Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This report describes 21 infants and children with bilateral abductor vocal cord paralysis and associated meningomyelocele, Arnold-Chiari malformation, and hydrocephalus. Two life-threatening forms of respiratory distress are distinguished: (1) upper airway obstruction due to bilateral abductor cord paralysis and (2) apnea. Clinically significant episodes of apnea were documented in 13 infants. Ten infants had evidence of aspiration and dysphagia. Vocal cord paralysis, apnea, aspiration, and dysphagia were frequently temporally related to increased intracranial pressure.
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PMID:Respiratory obstruction and apnea in infants with bilateral abductor vocal cord paralysis, meningomyelocele, hydrocephalus, and Arnold-Chiari malformation. 63 75

Syringobulbia is a term which has been clinically applied to brain stem symptoms or signs in patients with syringomyelia. Syringobulbia clefts are found on investigation or at necropsy caused by cutting outwards of the CSF under pressure from the fourth ventricle into the medulla. These should be differentiated from the ascending syringobulbia which may occur from upward impulsive fluid movements in a previously established syringomyelia. Clinical analysis of 54 patients suggests that bulbar features are most often found with neither of the above mechanisms but are due to the effects of pressure differences acting downward upon the hind-brain with consequent distortion of the cerebellum and brainstem, traction on cranial nerves or indentation of the brain-stem by vascular loops. The commonest symptoms in the 54 patients were headache (35), vertigo (27), dysphonia or dysarthria (21), trigeminal paraesthesiae (27), dysphagia (24), diplopia (16), tinnitus (11), palatal palsy (11) and hypoglossal involvement (11). Careful attention to hydrocephalus is advisable before craniovertebral surgery, but the decompression of the hindbrain and the correction of craniospinal pressure dissociation remains the mainstay of surgical treatment. The results of careful surgery are good, 45 of the 54 cases reported improvement. Most of the reported deterioration occurred in a few patients who did conspicuously badly.
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PMID:Syringobulbia: a surgical appraisal. 147 91

The authors report a rare case of a huge jugular foramen neurinoma extending to pharyngeal region in a 64 year-old woman who visited an otolaryngologist with complaints of dysphagia, hoarseness and headache in 1984. At that time a submucosal lump was noted in her left pharyngeal region. Biopsy of the tumor proved it to be neurinoma. A CT scan disclosed a dumbell shaped jugular foramen neurinoma and noncommunicating hydrocephalus. Because her symptoms slowly progressed and cerebellar signs as well as signs of increased intracranial pressure was noted, she was referred to our hospital in 1986. She had shown typical sings of left Vernet syndrome, VIIth, VIIIth cranial nerve impairment as well as cerebellar, long tract and increased ICP signs. A subtotal removal was performed from the extracranial and posterior fossa in one stage. The tumor seemed to originate from the Xth cranial nerve. The histological diagnosis of neurinoma was confirmed. Postoperatively, although her dysphagia increased for several weeks, a tracheostomy was not necessary. She was discharged 2 months later and returned to her usual occupation as a house wife. Slight dysphagia and hoarseness were her only chronic symptoms. So far, 88 cases of jugular foramen neurinoma have been reported, 15 of them including our case from Japan. Our case is probably the largest of these reported tumors. Tumors in jugular foramen often masquerade as an acoustic neurinoma or other tumor. However, recently this can usually be diagnosed preoperatively with a careful neurological examination and by means of neuroradiological investigations such as jugular venography, CT scan and MRI.
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PMID:[Huge jugular foramen neurinoma extending to the pharyngeal region: a case report]. 341 64

