0001) in both healthy individuals and patients with idiopathic UVP. Future studies will investigate parameters of aortic compliance change as a potential contributor to the onset of left-sided UVP.NEW & NOTEWORTHY Unilateral vocal fold paralysis results from impaired function of the recurrent laryngeal nerve (RLN) impacting breathing, swallowing, and voice production. A large proportion of adults suffering from this disorder have an idiopathic etiology (i.e., unknown cause). The current study determined that individuals diagnosed with left-sided idiopathic vocal fold paralysis exhibited significantly greater compliance than age- and sex-matched controls
Background The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not. Methods A total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion. Results In the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively). Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p < 0.05 and p > 0.05, respectively) for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. Conclusions In this study, it was found that in patients with total paralysis
Aydın, Atakan; Biçer, Ahmet; Özkan, Türker; Mersa, Berkan; Özkan, Safiye; Yıldırım, Zeynep Hoşbay
The surgical management of obstetrical brachial plexus palsy can generally be divided into two groups; early reconstructions in which the plexus or affected nerves are addressed and late or palliative reconstructions in which the residual deformities are addressed. Tendon transfers are the mainstay of palliative surgery. Occasionally, surgeons are required to utilise already denervated and subsequently reinnervated muscles as motors. This study aimed to compare the outcomes of tendon transfers for residual shoulder dysfunction in patients who had undergone early nerve surgery to the outcomes in patients who had not. A total of 91 patients with obstetric paralysis-related shoulder abduction and external rotation deficits who underwent a modified Hoffer transfer of the latissimus dorsi/teres major to the greater tubercle of the humerus tendon between 2002 and 2009 were retrospectively analysed. The patients who had undergone neural surgery during infancy were compared to those who had not in terms of their preoperative and postoperative shoulder abduction and external rotation active ranges of motion. In the early surgery groups, only the postoperative external rotation angles showed statistically significant differences (25 degrees and 75 degrees for total and upper type palsies, respectively). Within the palliative surgery-only groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. The significant differences between the early surgery groups and the palliative surgery groups with total palsy during the preoperative period diminished postoperatively (p < 0.05 and p > 0.05, respectively) for abduction but not for external rotation. Within the upper type palsy groups, there were no significant differences between the preoperative and postoperative abduction and external rotation angles. In this study, it was found that in patients with total paralysis, satisfactory shoulder abduction values can
Joffily, Lucia; Vincent, Maurice Borges
Background. Parsonage-Turner syndrome, or neuralgic amyotrophy (NA), is an acute brachial plexus neuritis that typically presents with unilateral shoulder pain and amyotrophy but also can affect other peripheral nerves, including the recurrent laryngeal nerve. Idiopathic vocal fold paralysis (VFP) represents approximately 12% of the VFP cases and recurrence is extremely rare. Methods and Results. We report a man with isolated recurrent unilateral right VFP and a diagnosis of NA years before. Conclusions. We emphasize that shoulder pain and amyotrophy should be inquired in any patient suffering from inexplicable dysphonia, and Parsonage-Turner syndrome should be considered in the differential diagnosis of idiopathic VFP. PMID:24288639
Ohaeri, J U
The supernatural fears associated with the experience of isolated sleep paralysis in the culture of developing countries is sometimes associated with the evolution of somatic symptoms of psychological origin in patients predisposed to neurotic illness. Patients rarely spontaneously volunteer these fears and doctors pay them scant attention. Illustrative case histories that demonstrate the dynamics of the clinical presentation, as well as the treatment approach, are highlighted. It is hoped that doctors in general medical practice and in psychological medicine in developing countries where belief in supernatural causation of illness is rife will consider these factors in order to provide more effective treatment.
Maharaj, J C
This descriptive analytical ten year (1985-1994) retrospective study assessed the pattern of spinal cord paralysis (SCP) in the Fiji Islands utilising medical rehabilitation hospital data. Fiji Islands is an archipelago of 300 islands in the south western Pacific with a multi-ethnic population of over three quarters of a million. Rehabilitation of all SCP is provided at the Medical Rehabilitation Unit (MRU). Data was collected from medical records of new SCP (n = 140) admitted to MRU and analysed with Epi Info 5 assessing associations between cause and other variables. The incidence of new SCP admitted to the MRU was 18.7/million/year. There were 75 (53.6%) traumatic and 65 (46.4%) non-traumatic SCP. The incidence varied according to gender and ethnicity with Fijian male being at the highest (41.85) risk. Amongst traumatic SCP, 38.7% were due to falls, 25.3% motor vehicle accidents, 20% sports, 8% shallow water dive and 4% each deep sea diving and others, whereas among non-traumatic SCP, 52.3% were due to unknown causes, 32.3% infections, 9.2% neoplasms and 6.2% others. The male/female ratio was 4:1. The 16-30 year age group accounted for 35% of SCP. 31% had tetraplegia and 52.1% had complete lesions. The subset of the sample who experienced traumatic SCP were more likely to be employed, aged between 16-30 years at the time of paralysis and to have complete tetraplegia. Those who experienced incomplete paraplegia were more likely to be unemployed, aged 46-60 years and educated to primary level at the time of paralysis. There was a high proportion of complete spinal lesion when compared with other studies. The incidence of secondary complications such as pressure sores and UTI was also found to be high when compared with other studies. The results support the view that young Fijian males are most prone to sustaining traumatic spinal cord paralysis, and that there is a high incidence of secondary preventable complications. The need for preventative measures and
Joannides, Alexis J; Santarius, Thomas; Fernandes, Helen M; Laing, Rodney J C; Trivedi, Rikin A
Local anesthesia is widely used, in isolation or in conjunction with general anesthesia. The authors describe 2 adolescent patients presenting with absent brainstem reflexes and delayed awakening following elective foramen magnum decompression for Chiari Type I malformation. In both cases, neurological deficits were closely associated with the administration of a levobupivacaine field block following wound closure. In the absence of any structural or biochemical abnormalities, and with spontaneous recovery approximating the anesthetic half-life, the authors' observations are consistent with transient brainstem paralysis caused by perioperative local anesthetic infiltration.
Meyer, Martin Willy; Hahn, Christoffer Holst
Bell's palsy is defined as an idiopathic peripheral facial nerve paralysis of sudden onset. It affects 11-40 persons per 100,000 per annum. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement. The aim of this study was to make an overview of which pharmacological treatments have been used to improve outcomes. The available evidence from randomized controlled trials shows significant benefit from treating Bell's palsy with corticosteroids but shows no benefit from antivirals.
Reid, Samuel R; Hetzel, Thomas; Losek, Joseph
Facial palsy is not an uncommon presentation to an emergency department. Whereas most patients will ultimately receive a diagnosis of Bell palsy (idiopathic peripheral seventh cranial nerve palsy), a subset will have an identifiable cause for their facial paralysis. Children are more likely to have an identifiable cause than are adults. We present a case in which a child presented with acute peripheral facial nerve palsy and was found to have temporal bone rhabdomyosarcoma. The key clinical finding was the presence of both 7th and 12th cranial nerve palsy.
Groth, Shawn S; Andrade, Rafael S
Although etiology and pathology of symptomatic diaphragm paralysis and eventration are distinct, their treatments are the same: to reduce dysfunctional caudal excursion of the diaphragm during inspiration by plication. Minimally invasive diaphragm plication techniques have emerged as equally effective and less morbid alternatives to open plication. This review focuses on the etiology, pathophysiology, diagnosis, and treatment of diaphragmatic eventration or paralysis in adults.
Lam, R M K; Tsang, T H F; Chan, K Y; Lau, Y L; Lim, W L; Lam, T H; Leung, N K
To describe the characteristics of patients reported with acute flaccid paralysis between 1997 and 2002, and to evaluate the performance of the acute flaccid paralysis surveillance system using indicators recommended by the World Health Organization. Retrospective study. Department of Health, Hong Kong. Children aged younger than 15 years who were reported to the Department of Health between 1997 and 2002 with acute flaccid paralysis. Of 120 children with acute flaccid paralysis reported between 1997 and 2002, 42% were younger than 5 years of age. None of the cases were acute poliomyelitis or polio-compatible. A neurological cause was identified in 67.5% of cases, of which the most common was Guillain-Barre syndrome (42%), followed by transverse myelitis (15%). All except one of the performance indicators consistently met World Health Organization requirements and thus demonstrated the effectiveness of the acute flaccid paralysis surveillance programme. The acute flaccid paralysis notification rate consistently exceeded 1.0 per 100 000 population below 15 years of age. The requirement for adequate stool investigation was the single indicator that did not satisfy World Health Organization requirements. This highlighted the importance of maintaining physicians' awareness of acute flaccid paralysis surveillance. Hong Kong should remain vigilant for acute flaccid paralysis. The effective surveillance system and its evaluation may serve as a model for surveillance of other infectious diseases.
Kikura, Mutsuhito; Suzuki, Yuji; Itagaki, Taiga; Sato, Tsunehisa; Nishino, Junko
Vocal cord paralysis after tracheal intubation is rare. It causes severe hoarseness and aspiration, and delays recovery and discharge. Arytenoid cartilage dislocation and recurrent nerve paralysis are main causes of vocal cord paralysis. Physical stimulation of the tracheal tube as well as patient and surgical characteristics also contribute. Vocal cord paralysis occurs in 1 (0.07%) of 1,500 general surgery patients and on the left side in 70% of cases. It is associated with surgery/anesthesia time (two-fold, 3-6 hours; 15-fold, over 6 hours), age (three-fold, over 50 years), and diabetes mellitus or hypertension (two-fold). Symptoms resolve in 2-3 months. In adult cardiovascular surgery, vocal cord paralysis occurs in 1 (0.7-2%) of 50-100 cardiac surgery patients and 1 (8.6-32%) of 3-10 thoracic aortic surgery patients. In pediatric cardiac surgery, vocal cord paralysis occurs in 1 (0.1-0.5%) of 200-1,000 patients. We classified the severity of vocal cord paralysis as I, severe hoarseness; II, aspiration or dysphagia; and III, bilateral vocal cord paralysis, aspiration pneumonia, or the need for tracheal re-intubation or tracheotomy. We discuss the importance of informed consent for the patient and family.
McNally, Richard J; Clancy, Susan A
Sleep paralysis typically occurs as individuals awaken from rapid eye movement sleep before motor paralysis wanes. Many episodes are accompanied by tactile and visual hallucinations, often of threatening intruders in the bedroom. Pendergrast [Victims of Memory: Incest Accusations and Shattered Lives, HarperCollins, London, 1996] proposed that individuals who report repressed or recovered memories of childhood sexual abuse (CSA) may misinterpret episodes of sleep paralysis as reemerging fragments of dissociated ("repressed") memories of CSA. To investigate this issue, we administered a sleep paralysis questionnaire to people reporting either repressed (n = 18), recovered (n = 14), or continuous (n = 36) memories of CSA, or to a control group reporting no history of CSA (n = 16). The prevalence of sleep paralysis was: repressed memory group (44%), recovered memory group (43%), continuous memory group (47%), and control group (13%). Among the six individuals in the recovered memory group who had experienced sleep paralysis, one interpreted it as related to sexual abuse (i.e., a rate of 17%). All other participants who had reported sleep paralysis embraced other interpretations (e.g., saw a ghost). Dissociation and depressive symptoms were more common among those who had experienced sleep paralysis than among those who denied having experienced it.
Bothe, Carolina; López, Montserrat; Quer, Miquel; León, Xavier; García, Jacinto; Lop, Joan
To review the aetiology and treatment of laryngeal paralysis diagnosed at our hospital and to describe the available therapeutic options. Retrospective review of medical records of 108 patients diagnosed with unilateral and bilateral vocal fold paralysis between 2000 and 2012, identifying the cause of paralysis and its treatment. Of the 108 cases analysed, 70% had unilateral vocal fold immobility and 30% bilateral immobility. The most frequent aetiology in both cases was trauma (represented mainly by surgical injury), followed by tumours in unilateral paralysis and medical causes in bilateral paralysis. Half of the patients with unilateral paralysis (38) were treated surgically, with medialization thyroplasty. In bilateral vocal fold immobility, the treatment consisted of tracheostomy in patients with threatened airway (40%). We planned to widen the air passage in 9 patients (27%), performing cordectomy in most of them. The aetiology observed in our patients is similar to that described in the literature. In cases of unilateral vocal fold paralysis, we believe thyroplasty is the procedure of choice. In bilateral paralysis, it is possible to perform cordectomy in selected patients once the airway has been secured. Copyright © 2013 Elsevier España, S.L. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.
Benabdellah, A; Souhil, Touati; Farouk, Zaoui Omar
Motor complications after herpes zoster are not uncommon. There have been reports of muscular paralysis following herpes zoster. The association between diaphragmatic paralysis and zoster was first reported in 1949 by Halpern. The case presented below showed diaphragmatic involvement following herpes zoster in a HIV-tuberculosis coinfected patient.
Malik, Vikas; Joshi, Vineeta; Green, Kevin M J; Bruce, Iain A
To present a structured approach for an outpatient consultation of a child with facial paralysis. Review of literature and description of approach followed in our unit. A focused history and examination is key to establish the cause and draw a management plan for paediatric facial paralysis.
Burgmer, Markus; Konrad, Carsten; Jansen, Andreas; Kugel, Harald; Sommer, Jens; Heindel, Walter; Ringelstein, Erich B; Heuft, Gereon; Knecht, Stefan
Dissociative paralysis in conversion disorders has variably been attributed to a lack of movement initiation or an inhibition of movement. While psychodynamic theory suggests altered movement conceptualization, brain activation associated with observation and replication of movements has so far not been assessed neurobiologically. Here, we measured brain activation by functional magnetic resonance imaging during observation and subsequent imitative execution of movements in four patients with dissociative hand paralysis. Compared to healthy controls conversion disorder patients showed decreased activation of cortical hand areas during movement observation. This effect was specific to the side of their dissociative paralysis. No brain activation compatible with movement inhibition was observed. These findings indicate that in dissociative paralysis, there is not only derangement of movement initiation but already of movement conceptualization. This raises the possibility that strategies targeted at reestablishing appropriate movement conceptualization may contribute to the therapy of dissociative paralysis.
Cojan, Yann; Waber, Lakshmi; Schwartz, Sophie; Rossier, Laurent; Forster, Alain; Vuilleumier, Patrik
Brain mechanisms of hypnosis are poorly known. Cognitive accounts proposed that executive attentional systems may cause selective inhibition or disconnection of some mental operations. To assess motor and inhibitory brain circuits during hypnotic paralysis, we designed a go-no-go task while volunteers underwent functional magnetic resonance imaging (fMRI) in three conditions: normal state, hypnotic left-hand paralysis, and feigned paralysis. Preparatory activation arose in right motor cortex despite left hypnotic paralysis, indicating preserved motor intentions, but with concomitant increases in precuneus regions that normally mediate imagery and self-awareness. Precuneus also showed enhanced functional connectivity with right motor cortex. Right frontal areas subserving inhibition were activated by no-go trials in normal state and by feigned paralysis, but irrespective of motor blockade or execution during hypnosis. These results suggest that hypnosis may enhance self-monitoring processes to allow internal representations generated by the suggestion to guide behavior but does not act through direct motor inhibition.
Ludwig, Vera U; Seitz, Jochen; Schönfeldt-Lecuona, Carlos; Höse, Annett; Abler, Birgit; Hole, Günter; Goebel, Rainer; Walter, Henrik
The distinct feeling of wanting to act and thereby causing our own actions is crucial to our self-perception as free human agents. Disturbances of the link between intention and action occur in several disorders. Little is known, however, about the neural correlates of wanting or intending to act. To investigate these for simple voluntary movements, we used a paradigm involving hypnotic paralysis and functional magnetic resonance imaging. Eight healthy women were instructed to sequentially perform left and right hand movements during a normal condition, as well as during simulated weakness, simulated paralysis and hypnotic paralysis of the right hand. Right frontopolar cortex was selectively hypoactivated for attempted right hand movement during simulated paralysis while it was active in all other conditions. Since simulated paralysis was the only condition lacking an intention to move, the activation in frontopolar cortex might be related to the intention or volition to move.
Eliçora, Sultan Şevik; Dinç, Aykut Erdem; Bişkin, Sultan; Damar, Murat; Bilgin, Ergin
Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB) facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT) examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis. PMID:26175920
Eliçora, Sultan Şevik; Dinç, Aykut Erdem; Bişkin, Sultan; Damar, Murat; Bilgin, Ergin
Bilateral facial paralysis caused by bilateral temporal bone fracture is a rare clinical entity, with seven cases reported in the literature to date. In this paper, we describe a 40-year-old male patient with bilateral facial paralysis and hearing loss that developed after an occupational accident. On physical examination, House-Brackmann (HB) facial paralysis of grade 6 was observed on the right side and HB grade 5 paralysis on the left. Upon temporal bone computed tomography (CT) examination, a fracture line exhibiting transverse progression was observed in both petrous temporal bones. Our patient underwent transmastoid facial decompression surgery of the right ear. The patient refused a left-side operation. Such patients require extensive monitoring in intensive care units because the presence of multiple injuries means that facial functions are often very difficult to evaluate. Therefore, delays may ensue in both diagnosis and treatment of bilateral facial paralysis.
