Cases Of Paralysis Research Articles

Bilateral vocal cord paralysis in intermediate syndrome: a rare clinical presentation of organophosphorus poisoning.

Organophosphorus poisoning poses a significant health threat, often resulting in high mortality and disability. The intermediate syndrome, characterized by muscle weakness in neck flexors and limbs, is prevalent. While uncommon, cases of vocal cord paralysis have been observed. Recognition and early management of such neurological complications are crucial for optimal patient care.

Clinical analysis of endoscopic transnasal resection of skull base chondrosarcoma

Objective:To explore the surgical techniques and clinical outcomes of endoscopic transnasal approaches in the treatment of skull base chondrosarcomas. Methods:Data from patients diagnosed with skull base chondrosarcomas and treated via endoscopic transnasal surgery at the Department of Otorhinolaryngology and Head and Neck Surgery, Xuanwu Hospital, Capital Medical University, from 2013 to 2022 were collected. This retrospective study analyzed the patients' clinical presentations, histopathological grading, involved sites and extents, and complications following the endoscopic transnasal surgery. Disease-free survival rates were calculated using the Kaplan-Meier method. Results:Complete data from 31 patients showed that the primary tumor site was in the petroclival region in 27 cases（87%）, and the anterior skull base in 4 cases（13%）. Pathological grades were Grade Ⅰ（12 cases）, Grade Ⅱ（16 cases）, and Grade Ⅲ（3 cases）. Total resection was achieved in 25 cases, with residual disease post-surgery in 6 cases. The average follow-up duration was 35.7 months（ranging from 6 to 120 months）. Among those who achieved complete resection, recurrence occurred in 5 cases（5/25）, with a five-year disease-free survival rate of 80%. Postoperative complications included transient abducens nerve palsy in 6 patients and cerebrospinal fluid rhinorrhea in 4 patients. There were no cases of death or permanent cranial nerve palsy. Total resection rate（P=0.001） and involvement of the cerebellopontine angle and jugular foramen（P=0.037） were identified as independent risk factors for residual disease and recurrence of chondrosarcoma. Conclusion:The endoscopic transnasal approach is a safe and feasible treatment option for skull base chondrosarcomas.

Deep learning model meets community-based surveillance of acute flaccid paralysis

Acute flaccid paralysis (AFP) case surveillance is pivotal for the early detection of potential poliovirus, particularly in endemic countries such as Ethiopia. The community-based surveillance system implemented in Ethiopia has significantly improved AFP surveillance. However, challenges like delayed detection and disorganized communication persist. This work proposes a simple deep learning model for AFP surveillance, leveraging transfer learning on images collected from Ethiopia's community key informants through mobile phones. The transfer learning approach is implemented using a vision transformer model pretrained on the ImageNet dataset. The proposed model outperformed convolutional neural network-based deep learning models and vision transformer models trained from scratch, achieving superior accuracy, F1-score, precision, recall, and area under the receiver operating characteristic curve (AUC). It emerged as the optimal model, demonstrating the highest average AUC of 0.870 ± 0.01. Statistical analysis confirmed the significant superiority of the proposed model over alternative approaches (P < 0.001). By bridging community reporting with health system response, this study offers a scalable solution for enhancing AFP surveillance in low-resource settings. The study is limited in terms of the quality of image data collected, necessitating future work on improving data quality. The establishment of a dedicated platform that facilitates data storage, analysis, and future learning can strengthen data quality. Nonetheless, this work represents a significant step toward leveraging artificial intelligence for community-based AFP surveillance from images, with substantial implications for addressing global health challenges and disease eradication strategies.

Total Hip Arthroplasty Using the Conjoined Tendon-Preserving Posterior Approach: The Modified Posterior Approach with a Minimum of 2-Year Follow-Up.

