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Query: UMLS:C0030552 (paresis)
 5,831 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of intracranial hypoglossal neurinoma is reported. A 32-year-old man with a history of unsteady gait and headache for one and a half years was admitted to our hospital on September 23, 1983. Neurological findings on admission were nystagmus toward the left, left IXth and Xth cranial nerve paresis, left cerebellar signs, paresthesia of the left upper and lower extremities on neck flexion, and left pyramidal signs. Atrophy or fasciculation of the tongue was not noted. Computed tomography demonstrated a large isodensity and partially low density mass in the posterior fossa which was markedly enhanced and sharply margined with contrast medium. The tumor extended 45 mm over the edge of the foramen magnum. The maximum size was 45 mm X 40 mm. The coronal and sagittal reconstruction CT scan clearly demonstrated the attachment and extension of the tumor. Enlargement of the hypoglossal canal was clarified by changing the window level, window width and using 2 mm slice CT scan. Anterior-posterior x-ray view of the skull tomography showed enlargement of the hypoglossal canal, as indicated by the CT scan. The left hypoglossal canal was 7 mm and right was 3 mm in diameter. Vertebral angiography demonstrated that the tumor was located in the left posterior fossa, but no tumor stain appeared. This patient did not have XIIth cranial nerve palsy, but the neuroradiological findings strongly suggested a hypoglossal neurinoma, especially the findings of the CT scan and the anterior-posterior x-ray view of the skull tomography. On October 5, suboccipital craniotomy with Cl laminectomy was performed in prone position.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of intracranial hypoglossal neurinoma]. 380 8

Four patients aged 41 to 73 years, who had had rheumatoid arthritis for eight to 25 years, had signs and symptoms of cervical myelopathy and radiculopathy due to either atlantoaxial dislocation with herniation of the odontoid through the foramen magnum, or subluxation of the middle to lower cervical vertebrae. Spastic paraparesis or quadriparesis, severe nuchal immobility and pain, and flaccid paresis of the upper limbs necessitated anterior medullary decompression and posterior cervical fusion. Postmortem examination disclosed old ischemic necrosis, atrophy, and gliosis in the low medulla and cervical cord. Anterior and posterior gray horns and contiguous posterior and lateral funiculi bore the brunt of the damage. Ascending and descending wallerian degeneration and atrophy of the cervical nerve root were evident. In three cases, anterior spinal or radicular arteries demonstrated intimal fibrosis with moderate stenosis; two cases depicted chronic phlebitis or subarachnoid vessels. Previous reports have infrequently provided evidence of a vasculopathy.
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PMID:Cervical myelopathy due to atlantoaxial and subaxial subluxation in rheumatoid arthritis. 668 27

The anterior spinal artery syndrome in three patients is described and from the literature 60 additional patients were collected. Motor recovery in the following groups of patients was noted: (1) Partial loss of motor function and pain sensation--70.4 per cent (19/27); (2) Complete motor loss but partial loss of pain--83.3 per cent (5/6); (3) Paresis but pain sensation absent--66.7 per cent (6/9); and (4) Absent motor function and pain--38.9 per cent (7/18). Motor recovery was also found to vary according to aetiology: (A) Unknown cause--92.9 per cent (13/14); (B) Post-infection or vaccination--88.9 per cent (8/9); (C) Anterior spinal artery occlusion--33.3 per cent (3/9); (D) Spinal cord angioma--20 per cent (2/10); and (E) Aortic lesion--20 per cent (1/5). Patients with sparing of motor function or pain sensation below the lesion do better than those without both functions. Neurological return also varies with the aetiology of the syndrome.
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PMID:Anterior spinal artery syndrome and its natural history. 683 86