Ishihara, T; Hirata, K; Yuki, N; Sato, T
Bilateral facial paralysis(facial diplesia) is often observed in Guillain-Barré syndrome(GBS) and Fisher's syndrome (FS). We tried to observe injured facial nerves using three-dimensional(3-D) MRI in facial diplesia due to GBS and its variants and examined function of blood nerve barrier and clinical use of 3-D MRI for detecting injured facial nerves. In the four patients with GBS and its variants(GBS three cases, FS one case), while routine brain MRI did not show any abnormal findings, contrast-enhanced 3-D MRI revealed Gd-enhancement of the facial nerves. On the other hand, only one case showed visualization using contrast-enhanced 3-D MRI in twelve cases of Bell's palsy. Therefore, it may be presumed that the reason why the significantly higher rate of visualization in facial paralysis in GBS and its variants than in Bell's palsy is attributable to a difference in the mechanism of injury or the extreme seriousness of the disease. In conclusion, the observation of facial nerve using 3-D MRI was very useful to know the condition of the facial diplesia in GBS and its variants.
Revol, M; Servant, J-M
Intrinsic muscles of the fingers are the interosseous, lumbricals and hypothenar muscles. Their main action is metacarpophalangeal (MP) flexion and interphalangeal (IP) extension. If extrinsic muscles remain active, intrinsic paralysis results in a claw deformity: MP hyperextension and IP flexion. Bouvier's test is positive if IP extension is actively possible when MP hyperextension is passively prevented. Surgical operations to correct claw deformity are divided into passive and active palliative procedures. Passive palliative procedures are tenodeses and capsuloplasties. Active palliative procedures have either a proximal action (MP flexion only): lasso and direct interosseous activation, or a distal action (MP flexion and IP extension). When Bouvier's maneuver is positive, a simple claw deformity may be treated by a passive procedure and/or an active palliative with proximal action procedure. This last procedure should be preferably indicated on index and middle finger if a few muscular motors are available. When claw deformity is complicated by MP stiffness in extension, a capsulectomy-capsuloplasty is indicated. When Bouvier's test is negative, and passive IP extension is possible, an active palliative with distal action procedure is indicated. Even when there is no claw deformity, intrinsic paralysis may be treated by an active palliative with proximal action procedure, in order to stabilize pinch and grasp. Capsuloplasties, lassos and interosseous activation procedures were all invented by Eduardo Zancolli.
Kelly, S; Zin, W A; Decramer, M; De Troyer, A
To examine the mechanical effects of the fall in abdominal pressure (Pab) that occurs during inspiration in diaphragmatic paralysis, we studied lung inflation and rib cage expansion before and after the abdomen was opened in nine spontaneously breathing dogs with bilateral phrenicotomy . We measured Pab, tidal volume, and parasternal electromyographic (EMG) activity during quiet breathing and CO2-induced hyperpnea. In six dogs, we also measured changes in anteroposterior and transverse rib cage diameters, the resting length of the parasternal intercostal muscles, and the amount of shortening of these muscles during inspiration. Opening the abdomen caused a marked reduction in the fall in Pab during inspiration and invariably resulted in a decrease in tidal volume (mean decrease, 13%), which contrasted with marked increases in inspiratory rib cage expansion and in the amount of parasternal intercostal shortening. The procedure, however, did not affect the resting length or inspiratory EMG activity of the parasternals . These findings indicate that although the fall in Pab, which occurs during inspiration in diaphragmatic paralysis, causes paradoxical inward displacement of the ventral abdominal wall, it has a salutary effect on tidal volume. This phenomenon is probably due to the fact that the diaphragm is part of the abdominal wall.
Girard, T A; Cheyne, J A
Individual differences were investigated in the lateralisation of two general categories of hypnagogic and hypnopompic hallucinations associated with sleep paralysis: (1) Vestibular-motor (V-M) hallucinations; comprising sensations of floating, flying, illusory locomotion and postural adjustments, out-of-body experiences (OBE), and autoscopy; and (2) Intruder hallucinations; incorporating a sense of the presence, and visual and auditory hallucinations of external, alien agents. Left-right lateralisation of such hallucinations, as well as handedness and footedness, were assessed in a diverse, nonclinical sample of 201 subjects participating in a web-based survey of sleep paralysis experiences. V-M hallucinations, but not Intruder hallucinations were predicted, based on the hypothesised distinctive neural sources of the different hallucinations, to be positively associated with handedness and footedness. Specifically, the predictions were based on the hypothesis that the activation of components of a vestibular, motor, and kinaesthetic bodily-self neuromatrix underlies V-M hallucinations, whereas a threat-activated vigilance system is responsible for Intruder hallucinations. As predicted, limb preferences were consistently found to be significantly and positively associated with a side bias of V-M, but not Intruder, hallucinations.
Yongwei, Pan; Guanglei, Tian; Jianing, Wei; Shuhuan, Wang; Qingtai, Li; Wen, Tian
To present an uncommon lesion of radial nerve paralysis with multiple constrictions. Eight patients were treated in our department between January 1994 and August 2000. There were 4 men and 4 women with a mean age of 26 years (10-43 y). The radial nerves of all patients were explored. There were 1 to 5 segmental constrictive lesions at the main trunks of the radial nerves or the posterior interosseous nerves; no obvious extrinsic compression was noted. Epineurolysis was performed in 3 patients, in the other 5 patients the constricted portions of the nerves were resected, and neurorrhaphy was performed in 2 patients, nerve-grafting in 3. Histologic examination of the resected portions showed concentration of inflammatory cells around the vessels in the perineurium. The patients were followed-up for 6 months to 4 years after surgery. Seven patients had at least grade 4 muscle strength in the involved muscles. One patient who was treated by external neurolysis 15 months after onset had no signs of recovery 10 months after surgery. Nontraumatic paralysis of the radial nerve with multiple constrictions is very uncommon. The etiology may be a focal inflammatory response around the feeding arteries in the perineurium.
Balakrishnan, Vini; Chandy, Zachariah; Hseih, Amy; Bui, Thanh-Lan; Verma, Sunil P
Patients use several online resources to learn about vocal cord paralysis (VCP). The objective of this study was to assess the readability and understandability of online VCP patient education materials (PEMs), with readability assessments and the Patient Education Materials Evaluation Tool (PEMAT), respectively. The relationship between readability and understandability was then analyzed. Descriptive and correlational design. Online PEMs were identified by performing a Google search with the term "vocal cord paralysis." After scientific webpages, news articles, and information for medical professionals were excluded, 29 articles from the first 50 search results were considered. Readability analysis was performed with 6 formulas. Four individuals with different educational backgrounds conducted understandability analysis with the PEMAT. Fleiss's Kappa interrater reliability analysis determined consistency among raters. Correlation between readability and understandability was determined with Pearson's correlation test. The reading level of the reviewed articles ranged from grades 9 to 17. Understandability ranged from 29% to 82%. Correlation analysis demonstrated a strong negative correlation between materials' readability and understandability (r = -0.462, P < .05). Online PEMs pertaining to VCP are written above the recommended reading levels. Overall, materials written at lower grade levels are more understandable. However, articles of identical grade levels had varying levels of understandability. The PEMAT may provide a more critical evaluation of the quality of a PEM when compared with readability formulas. Both readability and understandability should be used to evaluate PEMs. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2016.
López Sousa, M; Pérez Feal, A; Soto, A; Fraga, J M; Couce, M L
Patent ductus arteriosus (PDA) is a common problem in preterm newborns. Left vocal cord paralysis (LVCP) can complicate surgical closure if the recurrent nerve is damaged. A retrospective case series study was conducted on preterm babies diagnosed with PDA in our unit from 1999 to 2013. Their clinical features and treatment complications were reviewed. In those patients that received surgical treatment a telephone questionnaire on the symptoms of LVCP symptoms was completed, and laryncoscopy examination offered. A total of 88 subjects diagnosed with PDA were found, of whom 13.64% (12/88) needed surgery. These patients had a lower gestational age and birth weight. They required mechanical ventilation more frequently, and they had more complications such as, diaphragmatic paralysis, bronchopulmonary dysplasia and intraventricular hemorrhage. One third (3/9) of the surgically treated patients had LVCP, and all of them had dysphonia (100% vs. 16.7%, p=.05). LVCP is a common complication of PDA surgery. Further studies are needed to determine its risk factors and its short and long-term consequences. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.
There is overwhelming evidence that prone sleeping entails more risk of sudden infant death than supine sleeping does. However, no generally accepted biological explanation of this phenomenon has been found. In a viewpoint article in Acta Paediatrica in 1994 the author has re-emphasized that the fear paralysis reflex (tonic immobility) could be a cause of sudden infant death. The response consists of immobility, apnea, profound bradycardia and vasoconstriction. The bradycardia may proceed to irreversible asystole and silent death within a few minutes. In infant monkeys, this innate, atavistic reflex, which is prompted by aversive environmental fear-producing events, has the same age distribution as sudden infant death syndrome between the 2nd and 5th month of life. Main triggering stimuli are: restraint of movement (preventing flight) and sudden exposure to unfamiliar environments and persons, events for which the organism appears to be unprepared. Movements of the extremities are more restrained in the prone than in the supine position with greater chance of eliciting fear paralysis responses and death in prone sleepers. This biological mechanism presumably also applies to the winter peak (restraint due to overwrapping), sleeping outdoors (overwrapping) and co-sleeping in the same bed as another (parent).
Maloney, J A; Mirsky, D M; Messacar, K; Dominguez, S R; Schreiner, T; Stence, N V
Enterovirus D68 was responsible for widespread outbreaks of respiratory illness throughout the United States in August and September 2014. During this time, several patients presented to our institution with acute flaccid paralysis and cranial nerve dysfunction. The purpose of this report is to describe the unique imaging findings of this neurologic syndrome occurring during an enterovirus D68 outbreak. Patients meeting a specific case definition of acute flaccid paralysis and/or cranial nerve dysfunction and presenting to our institution during the study period were included. All patients underwent routine MR imaging of the brain and/or spinal cord, including multiplanar T1, T2, and contrast-enhanced T1-weighted imaging. Eleven patients met the inclusion criteria and underwent MR imaging of the brain and/or spinal cord. Nine patients presented with brain stem lesions, most commonly involving the pontine tegmentum, with bilateral facial nerve enhancement in 1 patient. Ten patients had longitudinally extensive spinal cord lesions; those imaged acutely demonstrated involvement of the entire central gray matter, and those imaged subacutely showed lesions restricted to the anterior horn cells. Ventral cauda equina nerve roots enhanced in 4 patients, and ventral cervical nerve roots enhanced in 3, both only in the subacute setting. Patients presenting with acute flaccid paralysis and/or cranial nerve dysfunction during the recent enterovirus D68 outbreak demonstrate unique imaging findings characterized by brain stem and gray matter spinal cord lesions, similar to the neuroimaging findings described in previous outbreaks of viral myelitis such as enterovirus 71 and poliomyelitis. © 2015 by American Journal of Neuroradiology.
Youssef, Ibrahim; Schurr, Frank; Goulet, Adeline; Cougoule, Nicolas; Ribière-Chabert, Magali; Darbon, Hervé; Thiéry, Richard; Dubois, Eric
Chronic bee paralysis virus (CBPV) causes an infectious and contagious disease of adult honeybees. Its segmented genome is composed of two major positive single-stranded RNAs, RNA 1 (3,674 nt) and RNA 2 (2,305 nt). Three minor RNAs (about 1,000 nt each) have been described earlier but they were not detected by sequencing of CBPV genome. In this study, the results of in vivo inoculation of the two purified CBPV major RNAs are presented and demonstrate that RNA 1 and RNA 2 are infectious. Honeybees inoculated with 109 RNA copies per bee developed paralysis symptoms within 6 days after inoculation. The number of CBPV RNA copies increased significantly throughout the infection. Moreover, the negative strand of CBPV RNA was detected by RT-PCR, and CBPV particles were visualized by electronic microscopy in inoculated honeybees. Taken together, these results show that CBPV RNA 1 and CBPV RNA 2 segments can induce virus replication and produce CBPV virus particles. Therefore, the three minor RNAs described in early studies are not essential for virus replication. These data are crucial for the development of a reverse genetic system for CBPV. PMID:26583154
Brichant, J F; De Troyer, A
1. Paralysis of the diaphragm in the dog is known to cause a compensatory increase in activation of the inspiratory intercostal muscles (parasternal intercostals, external intercostals, and levator costae). The present studies were designed to assess the mechanism(s) of that compensation. 2. Complete, selective diaphragmatic paralysis was induced by injecting local anaesthetic into small silicone cuffs placed around the phrenic nerve roots in the neck. 3. Paralysis produced a decrease in tidal volume and an increase in arterial P(CO2) (P(a,CO2)). The increased hypercapnic drive was a primary determinant of the increased inspiratory intercostal activity. 4. However, paralysis also produced an increased inspiratory cranial displacement of the ribs. When this increased rib displacement was reduced to that seen before paralysis, it appeared that the increase in external intercostal and levator costae inspiratory activity was commonly greater than anticipated on the basis of the increased P(a,CO2). 5. Diaphragmatic paralysis after bilateral vagotomy also elicited disproportionate increases in inspiratory intercostal activity, thus indicating that these increases are not caused by vagal afferent inputs. 6. These observations are consistent with the idea that the intercostal muscle compensation for diaphragmatic paralysis is, in part, due to the release of an inhibition originating from the contracting diaphragm. This inhibition might arise in the diaphragmatic tendon organs. PMID:9097948
Ausk, Brandon J; Worton, Leah E; Smigiel, Kate S; Kwon, Ronald Y; Bain, Steven D; Srinivasan, Sundar; Gardiner, Edith M; Gross, Ted S
Transient muscle paralysis engendered by a single injection of botulinum toxin A (BTxA) rapidly induces profound focal bone resorption within the medullary cavity of adjacent bones. While initially conceived as a model of mechanical disuse, osteoclastic resorption in this model is disproportionately severe compared to the modest gait defect that is created. Preliminary studies of bone marrow following muscle paralysis suggested acute upregulation of inflammatory cytokines, including TNF and IL-1. We therefore hypothesized that BTxA-induced muscle paralysis would rapidly alter the inflammatory microenvironment and the osteoclastic potential of bone marrow. We tested this hypothesis by defining the time course of inflammatory cell infiltration, osteoinflammatory cytokine expression, and alteration in osteoclastogenic potential in the tibia bone marrow following transient muscle paralysis of the calf muscles. Our findings identified inflammatory cell infiltration within 24 hours of muscle paralysis. By 72 hours, osteoclast fusion and pro-osteoclastic inflammatory gene expression were upregulated in tibia bone marrow. These alterations coincided with bone marrow becoming permissive to the formation of osteoclasts of greater size and greater nuclei numbers. Taken together, our data are consistent with the thesis that transient calf muscle paralysis induces acute inflammation within the marrow of the adjacent tibia and that these alterations are temporally consistent with a role in mediating muscle paralysis-induced bone resorption. Copyright © 2017, American Journal of Physiology-Cell Physiology.
Saetti, R; Silvestrini, M; Galiotto, M; Derosas, F; Narne, S
Vocal fold paralysis is a pathological condition characterised by varying degrees of respiratory distress in relation to the degree of glottic stenosis. Dyspnoea may be present even when resting and may even require emergency tracheotomy. Frequently, the patient arrives for attention after the onset of exertional dyspnoea associated with a certain degree of dysphonia. The causes may be central or peripheral, more commonly iatrogenic following thyroid or tracheal surgery or secondary to injury. The aim of all surgical techniques used in the treatment of vocal fold paralysis is to restore a lumen sufficient to guarantee adequate breathing through the natural airway, without the patient having to permanently maintain the tracheotomy tube, while preserving acceptable phonatory quality. Between 1990 and 2001, at the Padua Hospital Unit of Endoscopic Airway Surgery, 48 patients (27 female, 21 male) were treated for respiratory distress secondary to vocal fold paralysis. At the beginning of this experience, 7 patients underwent arytenoidectomy with the Ossoff technique. In 34 cases, a modified Dennis-Kashima posterior cordectomy was performed. In 7 patients, since widening of the airway was necessary, cordectomy was extended to the false homolateral chord in 5 cases and to the arytenoid vocal process in another 2. In 9 patients, the operation was carried out with a Nd Yag (1064 nm) contact laser; the remaining 39 were treated with a GaArAl (810 nm) diode laser in use since 1995. Satisfactory results were obtained in all patients first treated by us and not already tracheotomised (35). In 23 cases (66%), results were considered "good" since no exertional dyspnoea occurred. In 12 patients (34%), the result was considered "sufficient" since there was no resting dyspnoea and normal everyday activity could be undertaken. Of the 13 patients already tracheotomised on arrival, 11 (85%) were decanulated on average 2 months after surgery. In conclusion, the present results show
Birbaumer, Niels; Piccione, Francesco; Silvoni, Stefano; Wildgruber, Moritz
The paper presents some speculations on the loss of voluntary responses and operant learning in long-term paralysis in human patients and curarized rats. Based on a reformulation of the ideomotor thinking hypothesis already described in the 19th century, we present evidence that instrumentally learned responses and intentional cognitive processes extinguish as a consequence of long-term complete paralysis in patients with amyotrophic lateral sclerosis (ALS). Preliminary data collected with ALS patients during extended and complete paralysis suggest semantic classical conditioning of brain activity as the only remaining communication possibility in those states.
Lange, B; Langer, C; Markus, P M; Becker, H
Totally extraperitoneal preparation (TEP) of an inguinal hernia is an established method of treating inguinal hernias associated with an acceptable complication rate (2-12%) and low rate of recurrence (0-3%). This is the first reported case of sensorimotor paralysis of the femoral nerve following the complete endoscopic mesh treatment of a primary inguinal hernia to the left side. Following a discussion of the necessary diagnostic and therapeutic steps, traumatic postsurgical paralysis of the nerve as well as spontaneous paralysis of the femoral nerve are discussed. The prognosis is positive given the lack of macroscopic evidence of any direct damage to the nerve.