The conjoined tendon-preserving posterior (CPP) approach is a modified posterior approach for total hip arthroplasty (THA) that preserves the short external rotator muscles and most ischiofemoral ligaments. The objective of the present study was to compare the short-term clinical outcomes, complications, and imaging evaluations of CPP and posterior approaches in THA. This retrospective study included 83 patients from May 2018 to September 2021: 36 patients with 42 hips who underwent THA with the CPP approach (CPP group) and 47 patients with 60 hips who underwent THA with the standard posterior approach (PA group) with a minimum of 2 years of follow-up. Assessment tools included operative times, blood loss, preoperative and last follow-up Harris Hip Scores (HHS), postoperative complications, and implant placement angles between the groups. Statistical analysis was performed using chi-square tests and T-tests. The CPP approach had a significantly longer operative time and greater blood loss compared to the PA group. Preoperative and postoperative HHS were not significantly different between groups. Considering complications, the PA group had one case each of dislocation and infection, and the CPP group had two cases of sciatic nerve palsy, but the difference was not significant. Cup anteversion, inclination and stem anteversion were not significantly different between groups. Functional outcomes, complication rates, and implant placement angles were comparable with the posterior approach, and the CPP approach has the potential to reduce postoperative dislocations. However, careful attention should be paid to sciatic nerve palsy during early initiation of the CPP approach, and this study did not demonstrate that the CPP approach was clearly superior to the posterior approach.

Recent Molecular Epidemiology of Echovirus 11 Throughout North and West Africa Resulted in the First Identification of a Recombinant Strain from an Acute Flaccid Paralysis Case in West Africa.

Echovirus 11 has emerged as a major public health concern, causing sepsis in neonates in many European countries in recent years. In Africa, especially West Africa, where resources and diagnostic capacities are limited, only sporadic cases have been reported. To better understand the recent molecular epidemiology of E11 in West Africa, we characterized twenty-three echovirus 11 strains isolated through the acute flaccid paralysis and environmental surveillance systems for polio from 2013 to 2023, using high-throughput sequencing. Our data are noteworthy due to identifying for the first time a recombinant strain from an acute flaccid paralysis case and represent the first focus to date on molecular characterization of echovirus 11 in West Africa. Moreover, our data show that echovirus 11 diverged from 1970 (95% HPD range, 1961-1979) and evolved into four distinct clades, with the virus spread from West Africa to Europe, exhibiting two introductions in France around 2017, from Senegal and Guinea. Furthermore, the in silico analysis reveals four non-conservative amino acid substitutions in the VP1 sequences of the European strains associated with neonatal sepsis in newborns and a conserved amino acid motif in the VP1 protein toward enterovirus genotypes. Our data provide new insights into the epidemiology of echovirus 11 and point to the crucial need to implement specific surveillance programs targeting non-polio enteroviruses for the rapid identification of emerging or re-emerging enterovirus species, particularly in Africa.

Phrenic Nerve Palsy After Posterior Cervical Fusion: A Case Report and Review of Literature.

Cervical nerve palsies, most commonly C5, are relatively common following posterior cervical decompression and fusion (PCDF) for the management of cervical myelopathy. However, phrenic nerve palsy following PCDF is a rare complication documented in only one previous case report. The authors present a case of phrenic nerve palsy following PCDF. The patient is a 51-year-old male who presented with cervical myelopathy and radiculopathy as well as cervicalgia of 1 year's duration. The patient underwent C3-C6 posterior cervical decompression and fusion (PCDF). On postoperative day 5, he was found to have a right C5 nerve palsy, which improved with steroid use and physical therapy. When he returned at 7 weeks postoperatively, the patient had progressive dyspnea. A fluoroscopic exam by pulmonology revealed a right-sided phrenic nerve palsy was the cause of the dyspnea. Phrenic nerve palsy causing hemi-diaphragmatic paralysis is a rare complication of cervical spine surgery that requires a high degree of suspicion due to the nonspecific signs and symptoms. Our clinical case suggests that surgeons should bear in mind phrenic nerve palsy as a potential complication in patients with respiratory distress following cervical laminectomy.