Parkinsonism is an uncommon movement disorder in childhood. Six unusual cases of acquired parkinsonism in hospitalized children are described. Clinical manifestations included an akinetic-rigid syndrome with and without tremor, the combination of parkinsonism and dystonia, and a parkinsonism-plus syndrome. Altered mental status, mutism, dysphagia, and sialorrhea were frequent associations. Etiologies included hypoxic-ischemic encephalopathy; haloperidol treatment with and without neuroleptic malignant syndrome; toxicity of cytosine arabinoside, cyclophosphamide, amphotericin B, and methotrexate; St. Louis encephalitis and other encephalitides; and a pineal tumor with hydrocephalus. Cranial magnetic resonance imaging results ranged from normal to profound cerebral and cerebellar atrophy with chemotherapeutic toxicity. The illnesses usually were severe enough to require pharmacotherapy. Incorrect diagnoses of depression or catatonia delayed treatment or aggravated the problem. Acute treatment included amantadine, levodopa/carbidopa with or without selegiline, diphenhydramine, or benztropine. The concentration of CSF homovanillic acid was normal in a neuroleptic-associated patient, but the level was low in an encephalitic patient. All patients demonstrated dramatic improvement, including two who were not treated; some had complete resolution of symptoms and none required continued antiparkinsonian drugs despite poor scores on the Unified Parkinson's Disease Rating Scale and the Modified Hoehn and Yahr Rating Scales. The causes of parkinsonism described are more common in a general pediatric hospital than the parkinsonism associated with the popularized Segawa syndrome.
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PMID:Clinical spectrum of secondary parkinsonism in childhood: a reversible disorder. 802 61

Both neurologic and medical complications influence outcome after stroke. Space-occupying supratentorial infarcts can cause transtentorial or uncal herniation, which leads to death. Treatments aimed at reducing intracranial pressure in patients with such infarcts are of unproven value. Mass-producing cerebellar infarction may lead to brainstem compression and obstructive hydrocephalus. These lesions often are treated surgically. Although anticonvulsants are not indicated for prophylaxis, the occurrence of epileptic seizures mandates treatment to prevent recurrences. Depression is common in the acute stage of stroke, but is probably not more prevalent after stroke than after myocardial infarction. Although dysphagia is common, it usually is a transient problem. Patients with a decrease of consciousness or brainstem dysfunction usually need tube feeding for a certain period of time. Medical complications, such as fever, infections, hyperglycemia, cardiac disorders, pressure sores, and deep venous thrombosis, are associated with a poor prognosis and should be treated as early as possible. Measures to prevent these complications are part of general care. Hypertension is very common during the week after stroke and should be treated only in case of extremely high values or malignant hypertension. A multidisciplinary approach in the stroke unit is necessary to prevent and manage complications in the acute phase of stroke.
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PMID:Treatment or prevention of complications of acute ischemic stroke. 1468 26

A 77-year-old man with a 9-year history of prostate cancer presented with high fever and dysphagia. The initial diagnosis was aspiration pneumonia, but the patient became comatose 2 days after admission, and neuroradiological workup revealed cerebellar hemorrhage, obstructive hydrocephalus, and extensive destruction of the occipital bone secondary to cranial metastasis. The diagnosis was cerebellar hemorrhage secondary to cranial metastasis of prostate cancer. Tumor resection was abandoned because of the patient's poor health. Shunt surgery and palliative radiotherapy were temporarily effective in restoring his consciousness, but he died of systemic infection 3 weeks after surgery. Metastasis of prostate cancer to the cranium, particularly to the skull base, rarely causes lower cranial nerve paresis, and awareness of this sign may lead to earlier detection of the cranial metastasis and prevention of cerebellar hemorrhage.
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PMID:Cerebellar hemorrhage secondary to cranial metastasis of prostate cancer--case report. 1501 30

Despite major advances in skull base surgery and microsurgical techniques, surgery for vestibular schwannoma (VS) carries a risk of complications. Some are inherent to general anesthesia and surgery of any type and include myocardial infarction, pneumonia, pulmonary embolism, and infection. Some are specific to neurosurgery in this area of the brain, and include hydrocephalus, cerebrospinal fluid leak, facial nerve paralysis, facial numbness, hearing loss, ataxia, dysphagia, and major stroke. Even in the hands of very experienced acoustic surgeons, these risks cannot be eliminated. Radiosurgery provides an outpatient, noninvasive alternative for the treatment of small acoustic schwannomas. Initially radiosurgery was undertaken in "high-risk" patients, including the elderly, those with severe medical comorbidities, and those in whom tumors recurred after surgery. Additionally, a high rate of cranial nerve morbidity was reported. With improvements in dosimetry planning and dose selection, however, authors practicing at radiosurgical centers now report very low complication rates, as well as high tumor control rates. In this report the authors specifically review the results of linear accelerator-based radiosurgery for VS and compare these outcomes with the best surgical alternatives.
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PMID:Linear accelerator-based radiosurgery for vestibular schwannoma. 1566 13