Calcaterra, T C; Rand, R W; Bentson, J R
Numerous causes of peripheral facial nerve paralyses have been described; however, none has satisfactorily explained the genesis of the most common type of paralysis, Bell's palsy. Two patients undergoing an experimental embolization of vascular intracranial tumors suffered a total peripheral facial nerve paralysis when occlusion of the middle meningeal artery had been accomplished. It is speculated that this paralysis resulted from ischemia of the horizontal portion of the facial nerve, an observation that has not previously been described and that might be applicable as well to the etiology of Bell's palsy.
Vachha, Behroze; Cunnane, Mary Beth; Mallur, Pavan; Moonis, Gul
Neurogenic compromise of vocal fold function exists along a continuum encompassing vocal cord hypomobility (paresis) to vocal fold immobility (paralysis) with varying degrees and patterns of reinnervation. Vocal fold paralysis (VFP) may result from injury to the vagus or the recurrent laryngeal nerves anywhere along their course from the brainstem to the larynx. In this article, we review the anatomy of the vagus and recurrent laryngeal nerves and examine the various etiologies of VFP. Selected cases are presented with discussion of key imaging features of VFP including radiologic findings specific to central vagal neuropathy and peripheral recurrent nerve paralysis. PMID:23814687
To observe clinical therapeutic effects of different acupuncture times on peripheral facial paralysis. Forty-nine cases of peripheral facial paralysis were randomly divided into 2 groups, group A and B. The group A received acupuncture, once daily, and the group B twice each week. Their therapeutic effects were assessed after 3 courses. The acupuncture times were not direct proportion to the therapeutic effect (P<0.01), with no significant difference between the two groups in the cured rate (P>0.05). Acupuncture treatment can select twice each week for peripheral facial paralysis.
Yeung, Albert; Xu, Yong; Chang, Doris F
To investigate the prevalence and illness beliefs of sleep paralysis (SP) among Chinese patients in a psychiatric out-patient clinic, consecutive Chinese/Chinese-American patients who attended psychiatric out-patient clinics in Boston and Shanghai were asked about their lifetime prevalence, personal experience and perceptions regarding the causes, precipitating factors, consequences, and help-seeking of SP. During the 4-month study period, 42 non-psychotic psychiatric out-patients from the Boston site and 150 patients from the Shanghai site were interviewed. The prevalence of SP was found to be 26.2% in Boston and 23.3% in Shanghai. Patients with post-traumatic stress disorder (PTSD) or panic disorder reported a higher prevalence of SP than did patients without these disorders. Patients attributed SP to fatigue, stress, and other psychosocial factors. Although the experience has traditionally been labeled 'ghost oppression' among the Chinese, only two patients, one from each site, endorsed supernatural causes of their SP. Sleep paralysis is common among Chinese psychiatric out-patients. The endorsement of supernatural explanations for SP is rare among contemporary Chinese patients.
Datta, Siddhartha Sankar; Ropa, Berry; Sui, Gerard Pai; Khattar, Ramzi; Krishnan, Ravi Shankar Santhana Gopala; Okayasu, Hiromasa
High quality acute flaccid paralysis (AFP) surveillance is required to maintain polio-free status of a country. Papua New Guinea (PNG) is considered as one of the highest risk countries for polio re-importation and circulation in the Western Pacific Region (WPRO) of the World Health Organization due to poor healthcare infrastructure and inadequate performance in AFP surveillance. The Government of PNG, in collaboration with WHO, piloted the introduction of short-message-service (SMS) to sensitize pediatricians and provincial disease control officers on AFP and to receive notification of possible AFP cases to improve surveillance quality in PNG. Ninety six health care professionals were registered to receive SMS reminders to report any case of acute flaccid paralysis. Fourteen SMS messages were sent to each participant from September 2012 to November 2013. The number of reported AFP cases were compared before and after the introduction of SMS. Two hundred fifty three unique responses were received with an overall response rate of 21 %. More than 80 % of responses were reported within 3 days of sending the SMS. The number of reported AFP cases increased from 10 cases per year in 2009-2012 to 25 cases per year during the study period and correlated with provincial participation of the health care professionals. Combined with improved sensitization of health care professionals on AFP reporting criteria and sample collection, SMS messaging provides an effective means to increase timely reporting and improve the availability of epidemiologic information on polio surveillance in PNG.
Otto, Michael W; Simon, Naomi M; Powers, Mark; Hinton, Devon; Zalta, Alyson K; Pollack, Mark H
Initial research suggests that rates of isolated sleep paralysis (ISP) are elevated in individuals with panic disorder and particularly low in individuals with other anxiety disorders. To further evaluate these findings, we examined rates of ISP in a sample outpatients with primary diagnoses of panic disorder (n=24), social anxiety disorder (n=18), or generalized anxiety disorder (n=18). We obtained an overall rate of ISP of 19.7%; rates for patients with panic disorder (20.8%) fell between those with generalized anxiety disorder (15.8%) and social phobia (22.2%). Analysis of comorbidities failed to provide evidence of link between depressive disorders and ISP, but did indicate a significant association between anxiety comorbidity and higher rates of ISP. Results are discussed relative to other variables predicting variability in the occurrence of ISP.
Mansat, M; Bonnevialle, P; Fine, X; Guiraud, B; Testut, M F
Seventeen cases of late ulnar paralysis treated by neurolysis-transposition are reported. The clinical characteristics of these paralyses are emphasized: very prolonged symptom free interval, rapid onset and severe involvement. Ulnar transposition was most often done subcutaneously. Cubitus valgus and definite nerve compression proximal to the arcade of the flexor carpi ulnaris muscle are almost always present. The results as regards the neuropathy are undependable: no patient is completely cured and only half are improved. An anatomical study of the nerve path shows the essential role, in the compression of the nerve, of the muscular arcade of the flexor carpi ulnaris muscle which acts in a way similar to the bridge of a violin. Hence, opening it longitudinally is the principal step of neurolysis. This should be routine before the first signs of neuropathy occur in an elbow whose axis is out of alignment as a sequela of a childhood injury.
He, Yong; Pan, Hao; Xu, Hanbin
Professor SONG Nanchang's clinical experience and characteristics for treatment of peripheral facial paralysis are introduced. In clinical treatment, professor SONG has adopted staging treatment strategy, and performed acupuncture stimulation with different levels. He attaches great importance to the acupoint selection on distal limbs. For the treatment on the face, he takes temperature as necessity; he inherits from famous Chinese doctor ZONG Ruilin's acupuncture technique of slow-twisting and gentle-pressing. Meanwhile, he excels in combination, of different therapies, using acupuncture, moxibustion, electroacupuncture, auricular point sticking, Chinese herbal medicine, etc. according to individual condition and disease stages. He also emphasizes on psychological counseling and daily life care to achieve rehabilitation within the shortest time.
Googe, Benjamin; Nida, Andrew; Schweinfurth, John
A 77-year-old female with bilateral vocal cord paralysis and dependent tracheostomy status after total thyroidectomy presented to clinic for evaluation of decannulation via arytenoidectomy. Preliminary data suggests coblation versus standard CO2 laser ablation in arytenoidectomy may provide benefits in terms of decreased tissue necrosis and patient outcome. The patient elected to proceed with arytenoidectomy by coblation. The initial procedure went well but postoperative bleeding required a return trip to the operating room for hemostasis. In the coming months the patient's tracheostomy tube was gradually downsized and eventually capped. She was decannulated eight months after surgery, speaking well and without complaints. Details of the surgical procedure and outcome will be discussed. PMID:26457217
Zuker, R M
Facial paralysis can have significant functional, psychological and aesthetic concerns that alter the lives of our patients. These effects can be functional, affecting the eye, nose and mouth, or aesthetic, affecting the symmetry of the face and particularly the mimetic function of smile. Several reanimation procedures have been described to address this. In this chapter, we will outline our technique for reanimation utilizing segmental gracilis muscle transplants to the face. These are innervated either by the contralateral normal 7th nerve via a cross face nerve graft, or a different ipsilateral motor where no 7th nerve is available or would not produce the required result. The other ipsilateral motor that we have found extremely effective is the motor nerve to masseter. This can power a segmental gracilis muscle transplant and lead to excursion that is near normal. These techniques will be described in detail.
Atkins, R M; Bell, M J; Sharrard, W J
Seven pectoralis major transfers in children suffering from bilateral paralysis of elbow flexion due to arthrogryposis or to trauma are reported. A technique is described in which the muscle is mobilised from the clavicle to allow the tendon of insertion to be attached to the biceps tendon at the elbow. The biceps tendon was found to be present and could be mobilised forwards in all the arthrogrypotic elbows. Subjectively, the results were considered by patients or parents to be very good in six cases and fair in one. Elbow flexion power against gravity and against some resistance was achieved in all patients except one. The overall function was very good in one elbow, good in two, fair in three and poor in only one. The merits of the various procedures described for the restoration of elbow flexion in arthrogryposis are discussed. It is concluded that total pectoralis major transfer by the method described here has given the best results.
Ramadan, H H; Wax, M K; Avery, S
Unilateral vocal cord paralysis (UVCP) is relatively common, and previously, thyroidectomy used to be the leading cause. We retrospectively reviewed 98 cases of UVCP. The left vocal cord was involved in 70% of the cases and the right vocal cord in 30%. The cause was neoplastic in 32%, surgical in 30%, idiopathic in 16%, traumatic in 11%, central in 8%, and infectious in 3% of the cases. Only 4 cases were the result of thyroid surgery. Evaluation consisted of a review of the history, a physical examination, and computerized scanning or magnetic resonance imaging, as needed. The functional recovery rate as related to the cause was as follows: surgery 31%, idiopathic 19%, traumatic 18%, and neoplastic 0%. Thirty-five percent of patients required medialization laryngoplasty or Teflon injection. Lung and skull base tumors and their surgical treatment are the most common causes of UVCP.
Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro
Although in most cases Bell palsy resolves spontaneously, approximately one-third of patients will present sequela including facial synkinesis and paresis. Currently, the techniques available for reanimation of these patients include hypoglossal nerve transposition, free muscle transfer, and cross-face nerve grafting (CFNG). Between December 2008 and March 2012, eight patients with incomplete unilateral facial paralysis were reanimated with two-stage CFNG. Gender, age at surgery, etiology of paralysis denervation time, donor and recipient nerves, presence of facial synkinesis, and follow-up were registered. Commissural excursion and velocity and patient satisfaction were evaluated with the FACIAL CLIMA and a questionnaire, respectively. Mean age at surgery was 33.8 ± 11.5 years; mean time of denervation was 96.6 ± 109.8 months. No complications requiring surgery were registered. Follow-up period ranged from 7 to 33 months with a mean of 19 ± 9.7 months. FACIAL CLIMA showed improvement of both commissural excursion and velocity greater than 75% in 4 patients, greater than 50% in 2 patients, and less than 50% in the remaining two patients. Qualitative evaluation revealed a high grade of satisfaction in six patients (75%). Two-stage CFNG is a reliable technique for reanimation of incomplete facial paralysis with a high grade of patient satisfaction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Reiter, R; Pickhard, A; Smith, E; Hansch, K; Weber, T; Hoffmann, T K; Brosch, S
Vocal cord paralysis has diverse etiologies. In the present study, vocal chord paralysis caused by surgery/trauma was present in more than two thirds of the cases, followed by primary malignancy-associated paralysis. Thyroidectomy was the most common cause in bilateral paresis, especially if performed in recurrent or malignant disease. Voice therapy was promising in pa-tients with unilateral paresis and hoarseness as main symptom. Persistent dysphonia due to insufficiency of the glottic closure led to an operative glottis restricting procedure in only 6% of cases. In almost half the patients with dyspnea as the main symp-tom of bilateral vocal cord paresis, temporary tracheotomy or surgical glottis widening procedures had to be performed. The group of idiopathic and traumatic paresis patients showed the best spontaneous recovery within the first 12 months in comparison to primary malignancy-associated paralysis, which showed no recovery of the recurrens nerve.
Rasmussen, Eva Rye; Mey, Kristianna
Ramsay Hunt syndrome is defined by herpes zoster oticus and peripheral facial nerve palsy which is often associated with otalgia. The syndrome is, in rare cases, associated with other cranial nerve paralyses including the vagal nerve causing unilateral vocal cord paralysis. Vocal cord paralysis is more often seen as a symptom of various other diseases, that is, malignant tumours, neurodegenerative illness, cerebrovascular assaults, inflammatory processes or as a result of intubation or surgical procedures. The symptoms of unilateral vocal cord paralysis are mainly hoarseness, dyspnoea and dysphagia. We present a case of Ramsay Hunt syndrome combined with unilateral hearing loss and left vocal cord paralysis. The patient underwent MRI, CT and a lumbar puncture causing anxiety in the patient and delaying the initiation of antiviral and anti-inflammatory treatment, which is only efficient when initiated within 72 h. We hope to raise the awareness of this disease. PMID:24503657
Golzari, Samad Ej; Khodadoust, Kazem; Alakbarli, Farid; Ghabili, Kamyar; Islambulchilar, Ziba; Shoja, Mohammadali M; Khalili, Majid; Abbasnejad, Feridoon; Sheikholeslamzadeh, Niloufar; Shahabi, Nasrollah Moghaddam; Hosseini, Seyed Fazel; Ansarin, Khalil
Among the first three manuscripts written in Persian, Akhawayni's Hidayat al-muta'allemin fi al-tibb was the most significant work compiled in the 10th century. Along with the hundreds of chapters on hygiene, anatomy, physiology, symptoms and treatments of the diseases of various organs, there is a chapter on sleep paralysis (night-mare) prior to description and treatment of epilepsy. The present article is a review of the Akhawayni's teachings on sleep paralysis and of descriptions and treatments of sleep paralysis by the Greek, medieval, and Renaissance scholars. Akhawayni's descriptions along with other early writings provide insight into sleep paralysis during the Middle Ages in general and in Persia in particular.
Dai, Alper I; Demiryürek, Seniz
The aim of this study was to describe the clinical and electroencephalographic (EEG) findings of postictal Todd paralysis in benign rolandic epilepsy of childhood and find out the possible correlation with migraine. Based on International Headache Society pediatric migraine criteria, patients were investigated for migraine, and 12 of the 108 patients with benign rolandic epilepsy (6 girls and 6 boys, 11.1%) were found to have postictal Todd paralysis. Ten of these 12 patients (83.3%) had pediatric migraine based on the diagnostic criteria. We showed comorbidity of migraine and benign rolandic epilepsy with postictal Todd paralysis in children. Increased incidence of migraine in the present study suggest that children who have benign rolandic epilepsy and postictal Todd paralysis are more likely to have migraines.
Golzari, Samad EJ; Khodadoust, Kazem; Alakbarli, Farid; Ghabili, Kamyar; Islambulchilar, Ziba; Shoja, Mohammadali M; Khalili, Majid; Abbasnejad, Feridoon; Sheikholeslamzadeh, Niloufar; Shahabi, Nasrollah Moghaddam; Hosseini, Seyed Fazel; Ansarin, Khalil
Among the first three manuscripts written in Persian, Akhawayni’s Hidayat al-muta’allemin fi al-tibb was the most significant work compiled in the 10th century. Along with the hundreds of chapters on hygiene, anatomy, physiology, symptoms and treatments of the diseases of various organs, there is a chapter on sleep paralysis (night-mare) prior to description and treatment of epilepsy. The present article is a review of the Akhawayni’s teachings on sleep paralysis and of descriptions and treatments of sleep paralysis by the Greek, medieval, and Renaissance scholars. Akhawayni’s descriptions along with other early writings provide insight into sleep paralysis during the Middle Ages in general and in Persia in particular. PMID:22701323
Harris, Kassem; Maniatis, Gregory; Siddiqui, Faraz; Maniatis, Theodore
Diaphragmatic paralysis (DP) is a common condition. It can be unilateral or bilateral and the diagnosis is usually based on a clinical and radiological findings. Bilateral diaphragmatic paralysis is usually symptomatic with dyspnea and acute respiratory failure while unilateral diaphragmatic paralysis is typically asymptomatic and when present, symptoms usually depend on the presence of underlying pulmonary or neurologic disease. DP can be the result of various chest conditions that affect the phrenic nerve such as tumors, vascular abnormalities or traumatic incidents during surgery as well as blunt or penetrating chest or neck injuries. We report a unique case of phrenic nerve injury and unilateral diaphragmatic paralysis secondary to pacemaker pulse generator replacement that was successfully treated with diaphragmatic plication. Copyright © 2013 Elsevier Inc. All rights reserved.
Özkale, Yasemin; Erol, İlknur; Saygı, Semra; Yılmaz, İsmail
Peripheral facial nerve paralysis in children might be an alarming sign of serious disease such as malignancy, systemic disease, congenital anomalies, trauma, infection, middle ear surgery, and hypertension. The cases of 40 consecutive children and adolescents who were diagnosed with peripheral facial nerve paralysis at Baskent University Adana Hospital Pediatrics and Pediatric Neurology Unit between January 2010 and January 2013 were retrospectively evaluated. We determined that the most common cause was Bell palsy, followed by infection, tumor lesion, and suspected chemotherapy toxicity. We noted that younger patients had generally poorer outcome than older patients regardless of disease etiology. Peripheral facial nerve paralysis has been reported in many countries in America and Europe; however, knowledge about its clinical features, microbiology, neuroimaging, and treatment in Turkey is incomplete. The present study demonstrated that Bell palsy and infection were the most common etiologies of peripheral facial nerve paralysis.