PARALISIA PERIÓDICA HIPOCALÊMICA TIREOTÓXICA: RELATO DE CASO E REVISÃO BIBLIOGRÁFICA INTEGRATIVA

Thyrotoxic Hypokalemic Periodic Paralysis (THPP) is characterized by episodes of muscle weakness associated with hyperthyroidism and hypokalemia. The following study aims to report a case of Thyrotoxic Hypokalemic Periodic Paralysis, in addition to reviewing this uncommon topic in daily medical practice. The patient was a 38-year-old male patient, previously healthy, who was admitted to the emergency room due to pain syndrome in the lower limbs, concomitant with gradual, ascending and progressive loss of strength in the upper limbs, associated with generalized paresis. Hypokalemic flaccid paralysis was confirmed after gasometric and laboratory evidence of severe hypokalemia concomitant with the condition. Investigation was continued with a thyroid profile, which showed suppressed TSH and elevated free T4. The Burch and Wartofsky index was evaluated, compatible with imminent thyrotoxic crisis, and correction of hypokalemia and specific management with propylthiouracil (PTU), corticosteroid therapy and beta-blocker were instituted, with excellent clinical and laboratory response. Subsequently, the presence of antibodies above the reference values ​​was evidenced, confirming the presence of thyroid autoimmunity. Therefore, the insidious onset and rapid deterioration resulting from PPHT are emphasized, with the need for its early recognition as a differential diagnosis in the face of flaccid paralysis, considering the request for thyroid function tests in acute situations for adequate diagnosis and treatment.

Recurrent Bilateral Facial Palsy Associated with Herpes Simplex Virus Infection

Bell's palsy is the most common cause of facial paralysis with a lifetime risk of one in 60 in general population. The exact pathophysiology is unknown, but it is suspected to be associated with viral infections such as herpes simplex virus (HSV). Recurrent facial palsy is a rare condition that can be caused by various factors but the cause remains unknown. We report a case of recurrent facial palsy who had antibodies of Lyme immunoglobulin G (IgG), HSV IgG, and IgM.

Selective Deep-Lobe Parotidectomy for Benign Parotid Gland Tumors.

Deep-lobe tumors have been shown to possess a significantly thicker capsule with less tumor penetration compared to superficial tumors. Thus, more conservative surgical approaches, rather than aggressive methods, have been proposed for treating benign deep-lobe tumors of the parotid gland. To evaluate the surgical outcomes and oncological safety of selective deep-lobe parotidectomy (SDLP) in patients with benign lesions located in the deep lobe of the parotid gland. Twenty-two patients who underwent SDLP were enrolled in the study. Data on age, sex, tumor size, hospitalization duration, recurrence, cosmetic outcomes, and complications-including facial nerve (FN) impairment, Frey's syndrome (FS), sialocele, first-bite syndrome (FBS), wound infection, hematoma, and seroma -were retrospectively evaluated from hospital records. Facial contour symmetry was rated by each patient using a 0-10 VAS score at least six months post-surgery. Final histopathological examination revealed that the most common tumor was pleomorphic adenoma (PA) (59.1%). Three patients (13%) experienced temporary paralysis of the marginal branch of the FN, with a House-Brackman Grade III, which resolved spontaneously within two months post-surgery. No cases of permanent FN paralysis, FS, FBS, or sialocele were observed in any patients. The mean VAS score for facial contour symmetry was 9.43 ± 0.78. No recurrence were noted in any patients over a median follow-up period of 71.7 ± 21.2 months. SDLP may facilitate the safe surgical removal of benign lesions located in the deep lobe of the parotid gland, with oncological safety, reduced complication rates, and improved cosmetic outcomes.

A Case of Peripheral Facial Nerve Palsy Treated with Korean Medicine at a Korean Medicine Hospital

Objective: This study aimed to report the effects of Korean medicine in treating a patient with peripheral facial nerve palsy.Methods: The patient received Korean herbal medicine and pharmacopuncture and acupuncture treatment for 14 days. We measured the House-Brackmann (HB) scale, Yanagihara’s unweighed grading system (Yanagihara’s score), and the numeric rating scale (NRS) to assess symptom changes.Results: After treatment, the patient showed decreased HB, Yanagihara’s, and NRS scores.Conclusion: The results indicate that Korean medicine, including Korean herbal medicine and pharmacopuncture and acupuncture treatment, is effective in the management of patients with peripheral facial nerve palsy. Further clinical research on this patient group is needed.

