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Query: UMLS:C0030552 (paresis)
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Carbon monoxide (CO) has the toxic effects of tissue hypoxia and produces various systemic and neurological complications. The main clinical manifestations of acute CO poisoning consist of symptoms caused by alterations of the cardiovascular system such as initial tachycardia and hypertension, and central nervous system symptoms such as headache, dizziness, paresis, convulsion and unconsciousness. CO poisoning also produces myocardial ischemia, atrial fibrillation, pneumonia, pulmonary edema, erythrocytosis, leucocytosis, hyperglycemia, muscle necrosis, acute renal failure, skin lesion, and changes in perception of the visual and auditory systems. Of considerable clinical interest, severe neurological manifestations may occur days or weeks after acute CO poisoning. Delayed sequelae of CO poisoning are not rare, usually occur in middle or older, and are clinically characterized by symptom triad of mental deterioration, urinary incontinence, and gait disturbance. Occasionally, movement disorders, particularly parkinsonism, are observed. In addition, peripheral neuropathy following CO poisoning usually occurs in young adults.
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PMID:Carbon monoxide poisoning: systemic manifestations and complications. 1141 Jun 84

The objective was to assess the cochleovestibular symptoms in migraine. Therefore, a questionnaire form was prepared to record the data obtained from 20 migraineurs. All patients were assessed with audiometry, bithermal caloric testing and auditory brainstem response testing (ABR) between the migraine attacks, and 8 of them were also assessed during the attacks. Dizziness (30%) was the most common symptom that was followed by vertigo (25%) and tinnitus (20%). All patients had hearing within normal limits. Positional test (Hallpike maneuver) was positive in 2 (10%). Bithermal caloric testing revealed canal paresis in 3 (15%) patients. ABR results were normal in 13 patients. Seven patients (35%) had abnormal ABR results. Four of them (20%) had elongation in the absolute wave latencies (wave I, III and V) and normal IPLs of wave I-III, III-V and I-V. Three (15%) patients had elongation in the absolute wave latencies as well as in the IPLs of wave I-III, III-V and I-V. In conclusion, cochleovestibular symptoms can be seen in migraineurs. The test results between and during attacks are similar. The subjective cochleovestibular symptoms did not correlate with the objective tests performed (audiometry, ABR and caloric testing).
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PMID:Assessment of migraine-related cochleovestibular symptoms. 1171 66

We studied 28 patients with vestibular neuronitis treated at our hospital between 1997 and 1999. To determine the effects of steroid therapy on long-term canal prognosis and daily activity, we examined caloric tests and gave questionnaires to 12 steroid-treated and 16 nonsteroid-treated patients 2 years after onset. We found that canal improvement was 50% in the nonsteroid-treated group and 75% in the steroid-treated one. In cases with severe canal paresis (CP > or = 60%), canal improvement was 33% in the nonsteroid-treated group and 67% in the steroid-treated one. Steroid therapy at the acute stage of this disease significantly reduced the duration of spontaneous nystagmus and handicap in daily life due to dizziness induced by head and body movement, decreasing mood disturbance.
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PMID:[Effects of steroid therapy on long-term canal prognosis and activity in the daily life of vestibular neuronitis patients]. 1176 90

We clinically analyzed 15 cases of perilymphatic fistulas--11 caused by barotraumas and 4 idiopathic--identified by surgery between March 1995 and March 1999 at the Hyogo College of Medicine and affiliated hospitals. Subjects were 11 men and 4 women (aged 14 to 79 years (mean: 46.7 years)). All showed hearing loss in audiography and 12 cases reported tinnitus--stream-like in 5 and poping in 4. Dysequilibrium was seen in 9 cases. Perilymph leakage was detected intraoperatively from the oval window in 9, from the round window in 4, and from both windows in 1, while another had leakage from the fissura ante fenestram. After surgery, hearing level improved by over 10 dB in 9 of the 11 cases operated on within 14 days after onset. Hearing did not improve in 3 of 4 operated on later. Vertigo disappeared after surgery. Dizziness tended to persist in those having canal paresis or paralytic nystagmus before surgery. We suggest that patients with progressive hearing loss should be operated on as soon as possible and that patients with dysequilibrium or without response to conservative treatment undergo surgery within 14 days of onset.
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PMID:[Audiological and equilibrium study of perilymphatic fistulas]. 1180 47

Surgical treatment of brainstem lesions has been encouraged after the development of magnetic resonance imaging. However, direct approaches to intra-axial lesions in the brainstem still carry a high risk of morbidity because the neuronal structures can be injured along the entry routes. We present two patients whose pontine cavernous angiomas were removed via incision of the lateral aspect of the pons with presigmoid approach. The first case, a 41-year-old woman, presented with paresis of the cranial nerves VI, VII, and VIII, and left hemiparesis progressing over 2 weeks caused by a cavernous angioma ventrally located in the lower pons. The second case, a 50-year-old woman, developed dizziness over 2 months due to a large cavernous angioma in the center of the pons. These lesions were totally removed through the presigmoid approach and no additional neurological deficits were observed. An image-guided navigation system was used for the craniotomy and removal of the lesion in the second patient. The presigmoid approach provides a safe route to intra-axial lesions in the pons. A technique for presigmoid craniotomy with one-piece bone flap under the image-guided navigation is also described.
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PMID:Presigmoid approach for cavernous angioma in the pons--technical note. 1194 97