Reiter, Rudolf; Pickhard, Anja; Sander, Sylvia; Brosch, Sibylle
To analyze the prognostic relevance of mucosal waves (MWs) for recovery of unilateral vocal fold paralysis (UVP). The charts and stroboscopic examinations of 100 consecutive patients with a complete UVP were reviewed retrospectively. All had a minimal (estimated <3 mm) mucosal gap on stroboscopy. A positive or negative MW on the paralyzed vocal fold was associated with complete recovery to full adduction and abduction. All patients were followed for at least 12 months. Causes of the paralysis were iatrogenic/traumatic (n = 82), malignancy associated (n = 10), and idiopathic (n = 8). In patients with positive MW at diagnosis (n = 80), the chance of recovery of unilateral vocal fold paralysis was 91.25%, whereas the chance of recovery with a negative mucosal wave (n = 20) was only 10%. Positive MWs in stroboscopy are a predictor for recovery of (iatrogenic/traumatic) unilateral vocal fold paralysis and should be used in routine diagnostic assessment. © The Author(s) 2015.
Méndez Garrido, S; Ocete Pérez, R F
The vocal cords play a key role in the functions of the larynx. Their motor innervation depends on the recurrent laryngeal nerve (a branch of the tenth cranial nerve), which follows a long trajectory comprising intracranial, cervical, and mediastinal segments. Vocal cord paralysis usually manifests as dysphonia, the main symptom calling for CT study, the first-line imaging test to investigate the cause of the lesion. Patients are asymptomatic in a third of cases, so the incidental detection of signs of vocal cord paralysis in a CT study done for other reasons should prompt a search for a potentially severe occult lesion. This article aims to familiarize readers with the anatomy of the motor innervation of the glottis, the radiological presentation and most common causes of vocal cord paralysis, and conditions that can simulate vocal cord paralysis.
Koppel, R.; Friedman, S.; Fallet, S.
We describe an infant with congenital vocal cord paralysis born to consanguineous parents. While autosomal dominant and X-linked inheritance have been previously reported in this condition, we conclude that the degree of parental consanguinity in this case strongly suggests autosomal recessive inheritance. Although we cannot exclude X-linked inheritance, evidence from animal studies demonstrates autosomal recessive inheritance and provides a possible molecular basis for congenital vocal cord paralysis. 14 refs., 1 fig.
Alfonso Suárez, S
The relationship between isolated paralysis and panic disorder in adults is analyzed in this study. The patients included in this work presented anxiety disorder with agoraphobia and were compared with a group of normal controls. The percentage of patients with sleep paralysis was 40% significantly higher than those encountered in the control group (20%). The existence of this syndrome do not seem to modify the clinical manifestation or severity of panic disorder.
Kumar, S; Anantham, J; Wan, Z
One case of traumatic rupture of the iliacus muscle associated with a femoral nerve paralysis is described. The clinical picture was characterized by posttraumatic gradual worsening of pain in the groin, a tender mass in the iliac fossa, flexion deformity of the hip, and femoral nerve paralysis. The review of literature revealed a description of only nine similar cases. Early evacuation of the hematoma is suggested.
Cojan, Yann; Archimi, Aurélie; Cheseaux, Nicole; Waber, Lakshmi; Vuilleumier, Patrik
Cognitive hypotheses of hypnotic phenomena have proposed that executive attentional systems may be either inhibited or overactivated to produce a selective alteration or disconnection of some mental operations. Recent brain imaging studies have reported changes in activity in both medial (anterior cingulate) and lateral (inferior) prefrontal areas during hypnotically induced paralysis, overlapping with areas associated with attentional control as well as inhibitory processes. To compare motor inhibition mechanisms responsible for paralysis during hypnosis and those recruited by voluntary inhibition, we used electroencephalography (EEG) to record brain activity during a modified bimanual Go-Nogo task, which was performed either in a normal baseline condition or during unilateral paralysis caused by hypnotic suggestion or by simulation (in two groups of participants, each tested once with both hands valid and once with unilateral paralysis). This paradigm allowed us to identify patterns of neural activity specifically associated with hypnotically induced paralysis, relative to voluntary inhibition during simulation or Nogo trials. We used a topographical EEG analysis technique to investigate both the spatial organization and the temporal sequence of neural processes activated in these different conditions, and to localize the underlying anatomical generators through minimum-norm methods. We found that preparatory activations were similar in all conditions, despite left hypnotic paralysis, indicating preserved motor intentions. A large P3-like activity was generated by voluntary inhibition during voluntary inhibition (Nogo), with neural sources in medial prefrontal areas, while hypnotic paralysis was associated with a distinctive topography activity during the same time-range and specific sources in right inferior frontal cortex. These results add support to the view that hypnosis might act by enhancing executive control systems mediated by right prefrontal areas, but
Fujioka, Hiroyuki; Tsunemi, Kenjiro; Tsukamoto, Yoshitane; Oi, Takanori; Takagi, Yohei; Tanaka, Juichi; Yoshiya, Shinichi
We report a rare case of posterior interosseous nerve (PIN) paralysis in a tennis player. The PIN, a 2 cm section from a bifurcation point of the radial nerve, presented increased stiffness in the surgical findings and treated with free sural nerve grafting after excision of the degenerative portion of the PIN. We speculate that PIN paralysis associated with hourglass-like constriction can be caused and exacerbated by repetitive forearm pronation and supination in playing tennis.
Fujioka, Hiroyuki; Tsunemi, Kenjiro; Tsukamoto, Yoshitane; Oi, Takanori; Takagi, Yohei; Tanaka, Juichi; Yoshiya, Shinichi
We report a rare case of posterior interosseous nerve (PIN) paralysis in a tennis player. The PIN, a 2 cm section from a bifurcation point of the radial nerve, presented increased stiffness in the surgical findings and treated with free sural nerve grafting after excision of the degenerative portion of the PIN. We speculate that PIN paralysis associated with hourglass-like constriction can be caused and exacerbated by repetitive forearm pronation and supination in playing tennis. PMID:25104896
Lysyk, T J; Dergousoff, S J
Cattle and sheep can develop immunity to paralysis caused by Dermacentor andersoni Stiles; however, this has been reported only in animals that were initially challenged with a high dose of ticks and exhibited clear symptoms of paralysis. Paralysis in sheep occurs in a dose-dependent fashion, with no paralysis occurring in sheep exposed to <0.2 ticks per kilogram sheep weight, and 100% paralysis in sheep exposed to >0.8 ticks per kilogram. This experiment was conducted to determine if sheep exposed to a low dose of ticks would also develop immunity to paralysis. Sheep were exposed to either a low (0.2 ticks per kilogram) or high dose of ticks (0.8 ticks per kilogram), then re-exposed to a second challenge of a paralyzing dose of ticks. All naïve sheep (eight of the eight) were paralyzed, while paralysis occurred in only four of the eight sheep previously exposed to a low dose, and one of the eight sheep previously exposed to a high dose. Results indicate that immunity can develop when sheep are exposed to a subclinical dose of paralyzing ticks, but in a smaller percentage of animals than those exposed to a high dose of ticks. Vaccine development perhaps remains the best option for nonacaricidal control of tick paralysis. © Her Majesty the Queen in Right of Canada, as represented by the Minister of Agriculture and Agri-Food Canada 2016. Published by Oxford University Press on behalf of Entomological Society of America. All rights reserved. For Permissions, please email: email@example.com.
Tang, Yan; Zheng, Li-juan; Yin, Li-li
This paper introduce the professor WU Lian-zhong's clinical experience in acupuncture treatment for facial paralysis. Professor WU emphasizes the treatment based on syndrome differentiation. The appropriate theory, method, prescription and acupoints should be applied according to observing the subtle details of syndromes and differentiating the state of diseases development, so as to obtain effectiveness, to shorten the duration of treatment course and to reduce sequelae. The concrete methods of prognosis diagnosis for facial paralysis and three effective cases are introduced.
Misiolek, Maciej; Namyslowski, Grzegorz; Karpe, Jacek; Ziora, Dariusz; Misiolek, Hanna; Czecior, Eugeniusz; Scierski, Wojciech
The analysis of the correlation between bilateral vocal cord paralysis and the occurrence of obstructive sleep apnea syndrome and snoring is presented. The aim of the study was to establish whether the decrease of the air flow in the upper airway in patients with bilateral vocal cord paralysis involves OSAS and/or snoring occurrence and whether arytenoidectomy affects an improvement of breathing parameters measured during sleep. Fourteen patients with bilateral vocal cord paralysis underwent Poly-MESAM examination before and 3 months after arytenoidectomy. They had never complained of snoring before. The Epworth sleepiness scale was used to quantify excessive daytime somnolence. The RDI, DI, mean saturation and percentage of snoring, loud snoring and sleep without snoring were estimated and compared pre- and postoperatively. The results were compared by the Student's t-test for dependent values. No significant differences were shown between the Epworth scores before and after the treatment. The RDI, DI and mean saturation were normal before and after the operation. The percentage of loud snoring decreased and the percentage of sleep without snoring increased significantly after arytenoidectomy in both cases. The mechanism of snoring in patients with vocal cord paralysis seems to be similar to OSAS. The difference consists in the level of flow limitation. On the basis of the results there is no reason to diagnose OSAS and UARS in patients with bilateral vocal cord paralysis. On the other hand, the intensive snoring that occurs after paralysis was significantly reduced as a result of arytenoidectomy.
Brooks, Patricia L; Peever, John H
During REM sleep the CNS is intensely active, but the skeletal motor system is paradoxically forced into a state of muscle paralysis. The mechanisms that trigger REM sleep paralysis are a matter of intense debate. Two competing theories argue that it is caused by either active inhibition or reduced excitation of somatic motoneuron activity. Here, we identify the transmitter and receptor mechanisms that function to silence skeletal muscles during REM sleep. We used behavioral, electrophysiological, receptor pharmacology and neuroanatomical approaches to determine how trigeminal motoneurons and masseter muscles are switched off during REM sleep in rats. We show that a powerful GABA and glycine drive triggers REM paralysis by switching off motoneuron activity. This drive inhibits motoneurons by targeting both metabotropic GABA(B) and ionotropic GABA(A)/glycine receptors. REM paralysis is only reversed when motoneurons are cut off from GABA(B), GABA(A) and glycine receptor-mediated inhibition. Neither metabotropic nor ionotropic receptor mechanisms alone are sufficient for generating REM paralysis. These results demonstrate that multiple receptor mechanisms trigger REM sleep paralysis. Breakdown in normal REM inhibition may underlie common sleep motor pathologies such as REM sleep behavior disorder.
van de Graaf, R C; IJpma, F F A; Nicolai, J-P A; Werker, P M N
Bell's palsy is the eponym for idiopathic peripheral facial paralysis. It is named after Sir Charles Bell (1774-1842), who, in the first half of the nineteenth century, discovered the function of the facial nerve and attracted the attention of the medical world to facial paralysis. Our knowledge of this condition before Bell's landmark publications is very limited and is based on just a few documents. In 1804 and 1805, Evert Jan Thomassen à Thuessink (1762-1832) published what appears to be the first known extensive study on idiopathic peripheral facial paralysis. His description of this condition was quite accurate. He located several other early descriptions and concluded from this literature that, previously, the condition had usually been confused with other afflictions (such as 'spasmus cynicus', central facial paralysis and trigeminal neuralgia). According to Thomassen à Thuessink, idiopathic peripheral facial paralysis and trigeminal neuralgia were related, being different expressions of the same condition. Thomassen à Thuessink believed that idiopathic peripheral facial paralysis was caused by 'rheumatism' or exposure to cold. Many aetiological theories have since been proposed. Despite this, the cold hypothesis persists even today.
Engin, A; Elaldi, N; Bolayir, E; Dokmetas, I; Bakir, M
Tick paralysis is a disease that occurs worldwide. It is a relatively rare but potentially fatal condition. The only way to establish the diagnosis is to carefully search for the tick paralysis. It is caused by a neurotoxin secreted by engorged female ticks. Tick paralysis generally begins in the lower extremities and ascends symmetrically to involve the trunk, upper extremities and head within a few hours. Although early‐onset prominent bulbar palsy and isolated facial weakness without generalised paralysis are rare, there is no report in the English literature concerning isolated, reversible involvement of the upper trunk of brachial plexus caused by tick bite. We report a case of isolated, reversible involvement of the upper trunk of brachial plexus as a variant of tick paralysis. Diagnosis was confirmed with needle electromyography and nerve conduction examination. Within 2 weeks, the patient was fully recovered. The purpose of presenting this case is to remind clinicians that tick paralysis should be considered even in cases with atypical neurological findings admitted to the emergency department. PMID:16794084
Engin, A; Elaldi, N; Bolayir, E; Dokmetas, I; Bakir, M
Tick paralysis is a disease that occurs worldwide. It is a relatively rare but potentially fatal condition. The only way to establish the diagnosis is to carefully search for the tick paralysis. It is caused by a neurotoxin secreted by engorged female ticks. Tick paralysis generally begins in the lower extremities and ascends symmetrically to involve the trunk, upper extremities and head within a few hours. Although early-onset prominent bulbar palsy and isolated facial weakness without generalised paralysis are rare, there is no report in the English literature concerning isolated, reversible involvement of the upper trunk of brachial plexus caused by tick bite. We report a case of isolated, reversible involvement of the upper trunk of brachial plexus as a variant of tick paralysis. Diagnosis was confirmed with needle electromyography and nerve conduction examination. Within 2 weeks, the patient was fully recovered. The purpose of presenting this case is to remind clinicians that tick paralysis should be considered even in cases with atypical neurological findings admitted to the emergency department.
Wang, Sheng-qiang; Bai, Ya-ping; Dong, You-xin
To raise some problems in the literature of acupuncture and moxibustion for treatment of peripheral facial paralysis and improving suggestions. The CHKD system was used to search out 817 papers of acupuncture for treatment of peripheral facial paralysist, which were reviewed, organized and summarized. In the literature of acupuncture for treatment of peripheral facial paralysis, insufficient understanding in the relative information of clinical data, naming of intractable facial paralysis, differentiation between of the sequelae and complications, the criteria or cproblems in the literature and so on were found. There are some common and representative problems in these papers of acupuncture for treatment of peripheral facial paralysis, which may result in incorrect opinion about the theory and clinical study of acupuncture for treatment of peripheral facial paralysis. Sufficiently considering and resolving the above problems can not only improve the quality of the papers on acupuncture for treatment of peripheral facial paralysis as a whole, but also have active influence on both treatment and diagnosis of this disease.
D'Errico, Marcello M; Barbadoro, Pamela; Bacelli, Sonia; Esposto, Elisabetta; Moroni, Vania; Scaccia, Federica; Tantucci, Luana; Prospero, Emilia
Background The last case of poliomyelitis due to transmission of indigenous wild poliovirus occurred in Italy in 1982, however, it is important to guarantee a high quality surveillance as there is a risk of importation of cases from areas where polio is endemic. Stopping poliovirus transmission is pursued through a combination of high infant immunization coverage and surveillance for wild poliovirus through reporting and laboratory testing of all cases of acute flaccid paralysis (AFP) among children under fifteen years of age. The aim of this study was to describe and to evaluate 11 years of active surveillance in the Marches (Italy) in terms of: incidence, aetiology and clinical manifestation of AFP cases. Methods The active Acute Flaccid Paralysis surveillance has been carried out in the Marches region since February 1997 by the Chair of Hygiene which established a regional hospital network. Active surveillance involves 15 hospital centres. Results In the considered period, 0–15 years population varied between 187,051 in 1997 to 201,625 in 2007, so the number of AFP expected cases is 2 per year. From February 1997 to October 2007, 27 cases were found with rates of 1.0/100,000 in 1997; 2.0/100,000 in 1998; 1.0/100,000 in 1999; 0.5/100,000 in 2000; 2.5/100,000 in 2001; 1.0/100,000 in 2002; 0 in 2003; 0.5/100,000 in 2004; 1.5/100,000 in 2005; 2.0/100,000 in 2006; 1.5/100,000 in 2007. In 29.6% of cases two stool samples were collected in 14 days from the symptoms onset. The 60-days follow-up is available for 23 out of 27 cases reported. In 44.5% of cases the definite diagnosis was Guillain Barrè syndrome. Conclusion In general, the surveillance activity is satisfactory even if in presence of some criticalities in biological samples collection. The continuation of surveillance, in addition to the maintenance of current levels of performance, will tend to a further and more detailed sensitization of all workers involved, in order to obtain spontaneous and prompt
Jasem, Jagar A; Marof, Kawa; Nawar, Adnan; Khalaf, Yosra; Al-Hamdani, Faisal; Ali, Sagvan; Kalil, Andre C; Islam, K M Monirul
Acute flaccid paralysis surveillance (AFP) is an essential strategy of the WHO's Polio Eradication Initiative. This is the first study conducted to estimate the incidence, etiology, distribution, and surveillance performance of AFP in Iraq. Surveillance data about the AFP cases under the age of 15 years reported from Iraq during January 1997 to December 2011 were depended in the current study. A total of 4974 cases of AFP were reported from Iraq during the study period, with an annual incidence of 2.5/100,000 population. Guillain-Barré syndrome represented more than half of the reported cases (N = 2611, 52.5%), followed by traumatic neuritis (N = 715, 14.4%), and other CNS infections (N = 292, 5.9%). Poliomyelitis accounted for 166 (3.3%) of cases, the last reported case being in January 2000. Surveillance performance showed that all, but two, indicators were below the required WHO recommended levels. AFP surveillance remains the gold standard method for poliomyelitis detection. It witnessed dramatic changes over the last two decades. This has raised people's and clinicians' awareness to the importance of promptness in notifying suspected cases and timely transportation of stool specimens to the National Poliovirus Laboratory in Baghdad, or alternatively having more than one laboratory for poliovirus detection in the country, all of which are very useful measures to increase the surveillance performance in the country.