Paediatric cerebral palsy in South Africa: Prevention and care gaps at hospital level.

Population-based data show high proportions of severe cases of cerebral palsy (CP) in resource-poor regions such as sub-Saharan Africa, where most children have potentially preventable risk factors (factors that may increase the likelihood of CP occurrence but can be mitigated through medical interventions). This study aimed to describe the demographic and clinical profile of children living with CP accessing services at Tygerberg Hospital over a period of 10 years (2010-2020), identify the potential gaps in care (proportion of individuals in a country requiring but not receiving suboptimal or inadequate care), and comparison with a similar study at the same centre two decades ago. This 10-year retrospective study investigated causes and morbidities in children with CP, attending a central hospital in the Western Cape, South Africa. A total of 613 children with CP were identified. Perinatal causes were predominant, especially in 57.7% (n = 354) of the cohort: perinatal asphyxia (41.1%) and preterm birth (16.6%). Postnatal causes constituted 15.2% (n = 93), which included tuberculous meningitis (3.6%) and bacterial meningitis (3.6%). The most common complications were intellectual impairment (61.8%; n = 379); epilepsy (30.8%; n = 189) and visual impairment (54.7%; n = 234). A third of the cohort had severe CP, classified as Gross Motor Function Classification System IV and V (38%). Most of the previously documented main drivers of CP are still present and the implementation of healthcare prevention strategies remains inadequate. This study provides longitudinal evidence to confirm that CP in a South African setting is associated with a high burden of potentially preventable causes.

Complete genome sequences of nine double recombinant vaccine-derived novel oral poliovirus type 2 genomes from Nigeria 2023-2024.

We report the complete genome sequences of nine double recombinant vaccine-derived novel oral poliovirus type 2 genomes from acute flaccid paralysis (AFP) cases (n = 3), AFP case contacts (n = 4), and environmental surveillance sampling (n = 2) in Nigeria.

Relationship Between Gross Motor Function and Nutritional Status of Children with Cerebral Palsy-A cross-sectional study in a Tertiary Care Hospital of Bangladesh

Background: Cerebral Palsy (CP) is one of the most common causes of chronic disability in children. Childhood malnutrition is a major public health issue in low- and middle-income countries. The gross motor function of children with CP can easily be assessed by the tool Gross Motor Function Classification System- Expanded &amp;Revised (GMFCS-E&amp;R). This study aimed to determine the relationship between GMFCS and nutritional status in children with cerebral palsy. Method: This cross-sectional observational study was conducted in the Department of Pediatric Neurology, IPNA, BSMMU from October 2019 to August 2020. All the patients aged 2-12 years were diagnosed as CP by clinical criteria and classified by GMFCS. Nutritional status (weight for age, height for age, weight for height, BMI) is assessed and classified according to the World Health Organization growth charts. Then linear and multinomial logistic regression methods to determine the associations between GMFCS and nutritional status. The correlation between motor function and nutritional status was assessed. Results: Among the 50 children 68% were male and 32% were female. The mean age of the CP children was 4.90±3.05 years. Most patients (66.0%) came from poor families followed by 24% from the middle class. Functionally majority of patients were in GMFCS level IV (28.0% ) and level V (20.0%). Maximum patients in spastic quadriplegia 42%, spastic hemiplegia 16%. The level of GMFCS was associated with nutritional status, as determined by anthropometry. Moderate and severe underweight significantly related with GMFC level IV and V. Moderate and severe stunted was significantly related with IV and V GMFC level. Moderate wasted was significantly related to GMFC levels III and IV. Mild malnutrition was significantly with GMFC level II and III. Severe malnutrition is significantly related to GMFC level IV and V. Conclusion: This study showed majority of cerebral palsy cases had severe functional gross motor disability and also severe grade of malnutrition. A significant association between severe grade of malnutrition and severe grade of motor disability was found. J Bangladesh Coll Phys Surg 2024; 42: 342-349

Thyrotoxic periodic paralysis - a retrospective study from Southern India.