A 19-year-old immunocompetent man was admitted to hospital with diplopia, nausea, vomiting and change in mental status. The patient had a history of tuberculous meningitis that was diagnosed at another hospital 6 months before the present admission, and at that time anti-tuberculosis treatment was initiated using a first-line drug combination. A computed tomography (CT) scan of the brain revealed non-communicating hydrocephalus. A ventriculo-peritoneal shunt was inserted surgically. Two months later, the patient was hospitalized again for fever, dysphagia and left hemiparesis. At that time, his cranial CT findings were within normal limits; however, magnetic resonance imaging (MRI) revealed an irregular multilocular peripheral contrast-enhancing lesion in the posterior fossa. The abscess was surgically drained. The presence of acid-fast bacilli in the abscess material was demonstrated by Ziehl-Neelsen staining. Mycobacterium tuberculosis grew on Lowenstein-Jensen culture medium, and the strain was found to be resistant to isoniazid. One month after the operation, the patient became quadriparetic. Cervical MRI revealed a cervico-thoracic syringomyelitic cavity, after which a syringoperitoneal shunt was placed. Treatment with four drugs was continued for 10 months, and then treatment with three drugs for a total period of 18 months. The patient recovered, with residual quadriparesis. Even though very rare, isoniazid-resistant M. tuberculosis may be the causative agent of progressive tuberculosis.
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PMID:Cerebellar abscess and syringomyelia due to isoniazid-resistant Mycobacterium tuberculosis. 1713 74

We have operated on nine patients with a prepontine epidermoid extending to the bilateral cistern or the unilateral middle fossa using the anterior transpetrosal approach since 1986. The preoperative symptoms were unilateral trigeminal neuralgia, hearing disturbance, gait disturbance, double vision, facial hypesthesia, hemifacial spasm, and dysphagia. The most common neurological sign was unilateral trigeminal nerve disturbance. In two patients with useful hearing preoperatively lost, the labyrinth and mastoid air cells as well as the petrous apex were resected to extend the surgical field. Tumors were totally removed, except for capsules that were tightly adhered to the brain stem, cranial nerve, and vessels. The trigeminal neuralgia, hemifacial spasm, and dysphagia disappeared, but double vision improved only one out of three cases, and facial hypesthesia was unchanged in all cases. There were no postoperative deaths. New abducens palsy appeared in four cases and cerebrospinal fluid (CSF) leakage appeared in three cases postoperatively, but later these symptoms disappeared. In one case, postoperative chemical meningitis developed, and a ventricular shunt was required later to treat hydrocephalus. Postoperative follow-up, an average of 5,7 years, did not show any increases in any of the tumors. Based on our experience, we conclude that the anterior transpetrosal approach is more useful than the retromastoid suboccipital approach to resect the epidermoid located mainly in the prepontine cistern.
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PMID:Anterior transpetrosal approach to the prepontine epidermoids. 1717 Nov 21

A 10-year-old girl presented with a brainstem epidermoid cyst manifesting as dysphagia and post-prandial vomiting. Magnetic resonance imaging disclosed a cystic mass in the brainstem with associated hydrocephalus. She was treated under a presumptive diagnosis of abscess until the definitive histological diagnosis was established at the fourth admission. In spite of four interventions, she remained in good condition with minimal cranial nerve pareses. Subtotal removal of the epidermoid cyst in the brainstem results in recurrence within a relatively short period, especially in children. Total resection of the tumor is the optimum treatment. The differential diagnosis includes abscess, cystic glioma, and neurenteric cyst.
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PMID:Brainstem epidermoid cyst in a child. Case report. 1738 99


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