Ramsawh, Holly J; Raffa, Susan D; White, Kamila S; Barlow, David H
Isolated sleep paralysis (ISP) is a temporary period of involuntary immobility that can occur at sleep onset or offset. It has previously been reported in association with both panic disorder (PD) and posttraumatic stress disorder (PTSD). The current study examined the association between ISP and several possible risk factors--anxiety sensitivity, trauma exposure, life stress, and paranormal beliefs--in a sample of African American participants with and without a history of ISP. Significant between-group differences were found for PD and PTSD diagnoses, anxiety sensitivity, life stress, and certain aspects of paranormal belief, with the ISP group being higher on all of these indices. No differences were found with regard to trauma exposure. Hierarchical regression analyses indicated that PD, anxiety sensitivity, and life stress each contributed unique variance to ISP cognitive symptoms, whereas PTSD and paranormal beliefs did not. These results provide preliminary support for an association between ISP and anxiety sensitivity and corroborate previous reports of ISP's association with PD and life stress. The current trauma/PTSD findings are mixed, however, and warrant future research.
Mankodi, Ami; Grunseich, Christopher; Skov, Martin; Cook, Lisa; Aue, Georg; Purev, Enkhtsetseg; Bakar, Dara; Lehky, Tanya; Jurkat-Rott, Karin; Pedersen, Thomas H; Childs, Richard W
We report a patient with paramyotonia congenita/hyperkalemic periodic paralysis due to Nav1.4 I693T mutation who had worsening of myotonia and muscle weakness in the setting of hypomagnesemia and hypocalcemia with marked recovery after magnesium administration. Computer simulations of the effects of the I693T mutation were introduced in the muscle fiber model by both hyperpolarizing shifts in the Nav1.4 channel activation and a faster recovery from slow channel inactivation. A further shift in the Nav1.4 channel activation in the hyperpolarizing direction as expected with low divalent cations resulted in myotonia that progressed to membrane inexcitability. Shifting the channel activation in the depolarizing direction as would be anticipated from magnesium supplementation abolished the myotonia. These observations provide clinical and biophysical evidence that the muscle symptoms in sodium channelopathy are sensitive to divalent cations. Exploration of the role of magnesium administration in therapy or prophylaxis is warranted with a randomized clinical trial.
Weber, Marc-André; Nagel, Armin M; Marschar, Anja M; Glemser, Philip; Jurkat-Rott, Karin; Wolf, Maya B; Ladd, Mark E; Schlemmer, Heinz-Peter; Kauczor, Hans-Ulrich; Lehmann-Horn, Frank
Purpose To determine whether altered sodium (Na(+)) and chloride (Cl(-)) homeostasis can be visualized in periodic paralyses by using 7-T sodium 23 ((23)Na) and chlorine 35 ((35)Cl) magnetic resonance (MR) imaging. Materials and Methods Institutional review board approval and informed consent of all participants were obtained. (23)Na (repetition time msec/echo time msec, 160/0.35) and (35)Cl (40/0.6) MR imaging of both lower legs was performed with a 7-T whole-body system in patients with genetically confirmed hypokalemic periodic paralysis (Cav1.1-R1239H mutation, n = 5; Cav1.1-R528H mutation, n = 8) and Andersen-Tawil syndrome (n = 3) and in 16 healthy volunteers. Additionally, each participant underwent 3-T proton MR imaging on the same day by using T1-weighted, short-tau inversion-recovery, and Dixon-type sequences. Muscle edema was assessed on short-tau inversion-recovery images, fatty degeneration was assessed on T1-weighted images, and muscular fat fraction was quantified with Dixon-type imaging. Na(+) and Cl(-) were quantified in the soleus muscle by using three phantoms that contained 10-, 20-, and 30-mmol/L NaCl solution and 5% agarose gel as a reference. Parametric data for all subpopulations were tested by using one-way analysis of variance with the Dunnett test, and correlations were assessed with the Spearman rank correlation coefficient. Results Median muscular (23)Na concentration was higher in patients with Cav1.1-R1239H (34.7 mmol/L, P < .001), Cav1.1-R528H (32.0 mmol/L, P < .001), and Kir2.1 (24.3 mmol/L, P = .035) mutations than in healthy volunteers (19.9 mmol/L). Median muscular normalized (35)Cl signal intensity was higher in patients with Cav1.1-R1239H (27.6, P < .001) and Cav1.1-R528H (23.6, P < .001) than in healthy volunteers (12.6), but not in patients with the Kir2.1 mutation (14.3, P = .517). When compared with volunteers, patients with Cav1.1-R1239H and Cav1.1-R528H showed increased muscular edema (P < .001 and P = .003, respectively
Mullapudi, Edukondalu; Přidal, Antonín; Pálková, Lenka; de Miranda, Joachim R.
ABSTRACT The pollination services provided by the western honeybee (Apis mellifera) are critical for agricultural production and the diversity of wild flowering plants. However, honeybees suffer from environmental pollution, habitat loss, and pathogens, including viruses that can cause fatal diseases. Israeli acute bee paralysis virus (IAPV), from the family Dicistroviridae, has been shown to cause colony collapse disorder in the United States. Here, we present the IAPV virion structure determined to a resolution of 4.0 Å and the structure of a pentamer of capsid protein protomers at a resolution of 2.7 Å. IAPV has major capsid proteins VP1 and VP3 with noncanonical jellyroll β-barrel folds composed of only seven instead of eight β-strands, as is the rule for proteins of other viruses with the same fold. The maturation of dicistroviruses is connected to the cleavage of precursor capsid protein VP0 into subunits VP3 and VP4. We show that a putative catalytic site formed by the residues Asp-Asp-Phe of VP1 is optimally positioned to perform the cleavage. Furthermore, unlike many picornaviruses, IAPV does not contain a hydrophobic pocket in capsid protein VP1 that could be targeted by capsid-binding antiviral compounds. IMPORTANCE Honeybee pollination is required for agricultural production and to sustain the biodiversity of wild flora. However, honeybee populations in Europe and North America are under pressure from pathogens, including viruses that cause colony losses. Viruses from the family Dicistroviridae can cause honeybee infections that are lethal, not only to individual honeybees, but to whole colonies. Here, we present the virion structure of an Aparavirus, Israeli acute bee paralysis virus (IAPV), a member of a complex of closely related viruses that are distributed worldwide. IAPV exhibits unique structural features not observed in other picorna-like viruses. Capsid protein VP1 of IAPV does not contain a hydrophobic pocket, implying that capsid
Mullapudi, Edukondalu; Přidal, Antonín; Pálková, Lenka; de Miranda, Joachim R; Plevka, Pavel
The pollination services provided by the western honeybee (Apis mellifera) are critical for agricultural production and the diversity of wild flowering plants. However, honeybees suffer from environmental pollution, habitat loss, and pathogens, including viruses that can cause fatal diseases. Israeli acute bee paralysis virus (IAPV), from the family Dicistroviridae, has been shown to cause colony collapse disorder in the United States. Here, we present the IAPV virion structure determined to a resolution of 4.0 Å and the structure of a pentamer of capsid protein protomers at a resolution of 2.7 Å. IAPV has major capsid proteins VP1 and VP3 with noncanonical jellyroll β-barrel folds composed of only seven instead of eight β-strands, as is the rule for proteins of other viruses with the same fold. The maturation of dicistroviruses is connected to the cleavage of precursor capsid protein VP0 into subunits VP3 and VP4. We show that a putative catalytic site formed by the residues Asp-Asp-Phe of VP1 is optimally positioned to perform the cleavage. Furthermore, unlike many picornaviruses, IAPV does not contain a hydrophobic pocket in capsid protein VP1 that could be targeted by capsid-binding antiviral compounds. Honeybee pollination is required for agricultural production and to sustain the biodiversity of wild flora. However, honeybee populations in Europe and North America are under pressure from pathogens, including viruses that cause colony losses. Viruses from the family Dicistroviridae can cause honeybee infections that are lethal, not only to individual honeybees, but to whole colonies. Here, we present the virion structure of an Aparavirus, Israeli acute bee paralysis virus (IAPV), a member of a complex of closely related viruses that are distributed worldwide. IAPV exhibits unique structural features not observed in other picorna-like viruses. Capsid protein VP1 of IAPV does not contain a hydrophobic pocket, implying that capsid-binding antiviral compounds
Fontana, Stefano; Buttinelli, Gabriele; Fiore, Stefano; Mulaomerovic, Mirsada; Aćimović, Jela; Amato, Concetta; Delogu, Roberto; Rezza, Giovanni; Stefanelli, Paola
The WHO Regional Commission for the Certification of Poliomyelitis Eradication has recently indicated Bosnia and Herzegovina (B&H) as a high risk country for transmission, following importation, of wild poliovirus (WPV) or circulating vaccine-derived poliovirus (cVDPV). We analyzed data on Acute Flaccid Paralysis (AFP) surveillance between 2007 to 2016, and the trend of polio immunization coverage in B&H. The majority of AFP cases was recorded in 2016 suggesting an enhancement of the AFP surveillance activities. However, the decline in the immunization coverage, around 74%, and the isolation of two Sabin-like poliovirus type 2 strains, one of them close to a VDPV, require a particular attention in the area. Although B&H has successfully maintained its polio-free status since 2002 several challenges need to be addressed. © 2017 Wiley Periodicals, Inc.
Traggis, D G; Filler, R M; Druckman, H; Jaffe, N; Cassady, J R
Since 1947, we have treated 19 children with neuroblastoma whose first symptoms were paralysis or weakness of an extremity, and/or incontinence due to tumor in the spinal canal. In 18 patients, the spine tumor was part of a dumbbell tumor which was present in the adjacent paravertebral area and in one, no extraspinal tumor was found. Aggressive treatment was employed for all. In 17 children, the intraspinal tumor was treated by laminectomy and irradiation with and without chemotherapy. Radiation and chemotherapy were used for two. The extraspinal tumor was excised totally in six and partially in six. All 12 children received postoperative radiation and chemotherapy. In 6 children, the extraspinal tumor was treated only with radiation and chemotherapy. Nine of 19 children are alive without evidence of neuroblastoma. Thirteen patients showed either partial (6) or full (7) neurologic recovery. Survival was related to the child's age at diagnosis and the extent of disease. While 8 of 9 children under 1 yr of age survived, only 1 of 10 children over 1 yr survived. None of the 5 children with Stage IV disease at diagnosis could be saved. The degree and frequency of neurologic recovery were greatest in children whose neurologic symptoms had been present the shortest times and were equal among those who survived and those who died. The outlook for children who became paralyzed by neuroblastoma is not hopeless; therapy aimed at saving life or neurologic function is both worthwhile and rewarding.
Martínez-Oropeza, Luz del Carmen; González-Ojeda, Alejandro; Góvea-Camacho, Luis Humberto; Macías-Amezcua, Michel Dassaejv; Fuentes-Orozco, Clotilde
Bilateral vocal fold paralysis (BVFP) is characterized by fold immobility in complete adduction or abduction, secondary to a vagus nerve lesion, through the recurrent laryngeal nerve. The manifestation is variable dyspnea and stridor, fatal if the airway is not secured. There are endolaryngeal and extralaryngeal techniques to increase the glottic opening, improving ventilation and deglutition, and the possibility of decannulation and phonation. Case series consisting of BVFP patients, treated with posterior cordectomy, from January 2004 to January 2010. Clinical charts were reviewed to obtain data and registries of presurgical and postsurgical control endolaryngoscopies. Nineteen patients were identified. Twelve (63.2 %) had a tracheotomy cannula in place, and seven (36.8 %) didn't. Total thyroidectomy was the principal cause of the BVFP in 17 patients (89.5 %). A right cordectomy was performed on 10 patients (52.6 %). At 12 months, endolaryngoscopy detected a 40.26 % average increase in the glottic opening (p < 0.05), allowing for decannulation in 10 (83.3 %) of the tracheotomy patients. Laser cordectomy is a simple procedure for the treatment of BVFP, with few complications, permitting oronasal ventilation, decannulation and phonation.
Farhan, Hassan; McLean, Duncan
Neuromuscular blocking agents are used to facilitate tracheal intubation in patients undergoing ambulatory surgery. The use of high-dose neuromuscular blocking agents to achieve muscle paralysis throughout the case carries an increased risk of residual post-operative neuromuscular blockade, which is associated with increased respiratory morbidity. Visually monitoring the train-of-four (TOF) fade is not sensitive enough to detect a TOF fade between 0.4 and 0.9. A ratio <0.9 indicates inadequate recovery. Quantitative neuromuscular transmission monitoring (e.g., acceleromyography) should be used to exclude residual neuromuscular blockade at the end of the case. Residual neuromuscular blockade needs to be reversed with neostigmine, but it’s use must be guided by TOF monitoring results since deep block cannot be reversed, and neostigmine administration after complete recovery of the TOF-ratio can induce muscle weakness. The development and use of new selectively binding reversal agents (sugammadex and calabadion) warrants reevaluation of this area of clinical practice. PMID:25530723
Butler, Michelle T; Pastore, Roberta; Paterson, Beverley J; Durrheim, David N
Abstract Problem The emergence of Zika virus has challenged outbreak surveillance systems in many at-risk, low-resource countries. As the virus has been linked with Guillain–Barré syndrome, routine data on the incidence of acute flaccid paralysis (AFP) may provide a useful early warning system for the emergence of Zika virus. Approach We documented all Zika virus outbreaks and cases in 21 Pacific Islands and territories for the years 2007 to 2015. We extracted data from the Global Polio Eradication Initiative database on the reported and expected annual incidence of AFP in children younger than 15 years. Using a Poisson probability test, we tested the significance of unexpected increases in AFP in years correlating with Zika virus emergence. Data were analysed separately for each Pacific Island country and territory. Local setting In most Pacific Island countries, early warning surveillance for acute public health threats such as Zika virus is hampered by poor health infrastructure, insufficient human resources and geographical isolation. Relevant changes Only one example was found (Solomon Islands in 2015) of a significant increase in reported AFP cases correlating with Zika virus emergence. Lessons learnt We found no conclusive evidence that routinely reported AFP incidence data in children were useful for detecting emergence of Zika virus in this setting. More evidence may be needed from adult populations, who are more likely to be affected by Guillain–Barré syndrome. Reporting of AFP may be deficient in regions certified as polio-free. PMID:28053366
Paradis, C M; Friedman, S; Hatch, M
Isolated sleep paralysis (ISP) was assessed in African Americans and Whites diagnosed with panic disorder and other anxiety disorders. Participants were recruited from an outpatient clinic where they were diagnosed with panic disorder, generalized anxiety disorder, obsessive-compulsive disorder, social phobia, and simple phobia. Control groups of volunteers without a history of psychiatric disorder were included. All research participants completed a questionnaire to assess for ISP. Group differences were analysed through a series of chi-square analyses. The incidence of recurrent ISP was significantly higher in African Americans with panic disorder (59.6%) as compared with African Americans with other anxiety disorders (11.1%), African American control group participants (23%), Whites with panic disorder (7.5%), Whites with other anxiety disorders (0%), and White control group participants (6%). Recurrent ISP was found to be more common among African American participants, particularly for those with panic disorder. African Americans with panic disorder may experience recurrent ISP as a feature of their disorder.
de Lange, Floris P; Toni, Ivan; Roelofs, Karin
Conversion paralysis (CP) is a frequent and impairing psychiatric disorder, affecting voluntary motor function. Yet, we have previously shown that the motor system of CP patients with a unilateral conversion paresis is recruited to a similar degree during imagined movements of the affected and unaffected limb. In contrast, imagery of movements with the affected limb results in larger prefrontal activation. It remains unclear how this hand-specific increased prefrontal activity relates to the reduced responsiveness of motor and somatosensory areas, a consistent and important feature of CP patients. In the current study, we investigated changes in the inter-regional coupling between prefrontal cortex (PFC) and sensorimotor regions when CP patients imagined movements involving either the affected or the unaffected hand. We found that there were distinct connectivity patterns for different parts of the PFC. While ventromedial PFC was not functionally connected to the motor system, we observed strong functional coupling between the dorsolateral PFC and various sensorimotor areas. Furthermore, this coupling was modulated by whether patients imagined movements of their affected or unaffected hand. Together, these results suggest that the reduced motor responsitivity observed in CP may be linked to altered dorsolateral prefrontal-motor connectivity.
Arba, F; Inzitari, D; Lippi, D
Cosimo I de' Medici (1519-1574) was the first Grand Duke of Tuscany. He was one of the most important members of the Medici family. He was an excellent conqueror and a good politician. Moreover, he was able to attract and encourage artists, scientists and architects to promote Florence as the cultural capital of the Italian Renaissance. Historical chronicles report that he suffered from a stroke when he was 49 years old. Together with the acute manifestation of stroke, he displayed peculiar symptoms. He had gait disturbances and sphincter dysfunctions. His language became poor and hard to understand. His mood was very fluctuating and in the last years of his life he was a short-tempered man. In addition, he had a characteristic symptom, so-called pathological laughing and crying. The course of his disease was slow and stuttering. Taken together, these data seem to be one of the first reports of pseudobulbar paralysis. The disease of Cosimo I was probably due to a chronic cerebral vasculopathy, known as small vessels disease. We discuss this hypothesis regarding an ancient clinical case, with the support of current studies.