A 66-year-old woman was admitted to our hospital because of vomiting, dizziness and vertigo. Neurological examination on admission revealed only upbeat nystagmus without cranial nerve symptoms, paresis, cerebellar signs or sensory disturbances. Magnetic resonance(MR) images demonstrated a new T 2 high intensity and T 1 iso-intensity signal lesion in the right upper medial medulla. This medial medullary infarction caused central vestibular dysfunction. MR angiography and digital subtraction angiography demonstrated a persistent primitive hypoglossal artery (PPHA) originating from the right internal carotid artery to the vertebrobasilar artery associated with the stenosis of the right internal carotid artery at the level of the cervical bifurcation. This is the first report of medullary infarction with persistent carotid-basilar anastomosis. We suspected this medullary infarction was caused by artery to artery embolism in the branch of the right vertebral artery through the PPHA distal originated from the stenosis of the right internal carotid artery.
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PMID:[A case of medial medullary infarction with persistent primitive hypoglossal artery]. 1199 64

The aim of this study was an analysis of the localizing and lateralizing value of clinical symptoms in frontal lobe epilepsy. Nineteen patients with medically refractory seizures originating from the frontal lobe were examined retrospectively, seven of these patients underwent subsequent neurosurgical removal of the epileptogenic zone. The predominant clinical symptoms were clonic (53%) and tonic motor phenomena (89%). Dystonic posturing (32%) and postictal paresis (37%) occurred frequently, indicating a seizure onset in the contralateral hemisphere. Head version contralateral to the seizure onset zone, as demonstrated in 53% of the patients, was a reliable lateralizing sign, whereas early head and eye turning (11%) had no lateralizing significance. 37% of the patients showed ictal vocalisation, another 37% presented with automatisms--so called hypermotor seizures should be considered as a special subtype. An aura was present in 26% of the patients--in most cases as a somatosensory manifestation or a feeling of dizziness, especially with seizures originating from the supplementary motor area (SMA) or the precentral area. Secondary generalization and seizure series occurred frequently. Unilateral automatisms, head version, tonic phenomena, dystonic posturing, unilateral grimacing, postictal paresis and unilateral clonic movements could be identified as reliable lateralizing signs. We conclude that the analysis of clinical symptoms plays an important role in presurgical epilepsy diagnosis.
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PMID:[Frontal lobe epilepsy--clinical seizure seminology]. 1221 69

The experience of depression and anxiety among a sample of 91 patients with complaints of vertigo or dizziness was assessed using a widely available screening instrument, the Hospital Anxiety and Depression Scale (HADS). Questionnaires to assess reported symptoms, self-esteem and social support were also administered. On the basis of clinical vestibular testing, 53% of participants were classified as having a labyrinthine disorder (canal paresis or positional vertigo), 22% as having a vestibular imbalance (spontaneous nystagmus or directional preponderance), and 251% as having no identifiable vestibular abnormality (negative test results). Based on the self-report measures using the screening instrument, 17% of the sample could be classified as depressed, and 29% as anxious. The presence of a vestibular lesion (based on clinical findings) was not associated with reported depression (F (3, 72) = 0.98, p = 0.41). The variables were entered into a hierarchical multiple regression analysis with depression as the dependent variable. A model emerged which accounted for 50% of the variance. Three variables comprised the final model: anxiety (beta = 0.44, p < 0.001), self-esteem (beta = 0.27, p < 0.01), and satisfaction with social support (beta = 0.25, p < 0.01). The results demonstrate the value of identifying psychosocial factors, as well as disease characteristics, among patients presenting at neurootology clinics. In particular, the findings highlight the importance of screening for emotional distress in this patient group, regardless of clinical test results or severity of self-reported symptoms.
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PMID:Screening for depression among neuro-otology patients with and without identifiable vestibular lesions. 1270 81

Vestibular neuritis (VN) rapidly damages unilateral vestibular periphery, inducing severe balance disorders. In most cases, such vestibular imbalance is gradually restored to within the normal level after clinical therapies. This successive clinical recovery occurs due to regeneration of vestibular periphery and/or accomplishment of central vestibular compensation. We experienced 36 patients with VN treated at our hospital, including cases in our previous preliminary report. To elucidate effects of steroid therapy both on the recovery of peripheral function and on the adaptation of central vestibular compensation, we examined caloric test and several questionnaires with two randomly divided groups, 18 steroid-treated and 18 nonsteroid-treated patients, over two years after the onset. These examinations revealed that steroid-treated patients had a tendency of better canal improvements (13/18, 72%) than nonsteroid-treated ones (10/18, 55.6%). However, there was no significant difference between these two groups. In cases with persistent canal paresis, steroid-treated patients (n = 5) reduced handicaps in their everyday life due to the dizziness induced by head and/or body movements and the disturbance of their mood, more effectively than those with nonsteroid therapy (n = 8). These findings suggest that steroid therapy with VN could be effective on not only vestibular periphery but central vestibular system, to restore the balance.
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PMID:Steroid effects on vestibular compensation in human. 1273 40

Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We studied the clinical features and results of quantitative audiovestibular tests in six elderly patients (> or =65 years of age) who presented with drop attacks attributable to an inner ear pathology. Group was divided into Meniere's syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed. Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases. Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Meniere's syndrome.
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PMID:Drop attacks in elderly patients secondary to otologic causes with Meniere's syndrome or non-Meniere peripheral vestibulopathy. 1585 May 85


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