Acquired or congenital laryngotracheal stenosis is uncommon in children although premature infants with respiratory distress syndrome (SDR) requiring ventilatory support with prolonged intubation are at great risk. The different treatments used in the past show high rates of morbidity and mortality. Following the technique described by Cotton in 1980, anterior cricoid slit procedure in the upper two tracheal rings has been used as a primary treatment on five patients since 1991, four by intrinsic stenosis and one by extrinsic. Extubation failed in four of them, checking trough bronchoscopy different grades of laryngotracheal stenosis and in the fifth due to respiratory distress, secondary to subcricoid stenosis. Anterior cricoid split procedure with intubation with conventional endotracheal tube (SET) or Montgomery tube (TTM) was performed on infants whose ages ranged from 4 to 18 months old (averaged 8 months). They were extubated between the 5th and 340th days after surgery. Two of them underwent complications: a skin-tracheal fistula and a paresis of the left vocal cord, the two are asymptomatic after four and eighteen months of the procedure. All patients discharged without signs of upper airway obstruction, except one who developed a granuloma which diminished with cortisone. Anterior cricoid split with prolonged intubation is a safe and useful technique for the treatment of laryngotracheal stenosis.
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PMID:[Surgical treatment of laryngotracheal stenosis in childhood]. 776 82

Neuronal degeneration in the precentral gyrus alone cannot account for the occurrence of spastic paresis in motor neuron diseases. To look for more extensive cortical atrophy we measured MRIs of the upper parts of the frontal and parietal lobes in 11 sporadic cases of classical amyotrophic lateral sclerosis (ALS), eight patients with primary lateral sclerosis (PLS) and an age- and sex-matched group of 49 neurologically normal people. None of the patients had overt dementia or other mental diseases. In PLS there is progressive spastic paresis but in contrast to ALS there is no lower motor neuron degeneration. The surface area of the precentral gyri and the amount of underlying white matter in PLS were consistently approximately 75% of the normal size. By contrast, there was some shrinkage of the precentral gyri in some of the ALS patients but the mean measurements for the group did not differ significantly from the controls. Anterior to the precentral sulci, the cortical surface area in PLS was approximately 85% of that of the controls, with correspondingly reduced white matter. In ALS the cortical surface areas of the anterior frontal lobes did not differ from those of the controls, but the amount of underlying white matter was reduced almost as much in ALS as it was in PLS. The measured changes in the frontal lobes suggest that in PLS there is simultaneous atrophy of the primary, premotor and supplementary motor areas of the cortex, with consequent degeneration of corticospinal and corticoreticular axons descending through the underlying white matter. These changes could account for the progressive upper motor neuron syndrome. In ALS, with no significant frontal cortical atrophy, the shrinkage of the white matter may be due to degeneration of axons projecting to the frontal cortex from elsewhere. Deprivation of afferents could explain the diminution of motor functions of the frontal lobes in ALS and also the changes in word fluency, judgement and attention that can be detected by appropriate testing in some patients with the disease. Incidental observations include slightly larger parietal lobes but no difference in the frontal lobes in men as compared with women. There was also a small but significant decrease in size of the normal frontal lobes with age. The latter change was much smaller than the atrophy seen in patients with ALS and PLS.
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PMID:Frontal lobe atrophy in motor neuron diseases. 792 62

A number of cortical and subcortical areas are involved in the control of saccades and smooth pursuit, and lesions affecting these areas result in various ocular motor syndromes. Most of these syndromes are relatively subtle and have to be ascertained using recordings, because other brain areas may largely take over the function of a damaged area. Anterior cortical, posterior cortical, large and bilateral cortical, subcortical and degenerative cerebral lesions are successively reviewed. In the anterior part of the cerebral hemisphere, the frontal eye field (FEF), supplementary eye field (SEF) and prefrontal cortex (PFC), i.e. area 46 of Brodmann, control eye movements. The FEF appears to be principally involved in the control of intentional saccades, in particular those made with a retinotopic reference system, and in smooth pursuit. The SEF could control saccades made with a spatiotopic reference system, and sequences of saccades (requiring a temporal working memory). The PFC could control the inhibition of unwanted reflexive saccades, and be involved in spatial memory used for programming all types of memory-guided saccades. In the posterior part of the cerebral hemisphere, the parietal eye field (PEF) is involved in the triggering of reflexive visually guided saccades, and the middle temporal (MT) and medial superior temporal (MST) areas in smooth pursuit. Acute and large unilateral lesions usually result in transitory ipsilateral conjugate eye deviation. Bilateral lesions affecting both the FEF and the PEF result in severe saccade and smooth-pursuit paresis, whereas bilateral posterior temporoparietal lesions result in Balint's syndrome, consisting of both eye movement and visual-attention abnormalities. Subcortical lesions also result in various eye movement abnormalities, which have been little documented to date. Lastly, degenerative cerebral diseases, such as Alzheimer's disease, Parkinson's disease, Huntington's disease, progressive supranuclear palsy and corticobasal degeneration result in more or less severe eye movement disturbances. Eye movement recordings may contribute to early differential diagnosis of some of these degenerative diseases.
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PMID:Saccade and smooth-pursuit impairment after cerebral hemispheric lesions. 803 37