Gangdev, Prakash; Dua, Varinder; Desjardins, Nina
Usually remembered in the context of Narcolepsy-Cataplexy syndrome, isolated sleep paralysis (SP) and hypnic hallucination are widely prevalent and because of the overlap of symptoms with schizophrenia, their identification is important but unrecognized. To determine the presence of SP and hypnic hallucinations (HH) in people with schizophrenia and schizoaffective disorder. Cross-sectional survey. Participants were patients receiving follow-up care for schizophrenia from Assertive Community Treatment Team. A screening questionnaire was administered during their routine follow-up visits. Of 71 respondents (49 males, 22 females) only 11 (10 males and 1 female), that is, 15% reported SP, and 12 (7 males and 5 females), that is, 16.9% reported HH, a considerably low prevalence. It is difficult to study the presence of SP and HH in patients with active or residual symptoms of schizophrenia, and more refined studies and appropriate questionnaires are required. The possibility of SP and HH confounding or being misdiagnosed as psychotic symptoms needs to be borne in mind.
Ren, Junyuan; Cone, Abigail; Willmot, Rebecca; Jones, Ian M.
The dicistrovirus Israeli Acute Paralysis Virus (IAPV) has been implicated in the worldwide decline of honey bees. Studies of IAPV and many other bee viruses in pure culture are restricted by available isolates and permissive cell culture. Here we show that coupling the IAPV major structural precursor protein ORF2 to its cognate 3C-like processing enzyme results in processing of the precursor to the individual structural proteins in a number of insect cell lines following expression by a recombinant baculovirus. The efficiency of expression is influenced by the level of IAPV 3C protein and moderation of its activity is required for optimal expression. The mature IAPV structural proteins assembled into empty capsids that migrated as particles on sucrose velocity gradients and showed typical dicistrovirus like morphology when examined by electron microscopy. Monoclonal antibodies raised to recombinant capsids were configured into a diagnostic test specific for the presence of IAPV. Recombinant capsids for each of the many bee viruses within the picornavirus family may provide virus specific reagents for the on-going investigation of the causes of honeybee loss. PMID:25153716
Nagai, Hiromi; Nishiyama, Koichiro; Seino, Yutomo; Kimura, Yu; Tabata, Yasuhiko; Okamoto, Makito
The purpose of this prospective study was to determine the effect of autologous transplantation of fascia into the vocal fold (ATFV) with controlled release of basic fibroblast growth factor (bFGF) on unilateral vocal fold paralysis (UVFP) in a rat model. Unilateral recurrent laryngeal nerve (RLN) section was performed on 15 rats. Ten rats received an autologous fascia implant and gelatin hydrogel with or without bFGF (1 μg) to their larynxes (fascia only, "fascia group"; bFGF + fascia, "fascia + bFGF group"), while the rest underwent RLN transection ("RLN section group"). Four months later, evaluation of the laryngeal glottal gap and histological analysis were performed. The glottal gap was significantly reduced in the fascia + bFGF group, and fat volume increased significantly relative to the RLN section. The volume of the remaining fascia in the bFGF + fascia group was significantly greater than that of the fascia group. ATFV with controlled release of bFGF may compensate for diminished laryngeal volume in UVFP by reducing resorption of the implanted fascia and increasing fat volume. Our findings suggest that this modality may represent an attractive option for treating UVFP. Copyright © 2013 Elsevier Inc. All rights reserved.
Cha, Chang Il; Hong, Chang Kee; Park, Moon Suh
Purpose Facial nerve injury can occur in the regions ranging from the cerebral cortex to the motor end plate in the face, and from many causes including trauma, viral infection, and idiopathic factors. Facial nerve paralysis in children, however, may differ from that in adults. We, therefore, evaluated its etiology and recovery rate in children and adults. Materials and Methods We retrospectively evaluated the records of 975 patients, ranging in age from 0 to 88 years, who displayed facial palsy at Kyung Hee Medical Center between January 1986 and July 2005. Results The most frequent causes of facial palsy in adults were Bell's palsy (54.9%), infection (26.8%), trauma (5.9%), iatrogenic (2.0%), and tumors (1.8%), whereas the most frequent causes of facial palsy in children were Bell's palsy (66.2%), infection (14.6%), trauma (13.4%), birth trauma (3.2%), and leukemia (1.3%). Recovery rates in adults were 91.4% for Bell's palsy, 89.0% for infection, and 64.3% for trauma, whereas recovery rates in children were 93.1% for Bell's palsy, 90.9% for infection, and 42.9% for trauma. Conclusion These results show that causes of facial palsy are similar in adults and children, and recovery rates in adults and children are not significantly different. PMID:18972592
Gaber, Amira; Taher, Mona F; Wahed, Manal Abdel
Assessment of facial paralysis (FP) and quantitative grading of facial asymmetry are essential in order to quantify the extent of the condition as well as to follow its improvement or progression. As such, there is a need for an accurate quantitative grading system that is easy to use, inexpensive and has minimal inter-observer variability. A comprehensive automated system to quantify and grade FP is the main objective of this work. An initial prototype has been presented by the authors. The present research aims to enhance the accuracy and robustness of one of this system's modules: the resting symmetry module. This is achieved by including several modifications to the computation method of the symmetry index (SI) for the eyebrows, eyes and mouth. These modifications are the gamma correction technique, the area of the eyes, and the slope of the mouth. The system was tested on normal subjects and showed promising results. The mean SI of the eyebrows decreased slightly from 98.42% to 98.04% using the modified method while the mean SI for the eyes and mouth increased from 96.93% to 99.63% and from 95.6% to 98.11% respectively while using the modified method. The system is easy to use, inexpensive, automated and fast, has no inter-observer variability and is thus well suited for clinical use.
Peripheral facial paralysis (PFP) is a consequence of the peripheral neuronal lesion of the facial nerve (FN). It can be either primary (Bell`s Palsy) or secondary. The classical clinical presentation typically involves both stages of the hemiface. However, there may be other symptoms (ex. xerophthalmia, hyperacusis, phonation and deglutition changes) that one should recall. Clinical evaluation includes rigorous muscle tonus and sensibility search in the FN territory. Some useful instruments allow better objectivity in the patients' evaluation (House-Brackmann System, Facial Grading System, Functional Evaluation). There are clear referral criteria to Physical Medicine and Rehabilitation. Treatment of Bell`s Palsy may include pharmacotherapy, neuromuscular training (NMT), physical methods and surgery. In the NMT field the several treatment techniques are systematized. Therapeutic strategies should be problem-oriented and adjusted to the patient's symptoms and signs. Physical methods are reviewed. In about 15-20 % of patients permanent sequelae subside after 3 months of evolution. PFP is commonly a multidisciplinary condition. Therefore, it is important to review strategies that Physical Medicine and Rehabilitation may offer.
Jayatilake, Dushyantha; Isezaki, Takashi; Teramoto, Yohei; Eguchi, Kiyoshi; Suzuki, Kenji
We have been developing the Robot Mask with shape memory alloy based actuators that follows an approach of manipulating the skin through a minimally obtrusive wires, transparent strips and tapes based pulling mechanism to enhance the expressiveness of the face. For achieving natural looking facial expressions by taking the advantage of specific characteristics of the skin, the Robot Mask follows a human anatomy based criteria in selecting these manipulation points and directions. In this paper, we describe a case study of using the Robot Mask to assist physiotherapy of a hemifacial paralyzed patient. The significant differences in shape and size of the human head between different individuals demands proper customizations of the Robot Mask. This paper briefly describes the adjusting and customizing stages employed from the design level to the implementation level of the Robot Mask. We will also introduce a depth image sensor data based analysis, which can remotely evaluate dynamic characteristics of facial expressions in a continuous manner. We then investigate the effectiveness of the Robot Mask by analyzing the range sensor data. From the case study, we found that the Robot Mask could automate the physiotherapy tasks of rehabilitation of facial paralysis. We also verify that, while providing quick responses, the Robot Mask can reduce the asymmetry of a smiling face and manipulate the facial skin to formations similar to natural facial expressions.
Szmeja, Zygmunt; Wójtowicz, Jerzy G; Nowak, Katarzyna; Leszczyńska, Małgorzata
The introduction of surgical lasers into microsurgery of the larynx has made the resection of the posterior vocal cord with or without the arytenoid cartilage possible. This method of surgical treatment allows one to carry out a fast, non-open larynx procedure and practically bloodless operation with minimal postoperative trauma and edema of the surrounding tissues. Since November 1990 at the Clinic of Otolaryngology of the University School of Medical Sciences 48 arytenoidectomies (40 on the right side, 8 on the left side), 19 partial chordectomies and 25 Kashima operations. All surgical treatment were performed by means of CO2 laser in patients with bilateral paralysis of the vocal cords. In all patients postoperative recovery was correct and breathing difficulties were not observed after extubation. Laryngoscopic control examinations were performed a day after operation and a wide lumen of air through the operative field was observed. At the control examination, narrowing of the lumen of the larynx was not observed, the healing process of the operation area was without granulation. Laser arytenoidectomy allows good results of the breathing and phonation function. No changes of granulation proliferation were observed at the side of the CO2 laser treatment. Lack of reaction to laser beam there was possibility to use endoscopic procedures in patients who did not undergo a tracheotomy.
Yılmaz, Taner; Altuntaş, Ozan Muzaffer; Süslü, Nilda; Atay, Gamze; Özer, Serdar; Kuşçu, Oğuz; Sözen, Tevfik
Introduction. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. Discussion. The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO2 laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. Conclusion. Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy.
Krishnan, Arun V; Lin, Cindy S; Reddel, Stephen W; McGrath, Robert; Kiernan, Matthew C
Tick paralysis (TP) is an uncommon disorder caused by a neurotoxin secreted by engorged female ticks. The cause of TP remains unclear, although alterations in axonal ion channel function and neuromuscular transmission have been proposed. In the present case, nerve excitability techniques, which provide information regarding axonal ion channel function, were used to elucidate the mechanism underlying weakness in a 45-year-old man who presented with weakness following a tick bite in the lateral aspect of the left axilla. Standard clinical nerve conduction studies were undertaken during the acute phase of symptoms and following clinical recovery. Nerve excitability studies were performed to investigate possible changes in ion channel properties distal to the site of conduction failure. Nerve conduction studies and electromyography suggested the possibility of a lesion involving the lower trunk of the left brachial plexus. Nerve excitability studies distal to the site of the tick bite demonstrated an abrupt increase in refractoriness, a marker of recovery from inactivation of Na(+) channels. There was normalization of both nerve conduction and nerve excitability parameters associated with clinical recovery. The alteration in refractoriness is similar to that noted in disorders involving the terminal portion of the motor nerve. The changes raise the possibility that TP may cause weakness through impairment of distal neural transmission.
Gupta, Nitin; Dass, Arjun; Goel, Neha; Tiwari, Sandeep
Introduction: Tuberculous otitis media (TOM) is an uncommon, insidious, and frequently misdiagnosed form of tuberculosis (TB). In particular, TOM is usually secondary to direct transmission from adjacent organs, while the primary form has been rarely reported. The main aim of treatment is to start the patient on an antitubercular regime and early surgical intervention to decompress the facial nerve if involved. Case Report: The case report of a twenty year-old male with bilateral tuberculous otitis media, who presented himself with fever followed by sequential bilateral facial nerve paralysis, bilateral profound hearing loss, and abdominal tuberculosis leading to intestinal perforation, is presented. To the best available knowledge and after researching literature, no such case depicting the extensive otological complications of tuberculosis has been reported till date. Conclusion: Tuberculosis of the ear is a rare entity and in most cases the clinical features resemble that of chronic otitis media. The diagnosis is often delayed due to varied clinical presentations and this can lead to irreversible complications. Early diagnosis is essential for prompt administration of antitubercular therapy and to prevent complications. PMID:26082906
Zheng, Hui; Li, Ying; Chen, Min
The objective is to analyze the treatment used in relatively high quality randomized controlled trials to identify any similarities of therapeutic approaches and subsequently present recommendations for a standard acupuncture procedure for the treatment of peripheral facial paralysis (PFP). We searched Chinese and English language literatures through MEDLINE (January 1966 to October 2007), EMbase (January 1980 to October 2007), Chinese Biomedical Database (January 1978 to October 2007) and China National Knowledge Infrastructure (January 1979 to October 2007) for randomized controlled trials. With independent assessment by 2 observers, 33 of 386 originally identified articles were finally included. The extracted information from these articles was focused on the selection of meridians and acupoints, types of stimulation and duration of treatment. On the whole, when treating PFP, the best acupoints options are Dicang (ST4), Xiaguan (ST7), Jiache (ST6), Chengjiang (CV24), Yingxiang (LI20), Quanliao (SI18), Yifeng (TE17), Yangbai (GB14), Sibai (ST2), Fengchi (GB20), Shuigou (GV26), Yuyao (EX-HN4) and Hegu (LI4). Manual stimulation or electro-acupuncture combined with moxibustion is recommended. Moreover, the suggested duration of acupuncture treatment refers to once a day, 10 times for each course, 2 to 5 days as courses interval, and 20 to 40 treatments in total.
Süslü, Nilda; Atay, Gamze; Özer, Serdar; Kuşçu, Oğuz; Sözen, Tevfik
Introduction. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. Discussion. The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO2 laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. Conclusion. Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy. PMID:27830141
Holland, C T
To describe basic epidemiological features, clinical characteristics and outcomes of asymmetrical focal neurological deficits identified in dogs and cats with naturally occurring tick paralysis (Ixodes holocyclus). A retrospective study. Computer records were reviewed for all dogs and cats treated for tick paralysis between July 1999 and June 2006 at a suburban veterinary hospital in Newcastle, New South Wales. Neurological deficits were identified in 17/197 dogs and 10/89 cats and included unilateral facial paralysis (14 dogs; 2 cats), anisocoria (4 dogs; 7 cats), unilateral loss of the cutaneous trunci reflex (1 dog; 1 cat) and Horner's syndrome in 2 cats with anisocoria. Occurrence of deficits was not linked to season, severity of tick paralysis, breed, age, sex or body weight. With facial paralysis and anisocoria, the site of tick attachment was invariably on the head or neck and always ipsilateral to the facial paralysis. By contrast, with anisocoria alone, no consistent relationship was noted between any one pupillary dimension and the side of tick attachment. With cutaneous trunci deficits the site of tick attachment was the ipsilateral caudal axilla. Compared with recovery times from generalised signs of tick paralysis, those for facial paralysis were significantly longer (days to weeks; P < 0.001), those for anisocoria showed no significant difference (P = 0.25) and those for cutaneous trunci deficits lagged by 6 and 7 days. Asymmetrical focal neurological deficits are a consistent finding in a proportion of dogs and cats with naturally occurring tick paralysis due to I. holocylcus.
Bide, R W; Schofield, L; Risk, D J
There have been numerous studies of the central nervous system (CNS) involvement in organophosphate (OP) poisoning showing status epilepticus and/or 'electrographic seizures'. Brain damage has been demonstrated as 'neuronal necrosis' primarily in the cortex, thalamus and hippocampus. To the authors' knowledge there have been no reports of partial/total paralysis following close upon OP exposure although delayed paralysis has been reported. This report summarizes the immediate, OP induced paralytic events recorded in guinea pigs during development of the Canadian reactive skin decontaminant lotion (RSDL). As part of the development work, supra-lethal cutaneous doses of OP were applied to large numbers of guinea pigs followed by decontamination with the RSDL or predecessor lotions and solvents. Soman (pinacolyl methylphosphonofluoridate; GD) challenges were applied to 1277 animals and S-(2-diisopropyl-aminoethyl) methylphosphorothiolate (VX) challenges to 108. The classic sequence of clinical signs--ptyalism, tremors, fasciculations, convulsions, apnea and flaccid paralysis before death--was seen in the 658 animals that died and in many of the survivors. Eighty-four of 688 survivors of GD and 4 of 39 survivors of VX showed random paralysis of various distal regions following recovery from an insult which produced convulsions and/or flaccid paralysis. Because the experiments were designed to assess the decontamination procedures, there were no apparent relationships between the amounts of OP applied and the sequellae recorded. The observations of paralysis were also incidental to the prime focus of the experiments. Because of this, only ten animals paralysed following GD exposure were examined for histological effects. The pathologist diagnosed 'encephalomalacia' and 'focal necrotic lesions' in the cerebral cortex and 'focal necrotic lesions' in one spinal cord. Of the 84 guinea pigs paralysed after GD challenge, one was not decontaminated and the decontaminants used
Jiménez-Genchi, Alejandro; Avila-Rodríguez, Víctor M; Sánchez-Rojas, Frida; Terrez, Blanca E Vargas; Nenclares-Portocarrero, Alejandro
The aim of the present study was to evaluate the prevalence and characteristics of sleep paralysis in adolescents using a folk expression. Three hundred and twenty-two adolescents (mean age, 15.9 +/- 0.88 years; 66.8% female) from three high schools in Mexico City completed both a self-reported questionnaire, including a colloquial definition of sleep paralysis and the Epworth Sleepiness Scale. A high proportion of the adolescents (92.5%) had heard about the 'a dead body climbed on top of me' expression and 27.6% of them had experienced the phenomenon. Sleep paralysis was present in 25.5% while the prevalence rate for hypnagogic/hypnopompic hallucinations was 22%; 61% had experienced >or=2 episodes in their lifetime. The mean age of onset was 12.5 +/- 3 years. Sleepiness scores for the subjects who had experienced at least one event were not significantly different from subjects who had not experienced any. In 72% of cases, the episodes were composed of both sleep paralysis and hallucinations while 20.2% consisted of only sleep paralysis and 7.8% of only hallucinations. The number and characteristics of events were not significantly different between adolescents with only one episode and those with two or more episodes. The characteristics of the 'a dead body climbed on top of me' phenomenon suggest that is identical to sleep paralysis and a frequent experience among Mexican adolescents. During adolescence, sleep paralysis seems to be a recurrent phenomenon frequently accompanied by hallucinatory experiences.
Korb, Sebastian; Wood, Adrienne; Banks, Caroline A; Agoulnik, Dasha; Hadlock, Tessa A; Niedenthal, Paula M
The ability of patients with unilateral facial paralysis to recognize and appropriately judge facial expressions remains underexplored. To test the effects of unilateral facial paralysis on the recognition of and judgments about facial expressions of emotion and to evaluate the asymmetry of facial mimicry. Patients with left or right unilateral facial paralysis at a university facial plastic surgery unit completed 2 computer tasks involving video facial expression recognition. Side of facial paralysis was used as a between-participant factor. Facial function and symmetry were verified electronically with the eFACE facial function scale. Across 2 tasks, short videos were shown on which facial expressions of happiness and anger unfolded earlier on one side of the face or morphed into each other. Patients indicated the moment or side of change between facial expressions and judged their authenticity. Type, time, and accuracy of responses on a keyboard were analyzed. A total of 57 participants (36 women and 21 men) aged 20 to 76 years (mean age, 50.2 years) and with mild left or right unilateral facial paralysis were included in the study. Patients with right facial paralysis were faster (by about 150 milliseconds) and more accurate (mean number of errors, 1.9 vs 2.5) to detect expression onsets on the left side of the stimulus face, suggesting anatomical asymmetry of facial mimicry. Patients with left paralysis, however, showed more anomalous responses, which partly differed by emotion. The findings favor the hypothesis of an anatomical asymmetry of facial mimicry and suggest that patients with a left hemiparalysis could be more at risk of developing a cluster of disabilities and psychological conditions including emotion-recognition impairments. 3.
Hontanilla, Bernardo; Marre, Diego; Cabello, Alvaro
Our aim was to describe our experience with the masseteric nerve in the reanimation of short term facial paralysis. We present our outcomes using a quantitative measurement system and discuss its advantages and disadvantages. Between 2000 and 2012, 23 patients had their facial paralysis reanimated by masseteric-facial coaptation. All patients are presented with complete unilateral paralysis. Their background, the aetiology of the paralysis, and the surgical details were recorded. A retrospective study of movement analysis was made using an automatic optical system (Facial Clima). Commissural excursion and commissural contraction velocity were also recorded. The mean age at reanimation was 43(8) years. The aetiology of the facial paralysis included acoustic neurinoma, fracture of the skull base, schwannoma of the facial nerve, resection of a cholesteatoma, and varicella zoster infection. The mean time duration of facial paralysis was 16(5) months. Follow-up was more than 2 years in all patients except 1 in whom it was 12 months. The mean duration to recovery of tone (as reported by the patient) was 67(11) days. Postoperative commissural excursion was 8(4)mm for the reanimated side and 8(3)mm for the healthy side (p=0.4). Likewise, commissural contraction velocity was 38(10)mm/s for the reanimated side and 43(12)mm/s for the healthy side (p=0.23). Mean percentage of recovery was 92(5)mm for commissural excursion and 79(15)mm/s for commissural contraction velocity. Masseteric nerve transposition is a reliable and reproducible option for the reanimation of short term facial paralysis with reduced donor site morbidity and good symmetry with the opposite healthy side.
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Gil-Peña, Helena; Garcia-Lopez, Enrique; Alvarez-Garcia, Oscar; Loredo, Vanessa; Carbajo-Perez, Eduardo; Ordoñez, Flor A; Rodriguez-Suarez, Julian; Santos, Fernando
Hypokalemic tubular disorders may lead to growth retardation which is resistant to growth hormone (GH) treatment. The mechanism of these alterations is unknown. Weaning female rats were grouped (n = 10) in control, potassium-depleted (KD), KD treated with intraperitoneal GH at 3.3 mg x kg(-1) x day(-1) during the last week (KDGH), and control pair-fed with KD (CPF). After 2 wk, KD rats were growth retarded compared with CPF rats, the osseous front advance (+/-SD) being 67.07 +/- 10.44 and 81.56 +/- 12.70 microm/day, respectively. GH treatment did not accelerate growth rate. The tibial growth plate of KD rats had marked morphological alterations: lower heights of growth cartilage (228.26 +/- 23.58 microm), hypertrophic zone (123.68 +/- 13.49 microm), and terminal chondrocytes (20.8 +/- 2.39 microm) than normokalemic CPF (264.21 +/- 21.77, 153.18 +/- 15.80, and 24.21 +/- 5.86 microm). GH administration normalized these changes except for the distal chondrocyte height. Quantitative PCR of insulin-like growth factor I (IGF-I), IGF-I receptor, and GH receptor genes in KD growth plates showed downregulation of IGF-I and upregulation of IGF-I receptor mRNAs, without changes in their distribution as analyzed by immunohistochemistry and in situ hybridization. GH did not further modify IGF-I mRNA expression. KD rats had normal hepatic IGF-I mRNA levels and low serum IGF-I values. GH increased liver IGF-I mRNA, but circulating IGF-I levels remained reduced. This study discloses the structural and molecular alterations induced by potassium depletion on the growth plate and shows that the lack of response to GH administration is associated with persistence of the disturbed process of chondrocyte hypertrophy and depressed mRNA expression of local IGF-I in the growth plate.
Sovtić, Aleksandar; Minić, Predrag; Vukcević, Miodrag; Rodić, Milan
Laryngomalacia is the most frequent congenital anomaly of airways, and it may cause obstructive sleep apneas. The associated vocal cord paralysis may aggravate the symptoms of upper airway obstruction. In a 14 month old boy severe laryngomalacia and bilateral vocal cord paralysis were diagnosed by flexible bronchoscopy. A sleep study showed a severe obstructive sleep apnoea (OSA). The patient was ventilated at home via the face mask with non invasive mechanical ventilation (CPAP) for a year. The level of pressure had to be set at 7 cm H2O to correct desaturation with an improvement in mean SpO2. On the follow up bronchoscopic examination laryngomalatia was improved, vocal cord paralysis persisted and sleep study revealed significant improvement. In the patient with severe laryngomalatia and bilateral vocal cord paralysis with OSA conservative treatment with CPAP was used instead of a surgical intervention. Non invasive ventilation was used every night, for at least 6 hours, without adverse events. Invasive measurement of transdiaphragmatic pressure is the best way of titrating of CPAP level. This case report suggests the efficacy of noninvasive titrating of CPAP level by the hemoglobin oxygen saturation trend measurement. In case of severe laryngomalatia and associated vocal cord paralysis, followed by OSA non invasive ventilation by nasal CPAP represents an effective and safe alternative to surgery.
Munezawa, Takeshi; Kaneita, Yoshitaka; Osaki, Yoneatsu; Kanda, Hideyuki; Ohtsu, Tadahiro; Suzuki, Hiroyuki; Minowa, Masumi; Suzuki, Kenji; Higuchi, Susumu; Mori, Junichirou; Ohida, Takashi
The objective of this study was to clarify the prevalence of nightmares and sleep paralysis and associated factors among Japanese adolescents. This study was designed as a cross-sectional sampling survey. The targets were junior and senior high schools throughout Japan. Self-reported anonymous questionnaires were sent to schools for all students to complete. A total of 90,081 questionnaires were analyzed. The overall response rate was 62.6%, and the prevalence of nightmares and sleep paralysis was 35.2% and 8.3%, respectively. Multiple logistic analyses revealed that female sex, drinking alcohol, poor mental health, difficulty initiating sleep, low subjective sleep assessment, presence of excessive daytime sleepiness, and presence of sleep paralysis had higher odds ratios than others for nightmares. Male sex, poor mental health, drinking alcohol, taking a long daytime nap, early or late bedtime, difficulty initiating sleep, low subjective sleep assessment, presence of excessive daytime sleepiness, and presence of nightmares had higher odds ratios than other factors for sleep paralysis. This study has revealed the prevalence of nightmares and sleep paralysis among Japanese adolescents. Furthermore, the results of this study suggest that it is important to maintain regular sleep habits for preventing these symptoms. We propose that health education about regular sleep habits should be promoted among Japanese adolescents. Copyright © 2010 Elsevier B.V. All rights reserved.
Quesnel, Alicia M; Lindsay, Robin W; Hadlock, Tessa A
This study reports 4 cases of occult parotid malignancy presenting with sudden-onset facial paralysis to demonstrate that failure to regain tone 6 months after onset distinguishes these patients from Bell's palsy patients with delayed recovery and to propose a diagnostic algorithm for this subset of patients. A case series of 4 patients with occult parotid malignancies presenting with acute-onset unilateral facial paralysis is reported. Initial imaging on all 4 patients did not demonstrate a parotid mass. Diagnostic delays ranged from 7 to 36 months from time of onset of facial paralysis to time of diagnosis of parotid malignancy. Additional physical examination findings, especially failure to regain tone, as well as properly protocolled radiologic studies reviewed with dedicated head and neck radiologists, were helpful in arriving at the diagnosis. An algorithm to minimize diagnostic delays in this subset of acute facial paralysis patients is presented. Careful attention to facial tone, in addition to movement, is important in the diagnostic evaluation of acute-onset facial paralysis. Copyright 2010 Elsevier Inc. All rights reserved.
Liu, Xulong; Hong, Wenxue; Zhang, Tao; Wu, Zhenying
Facial paralysis is a frequently-occurring disease, which causes the loss of the voluntary muscles on one side of the face due to the damages the facial nerve and results in an inability to close the eye and leads to dropping of the angle of the mouth. There have been few objective methods to quantitatively diagnose it and assess this disease for clinically treating the patients so far. The skin temperature distribution of a healthy human body exhibits a contralateral symmetry. Facial paralysis usually causes an alteration of the temperature distribution of body with the disease. This paper presents the use of the histogram distance of bilateral local binary pattern (LBP) in the facial infrared thermography to measure the asymmetry degree of facial temperature distribution for objective assessing the severity of facial paralysis. Using this new method, we performed a controlled trial to assess the facial nerve function of the healthy subjects and the patients with Bell's palsy respectively. The results showed that the mean sensitivity and specificity of this method are 0.86 and 0.89 respectively. The correlation coefficient between the asymmetry degree of facial temperature distribution and the severity of facial paralysis is an average of 0.657. Therefore, the histogram distance of local binary pattern in the facial infrared thermography is an efficient clinical indicator with respect to the diagnosis and assessment of facial paralysis.
Nakazato, H; Ikeda, M
Interferons are produced in response to viral infection and play an important part in defense by their antiviral effects. An interferon-induced enzyme, 2'-5' oligoadenylate synthetase (2-5AS) also takes an important part of the system of defense against viral infections, and its activity elevates in nonspecific viral infections. This study was designed to evaluate the usefulness of examining serum 2-5AS activity and peripheral blood WBC 2-5AS (WBC 2-5AS) as diagnostic aids of viral infections that cause facial paralysis. Samples were obtained from 83 patients with Bell's palsy, 20 with Ramsay Hunt syndrome, 74 healthy individuals, and a total of 177 subjects. In 177, we measured serum 2-5AS level in 123 subjects, WBC 2-5AS level in 57, and both in 25. Serum 2-5AS levels in Bell's palsy (60 cases) ranged from 20 to 146 pmol/dl (average: 38.5). The range in Ramsay Hunt syndrome (13) was 20-333 (average: 59.0), and in healthy controls (50), it was 20-128 (average: 41.4). WBC 2-5AS level ranged from 20 to 5900 pmol/dl (average: 733.2) in Bell's palsy (23 cases), from 20-4540 (average: 1371.4) in Ramsay Hunt syndrome (7), and from 20-903 (average: 294.5) in healthy individuals (24). There were no statistically significant differences in serum 2-5AS activities. Otherwise, there was significant difference (p < 0.01) between healthy individuals and Patients with Ramsay Hunt syndrome in WBC 2-5AS activity. In Bell's palsy, 3 cases (13.0%) with markedly high WBC 2-5AS levels existed.(ABSTRACT TRUNCATED AT 250 WORDS)
Veyssière, A; Labbé, D; Bénateau, H
Congenital facial paralysis (FP) is present from birth. It can produce major esthetic and functional disorders. It can be from two different etiologies: developmental and acquired. There is no curative treatment for congenital FP and the aim for the plastic surgeon is to restore a smile as symmetrical and as dynamic as possible. For this, two opposite techniques can be used: muscular free flaps and locoregional flaps whose lengthening temporalis myoplasty. We report our series of 34 congenital FP patients who were operated by lengthening temporalis myoplasty (LTM). We divided the patients into three categories: acquired FP (11 cases), isolated developmental FP (13 cases), and syndromic developmental FP (10 cases). The evaluation of the smile is based on the quality of the commissural course compared to the healthy side and the spontaneity of it. In the acquired FP group, 100% obtained a spontaneous smile with a postoperative delay of 9.5 months, 12 of the 13 cases of isolated developmental FP (92.7%) after 7.3 months postoperatively, and finally, in the 10 cases of syndromic FP, nine (90%) had a spontaneous smile after 9.7 months. Muscular free flaps continue to be the gold standard for the reanimation of smile on the FP. To our knowledge, no articles comparing smile restoration using free flap and smile restoration using LTM exist. A comparison of the success rates from different studies shows that both these techniques yield good results and can be used for smile restoration in FP. This technique is faster and easier than a free flap and has a same result, which is why we consider this technique as a reference on smile reanimation in FP. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.
Silva, Anjana; Hodgson, Wayne C.; Isbister, Geoffrey K.
Antivenom therapy is currently the standard practice for treating neuromuscular dysfunction in snake envenoming. We reviewed the clinical and experimental evidence-base for the efficacy and effectiveness of antivenom in snakebite neurotoxicity. The main site of snake neurotoxins is the neuromuscular junction, and the majority are either: (1) pre-synaptic neurotoxins irreversibly damaging the presynaptic terminal; or (2) post-synaptic neurotoxins that bind to the nicotinic acetylcholine receptor. Pre-clinical tests of antivenom efficacy for neurotoxicity include rodent lethality tests, which are problematic, and in vitro pharmacological tests such as nerve-muscle preparation studies, that appear to provide more clinically meaningful information. We searched MEDLINE (from 1946) and EMBASE (from 1947) until March 2017 for clinical studies. The search yielded no randomised placebo-controlled trials of antivenom for neuromuscular dysfunction. There were several randomised and non-randomised comparative trials that compared two or more doses of the same or different antivenom, and numerous cohort studies and case reports. The majority of studies available had deficiencies including poor case definition, poor study design, small sample size or no objective measures of paralysis. A number of studies demonstrated the efficacy of antivenom in human envenoming by clearing circulating venom. Studies of snakes with primarily pre-synaptic neurotoxins, such as kraits (Bungarus spp.) and taipans (Oxyuranus spp.) suggest that antivenom does not reverse established neurotoxicity, but early administration may be associated with decreased severity or prevent neurotoxicity. Small studies of snakes with mainly post-synaptic neurotoxins, including some cobra species (Naja spp.), provide preliminary evidence that neurotoxicity may be reversed with antivenom, but placebo controlled studies with objective outcome measures are required to confirm this. PMID:28422078
Teixeira, Lázaro J; Valbuza, Juliana S; Prado, Gilmar F
Bell's palsy (idiopathic facial paralysis) is commonly treated by various physical therapy strategies and devices, but there are many questions about their efficacy. To evaluate physical therapies for Bell's palsy (idiopathic facial palsy). We searched the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2011), MEDLINE (January 1966 to February 2011), EMBASE (January 1946 to February 2011), LILACS (January 1982 to February 2011), PEDro (from 1929 to February 2011), and CINAHL (January 1982 to February 2011). We included searches in clinical trials register databases until February 2011. We selected randomised or quasi-randomised controlled trials involving any physical therapy. We included participants of any age with a diagnosis of Bell's palsy and all degrees of severity. The outcome measures were: incomplete recovery six months after randomisation, motor synkinesis, crocodile tears or facial spasm six months after onset, incomplete recovery after one year and adverse effects attributable to the intervention. Two authors independently scrutinised titles and abstracts identified from the search results. Two authors independently carried out risk of bias assessments, which , took into account secure methods of randomisation, allocation concealment, observer blinding, patient blinding, incomplete outcome data, selective outcome reporting and other bias. Two authors independently extracted data using a specially constructed data extraction form. We undertook separate subgroup analyses of participants with more and less severe disability. For this update to the original review, the search identified 65 potentially relevant articles. Twelve studies met the inclusion criteria (872 participants). Four trials studied the efficacy of electrical stimulation (313 participants), three trials studied exercises (199 participants), and five studies compared or combined some form of physical therapy
Cantarella, Giovanna; Dejonckere, Philippe; Galli, Anna; Ciabatta, Annaclara; Gaffuri, Michele; Pignataro, Lorenzo; Torretta, Sara
Previous studies have shown that the etiology of laryngeal paralysis has changed over the last decades, with an increase in the incidence of cases attributable to thyroid surgery. The aim of this study was to evaluate longitudinal changes in the etiology of unilateral vocal fold paralysis (UVFP) in a single institution over the last 25 years. This retrospective study analyzed the etiology of UVFP between 1990 and 2015 by comparing a cohort of patients treated in 1990-1992 with a cohort treated in 2013-2015. The final analysis was based on data concerning 356 patients (38.8 % males; mean age 55.3 ± 20.4 years): 113 in the 1990-1992 cohort, and 243 in the 2013-2015 cohort. The main cause of UVFP in the population as a whole was thyroidectomy (41.3 %), followed by an idiopathic origin (25.3 %) and thoracic surgery (12.1 %); this was confirmed in both intra-group analyses. There was a statistically significant association between etiology and the sub-group periods: the prevalence of post-thyroidectomy UVFP was highly significantly lower in the 2013-2015 cohort (35.4 vs 54.0 %), and the prevalence of idiopathic cases was higher (28.4 vs 18.6 %). Etiology significantly related to gender in both cohorts (p value ≤0.001). In the 2013-2015 cohort, there was also a statistically significant relationship between etiology and age classes (p value 0.017), and the left side was more frequently affected than the right (67.1 vs 32.9 %). Our findings document changes in the etiological pattern of UVFP over the last 25 years, with a considerable decrease in post-thyroidectomy UVFP, and a growing predominance of idiopathic and post-thoracic surgery UVFP.