Anterior rerouting of the intratemporal facial nerve in the infratemporal fossa approach is employed to access to the jugular bulb, hypotympanum, and lateral skull base, whereas posterior rerouting of the facial nerve, as employed in the transcochlear craniotomy, is most frequently used for surgery of the posterior fossa, cerebellopontine angle, prepontine region, and petrous apex. Facial nerve rerouting may lead to facial paresis or paralysis. This review of the literature is intended to define the physiologic "cost" of these procedures, so that the neurotologic surgeon can determine if the morbidity incurred in these techniques is worth the resultant exposure. Inconsistencies in reporting facial function places into question the validity of some of the cumulative data reported. Postoperatively, grades I-II facial nerve function was seen in 91% of patients undergoing short anterior rerouting, 74% of patients undergoing long anterior rerouting, and 26% of patients undergoing posterior complete rerouting. Although facial nerve rerouting allows unhindered exposure to previously inaccessible regions, it is achieved at the cost of facial nerve function. Facial nerve dysfunction increases with the length of facial nerve rerouted.
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PMID:Rerouting of the intratemporal facial nerve: an analysis of the literature. 889 79

Neuro-ophthalmologic complications from cataract surgery are uncommon and include central nervous system toxicity, binocular diplopia, traumatic optic neuropathy and ischemic optic neuropathy. Retrobulbar blocks may be accidentally injected into the subarachnoid space with diffusion to the brainstem. This leads to cardiovascular, respiratory, and mental status compromise. Most patients have complete recovery with adequate support. Post-operative, binocular diplopia may occur secondary to anisometropia or previously unrecognized misalignment. Periocular injection may cause paresis or fibrosis of extraocular muscles. Anterior or posterior ischemic optic neuropathy can occur in the first 6 weeks after cataract surgery with or without periocular injection. The risk to the other eye is high with subsequent contralateral cataract extraction. Post-operative vision loss associated with direct traumatic needle injury is recognized immediately. Therefore, an orbital MRI may be warranted for a patient with an optic neuropathy in the first 24 hours after cataract surgery using periocular anesthesia. If evidence of needle injury is present on neuroimaging, a trial of steroids should be considered.
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PMID:Neuro-ophthalmologic complications of cataract surgery. 1275 44

Anterior shoulder dislocations are one of the most common problems seen in an emergency department. Doubtless, immediate reduction is necessary for treatment, a procedure that is extremely rarely accompanied by complications. In these cases early diagnosis and treatment may be limb saving. We report a case with rupture of the arteria subscapularis following reduction of an anterior shoulder dislocation with formation of an axillary hematoma and consecutive paresis of the plexus brachialis. Interdisciplinary operative revision was necessary to remove the hematoma, stop the hemorrhage and for neurolysis of the plexus brachialis. Treatment resulted in a speedy recovery of the patient. Gentle reduction of a dislocated shoulder is a prerequisite for a low complication rate. Contrast-enhanced computed tomography facilitated diagnosis of the hematoma and identification of the bleeding vessel.
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PMID:[Rupture of the arteria subscapularis following reduction of an anterior shoulder dislocation]. 1605 27

Anterior plagiocephaly is a craniofacial anomaly related to premature unilateral synostosis. We present three cases of anterior plagiocephaly with contralateral superior oblique dysfunction. A detailed ophthalmic examination, including orthoptic assessment for the extraocular muscle misalignment, with appropriate radio-imaging was done in all the three cases. All of them showed a right-sided plagiocephaly, with overaction of the left superior oblique muscle, alternating exotropia and a dissociated vertical deviation. Two underwent surgical correction of squint. Both were well aligned after squint surgery. Plagiocephaly has been reported to simulate superior oblique muscle paresis. We report a rare occurrence of contralateral superior oblique muscle overaction in three children with anterior plagiocephaly.
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PMID:Anterior plagiocephaly with contralateral superior oblique overaction. 1897 24


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