Meeus, Ivan; de Miranda, Joachim R; de Graaf, Dirk C; Wäckers, Felix; Smagghe, Guy
Israeli acute paralysis virus (IAPV) together with Acute bee paralysis virus (ABPV) and Kashmir bee virus (KBV) constitute a complex of closely related dicistroviruses. They are infamous for their high mortality after injection in honeybees. These viruses have also been reported in non-Apis hymenopteran pollinators such as bumblebees, which got infected with IAPV when placed in the same greenhouse with IAPV infected honeybee hives. Here we orally infected Bombus terrestris workers with different doses of either IAPV or KBV viral particles. The success of the infection was established by analysis of the bumblebees after the impact studies: 50days after infection. Doses of 0.5×10(7) and 1×10(7) virus particles per bee were infectious over this period, for IAPV and KBV respectively, while a dose of 0.5×10(6) IAPV particles per bee was not infectious. The impact of virus infection was studied in micro-colonies consisting of 5 bumblebees, one of which becomes a pseudo-queen which proceeds to lay unfertilized (drone) eggs. The impact parameters studied were: the establishment of a laying pseudo-queen, the timing of egg-laying, the number of drones produced, the weight of these drones and worker mortality. In this setup KBV infection resulted in a significant slower colony startup and offspring production, while only the latter can be reported for IAPV. Neither virus increased worker mortality, at the oral doses used. We recommend further studies on how these viruses transmit between different pollinator species. It is also vital to understand how viral prevalence can affect wild bee populations because disturbance of the natural host-virus association may deteriorate the already critically endangered status of many bumblebee species.
Medin, Paul M; Foster, Ryan D; van der Kogel, Albert J; Meyer, Jeffrey; Sayre, James W; Huang, Hao; Öz, Orhan K
Background and Purpose Paralysis observed during a study of vertebral bone tolerance to single-session irradiation led to further study of the dose-related incidence of motor peripheral neuropathy. Materials and Methods During a bone tolerance study, cervical spinal nerves of 15 minipigs received bilateral irradiation to levels C5–C8 distributed into three dose groups with mean maximum spinal nerve doses of 16.9±0.3Gy(n=5), 18.7±0.5Gy(n=5), and 24.3±0.8Gy(n=5). Changes developing in the gait of the group of pigs receiving a mean maximum dose of 24.3 Gy after 10 – 15 weeks led to the irradiation of two additional animals. They received mean maximum dose of 24.9±0.2 Gy(n=2), targeted to the left spinal nerves of C5 – C8. The followup period was one year. Histologic sections from spinal cords and available spinal nerves were evaluated. MR imaging was performed on pigs in the 24.9Gy group. Results No pig that received a maximum spinal nerve point dose ≤19.0Gy experienced a change in gait while all pigs that received ≥24.1Gy experienced paralysis. Extensive degeneration and fibrosis were observed in irradiated spinal nerves from the 24.9Gy animals. All spinal cord sections were normal. Irradiated spinal nerve regions showed increased thickness and hypointensity on MR imaging. Conclusion The single-session tolerance dose of the cervical spinal nerves lies between 19.0 and 24.1 Gy for this model. PMID:24060168
Thakar, Alok; Sikka, Kapil; Verma, Rohit; Preetam, C
This study documents the speech and swallowing outcomes of isolated ipsilateral cricothyroid approximation (aka tensioning thyroplasty; Type IV thyroplasty) for the treatment of high vagal paralysis (combined superior laryngeal nerve and recurrent laryngeal nerve paralysis). This is a pilot study of five cases with high vagal paralysis consequent to skull base neoplasms. Unilateral cricothyroid tensioning sutures were used. In all cases, vocal fold tensioning and vertical realignment of lax vocal folds were achieved. A partial, but acceptable medialization of vocal cord position was achieved. In all cases, aspiration was minimized and normal swallow function was restored by 6 weeks. The voice outcome was excellent in four cases and acceptable in one. Cricothyroid approximation restores vocal fold tension; in addition, it restores vertical vocal fold position and partially restores horizontal vocal fold position. Good voice and swallowing outcomes have been achieved. The procedure is quick, safe, and convenient when combined with a skull-base excision procedure. Further evaluation is merited.
Rizzo, Francesca; Benetti, Cecilia; Ballatori, Consuelo; Binanti, Diana
An 18-month-old male entire Bloodhound dog was presented with a six-week history of progressive inspiratory dyspnoea, stridor, dysphonia and exercise intolerance. CT scan performed elsewhere had revealed the presence of an unencapsulated nodular mass (3x1x5 cm) dorsal to the larynx and first tracheal rings. Laryngoscopy demonstrated the presence of bilateral laryngeal paralysis and distorted laryngeal architecture suggestive of extraluminal compression. Histopathology results of incisional biopsies from the mass were suggestive of a benign non-neoplastic muscular lesion. Surgery was performed to manage laryngeal paralysis and attempt mass excision. A second histopathology examination confirmed an inflammatory and dysplastic lesion suggestive of a pseudotumour. All clinical signs resolved after surgery and at the 13 months follow-up the dog remains asymptomatic. To the authors’ knowledge, this is the first report of a case of laryngeal paralysis caused by a muscle pseudotumour in a young dog.
Yang, Jin-Sheng; Cui, Cheng-Bin; Gao, Xin-Yan; Zhu, Bing; Rong, Pei-Jing
To observe the clinical effects of the Hua Tuo Manual Acupuncture Therapeutic Stimulator for peripheral facial paralysis. 87 patients with peripheral facial paralysis were divided randomly into the SXDZ-100 Nerve and Muscle Stimulator treatment group (44 cases) and the G6805 Electric Stimulator control group (43 cases). The acupoints selected for both the two groups were local points as well as distal points as Hegu (LI 4), Waiguan (TE 5), Sanyinjiao (SP 6), Taichong (LR 3). Effectiveness was compared between the two groups. Both groups had a total effective rate of 100%. But the cure rate was 90.9% in the treatment group, and 73.0% in the control group, indicating a significant difference (P < 0.05). No side effects were found in either of the two groups. The SXDZ-100 stimulator is more effective than the G6805 electroacupuncture stimulator for treatment of peripheral facial paralysis.
Kwon, You-Jung; Lee, Seunghoon; Park, Sangmin; Lee, Ungin; Lim, Sung-Keun; Nam, Dongwoo; Lee, Sanghoon
The aim of this study was to investigate the effects of needle-pricking therapy on peripheral facial paralysis. This study included 162 patients with peripheral facial paralysis, 107 of whom were treated with usual care (conventional and alternative treatments) and 55 of whom were additionally treated with needle-pricking therapy on 3 specific extra-meridian acupuncture points known as 'Samjoong' (Sānchóng in Chinese). We evaluated changes in facial motor functions and sequelae using the Yanagihara and gross House-Brackmann grading systems before and after treatments. Yanagihara score and House-Brackmann grade significantly improved after treatments in both groups. However, the needle-pricking therapy group showed greater improvements in Yanagihara score and House-Brackmann grade than the usual care group. Our results suggest that Samjoong needle-pricking therapy could be applied as an adjunct therapy to usual care for patients with peripheral facial paralysis. © 2014 S. Karger GmbH, Freiburg.
Iengo, M; Villari, P; Cavaliere, M; De Clemente, M; Merolla, F
The authors present a study of 37 patients affected by monolateral vocal cord paralysis in order to analyze etiology, degree of dysphonia and possible recovery of vocal function. The patients underwent the following tests: case history to determine the vocal characteristics prior to the lesion; video-laryngoscopy to define the position of the paralytic cord on the horizontal glottic plane and any compensation mechanisms; determination of the degree of dysphonia (light, moderate, severe, aphonia) on the basis of psycho-perceptive parameters; spectrography evaluated in classes (I, II, III and IV) according to Yanagihara. Analysis of the data obtained makes it possible to draw the following conclusions: the most frequent etiology encountered by the otorhinolaryngologist is surgical (particularly subsequent to thyroidectomy); the position taken by the paralytic vocal cord does not appear to determine the degree of dysphonia; during the period immediately after occurrence of the lesion (0-4 months) the vocal disorder is more intense and tends to be reduced thereafter, attenuated by a spontaneous compensation mechanism. In this regard, it must be pointed out, however, that such compensation can prove bad or even dangerous for good vocal function (falsetto voice); speech therapy makes it possible to nearly totally normalize vocal function in all patients presenting moderate dysphonia and in 60% of those with severe dysphonia. In the remaining 40% of those patients with severe dysphonia a partial improvement of vocal function was seen (from severe dysphonia to moderate dysphonia). This was determined by the fact that several negative prognostic factors came into play simultaneously in these patients (i.e. advanced age, longer time gap since the lesion occurred, position assumed by the paralytic cord) which prevented them from achieving better phonatory results.
Sousa, Ivanildo P; Burlandy, Fernanda M; Oliveira, Silas S; Nunes, Amanda M; Sousa, Cristiane; da Silva, Elaine M; Souza, Jaqueline G A; de Paula, Valdemar A; Oliveira, Ivone C M; Tavares, Fernando Neto; da Costa, Eliane V; da Silva, Edson Elias
The last case of paralytic poliomyelitis caused by wild poliovirus in Brazil occurred in 1989. The interruption of the indigenous poliovirus transmission was obtained through mass immunization campaigns to eligible children and an active epidemiological and laboratorial surveillance of all cases of acute flaccid paralysis (AFP) among children under 15 y of age. This paper describes and evaluates the performance of the AFP surveillance system in different geographic areas of Brazil between 2005 and 2014, using indicators recommended by WHO. AFP surveillance indicators as well as virological investigation of polio and non-polio enteroviruses in stool samples received in the laboratory were assessed from 2005-2014. During the period, 5463 cases of AFP were investigated. Of these, 55% were males and 45% were females. Those under 5 y of age represented 48% of all cases reported and investigated. AFP notification rate was within the acceptable values with mean value of 1.3 (North), 1.4 (Northeast), 1.1 (Southern), 1.0 (Southeast) and 1.4 (Midwest) cases of AFP per 100.000 population aged 15 y as well as the adequacy of fecal specimens received in the laboratory. Sabin- related polioviruses accounted for 1.7% of the isolates while, 6.7% were non-polio enterovirus with the values ranging from 5.0% to 8.9 %. No wild-type polio was found. The AFP epidemiological and laboratorial surveillance activities have been kept at appropriate levels in Brazil. These data are a very strong indication, which supports the status of country free of polio.
Hovi, T.; Stenvik, M.
WHO recommends that surveillance of patients with acute flaccid paralysis (AFP) be used to demonstrate the eradication of wild poliovirus. In this article we report the results of a study to assess the frequency of AFP patients referred to Finnish hospitals and whether virological diagnostic coverage could be improved by repeated reminders and active feedback. For this purpose, we sent monthly questionnaires to all neurological and paediatric neurological units in Finland, requesting retrospective reporting on investigated paralytic patients with defined clinically relevant diagnoses, rather than AFP. Reminder letters included a pre-paid return envelope. Virological investigations were offered cost free. Of the 492 reporting forms sent, 415 (84%) were returned, evenly covering both the population and the study period (July 1997 to June 1998). Of the 90 patients reported, 83 were evaluable. The apparent incidences of the diagnoses covered were 1.6 per 100,000 at any age, and 1.0 per 100,000 for under--15-year-olds. Guillain-Barré syndrome was the most common diagnosis (0.80 per 100,000). The two faecal specimens required were virologically investigated in nine out of the 10 patients under 15 years of age, but in only 46% of all patients. Four adenovirus strains, but no polioviruses or other enteroviruses, were isolated. We conclude that a satisfactory monthly reporting system was readily established and that a sufficient number of patients with diagnoses resembling AFP are being referred to Finnish hospitals. Active feedback did not increase the proportion of virologically investigated patients to an acceptable level in all age groups. It is clear that other approaches must be used to quantify the circulation of poliovirus in Finland. PMID:10812725
Little, Max A; Costello, Declan A E; Harries, Meredydd L
Clinical acoustic voice-recording analysis is usually performed using classical perturbation measures, including jitter, shimmer, and noise-to-harmonic ratios (NHRs). However, restrictive mathematical limitations of these measures prevent analysis for severely dysphonic voices. Previous studies of alternative nonlinear random measures addressed wide varieties of vocal pathologies. Here, we analyze a single vocal pathology cohort, testing the performance of these alternative measures alongside classical measures. We present voice analysis pre- and postoperatively in 17 patients with unilateral vocal fold paralysis (UVFP). The patients underwent standard medialization thyroplasty surgery, and the voices were analyzed using jitter, shimmer, NHR, nonlinear recurrence period density entropy (RPDE), detrended fluctuation analysis (DFA), and correlation dimension. In addition, we similarly analyzed 11 healthy controls. Systematizing the preanalysis editing of the recordings, we found that the novel measures were more stable and, hence, reliable than the classical measures on healthy controls. RPDE and jitter are sensitive to improvements pre- to postoperation. Shimmer, NHR, and DFA showed no significant change (P>0.05). All measures detect statistically significant and clinically important differences between controls and patients, both treated and untreated (P<0.001, area under curve [AUC]>0.7). Pre- to postoperation grade, roughness, breathiness, asthenia, and strain (GRBAS) ratings show statistically significant and clinically important improvement in overall dysphonia grade (G) (AUC=0.946, P<0.001). Recalculating AUCs from other study data, we compare these results in terms of clinical importance. We conclude that, when preanalysis editing is systematized, nonlinear random measures may be useful for monitoring UVFP-treatment effectiveness, and there may be applications to other forms of dysphonia. Copyright Â© 2011 The Voice Foundation. Published by Mosby, Inc. All
Mau, Ted; Pan, Hao-Min; Childs, Lesley F
Patients with unilateral vocal fold paralysis (UVFP) are commonly told to wait 12 months for spontaneous recovery. This study aims to 1) determine the time to vocal recovery in UVFP, 2) use that data to develop a neurophysiologically plausible model for recovery, and 3) use the model to generate meaningful predictions for patient counseling. Case series with de novo mathematical modeling. Patients with UVFP who could pinpoint a discrete onset of vocal improvement were identified. The time-to-recovery data were modeled by assuming an "early" recovery group with neuropraxia and a "late" recovery group with more severe nerve injury. For the late group, a two-stage model was developed to explain the time to recovery: regenerating axons must cross the site of injury in stage 1 (probabilistic), followed by unimpeded regrowth to the larynx in stage 2 (deterministic). Of 727 cases of UVFP over a 7-year period, 44 reported spontaneous recovery with a discrete onset of vocal improvement. A hybrid distribution incorporating the two stages (exponentially modified Gaussian) accurately modeled the time-to-recovery data (R(2) = 0.918). The model predicts 86% of patients with recoverable UVFP will recover within 6 months, with 96% recovering within 9 months. Earlier vocal recovery is associated with recovery of vocal fold motion and younger age. Waiting 12 months for spontaneous recovery is probably too conservative. Repair across the site of injury, and not regrowth to larynx, is likely the rate-determining step in reinnervation, consistent with other works on peripheral nerve regeneration. 4. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.
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Sonne, Christian; Alstrup, Aage Kristian Olsen; Therkildsen, Ole Roland
We reviewed paralysis in wild birds with a special focus on the Baltic Sea paralytic syndrome recently described by Balk et al. (2009) by assessing multiple causative factors. The review showed that paralysis may occur in various species and that the aetiology can be divided into biotoxins, nutritional deficiencies, environmental contaminants and infectious diseases. The review also showed that the symptoms are influenced by age, sex and species of the affected individual. It seemed that paralysis may be treated or relieved by e.g. thiamine injections or additives. Due to a lack of extensive diagnostic studies, the potentially negative effects of paralysis at the population level of wild birds remain unsolved. We recommend that when investigating paralysis in wild birds, a holistic study approach including multiple factors are undertaken in order to pinpoint cause-and-effect relationships as well as the potential impacts on wild bird populations including those in the Baltic Sea.