Thyrotoxic periodic paralysis is a rare manifestation of thyrotoxicosis. Here, we describe the clinical and biochemical features and treatment outcomes of this disorder. This retrospective study was conducted at a tertiary care centre in southern India. The clinical and biochemical features, treatment received, and therapeutic outcomes of all patients with thyrotoxicosis and acute flaccid paralysis without any other identifiable causes (cases for the study) were compared with an equal number of consecutively selected patients who presented with thyrotoxicosis but without features of paralysis (controls for the study) during the same period. In total, 41 cases and controls were included in this study. The proportion of males was 92.6% and 43.9% in the cases and controls, respectively. The mean age was 32.8 (±7.6) years (cases) and 39.7 (±11.3) years (controls). In the cases, 20% of patients presented without clinical thyrotoxic features. Graves' disease was the most common aetiology of thyrotoxicosis in both groups (92.6% of cases and 87.8% of controls). The prevalence of goitre was significantly higher among controls (90.2%) than among cases (53.7%). The mean serum potassium, free T4, total T4 and total T3 levels were significantly lower in the cases than in the controls. In these cases, two patients had an additional aetiology for persistent hypokalaemia, likely Gitelman's syndrome. This is one of the largest series of thyrotoxic periodic paralysis cases in India. In subjects with thyrotoxicosis, serum potassium, free T4, total T4 and total T3 levels were significantly lower in those with periodic paralysis than in those without.

Diaphragmatic Palsy Due to a Paraneoplastic Autoimmune Syndrome Revealed by Checkpoint Inhibitors

Background and Clinical Significance: Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment but may underlie diverse and potentially life-threatening immune-related adverse events (irAEs). They may cause various conditions leading to respiratory failure, including myasthenic syndromes and myositis. However, diaphragmatic paralysis (DP) has rarely been reported. To describe patients with diaphragmatic paralysis in a pharmacovigilance registry, we searched the prospective REISAMIC registry at the Gustave Roussy Cancer Center (Villejuif, France) for cases of diaphragmatic palsy (DP) occurring from September 2014 to December 2021. Case Presentation: We identified three patients, in whom DP was confirmed by diaphragmatic ultrasonography, pulmonary function tests, and/or diaphragmatic electroneuromyogram. Diaphragmatic palsy was life-threatening in all patients, as it caused respiratory failure requiring mechanical ventilation. In all cases, a pre-existing subclinical paraneoplastic syndrome was detected. Onconeural antibodies (anti-titin and anti-VGCC) were detected in these patients before and after the initiation of ICI therapy, suggesting a mixed paraneoplastic syndrome with features overlapping those of myasthenic syndrome (myasthenia gravis in one patient and Lambert–Eaton syndrome in another) and myositis. Conclusions: Diaphragmatic palsy is a severe irAE potentially resulting from different mechanisms, including myositis and neuromuscular junction involvement (myasthenia gravis, Lambert–Eaton). Antineuronal antibodies associated with such conditions were already present in our patients prior to immunotherapy initiation, suggesting ICIs could trigger flare-ups of pre-existing silent paraneoplastic autoimmune conditions.

8728 Radiofrequency Thermal Ablation in Thyroid Microcarcinomas: Experience of the Brazilian Group with 143 Cases

Abstract Disclosure: L.G. Amato: None. P.H. Carani: None. L.D. Volpi: None. A. Rahal: None. E.M. Volpi: None. Introduction: Thyroid nodules are quite prevalent worldwide, with papillary thyroid carcinoma (PTC) being the most common histological subtype of thyroid malignant neoplasm, accounting for approximately 85% of thyroid cancers. When this carcinoma is less than 10 mm in its longest axis, it is defined as papillary thyroid microcarcinomas (mPTCs) which has had an increasing proportion of thyroid cancers and with a disease-specific survival of patients having this diagnosis more than 99% after 10 years of follow-up. Most guidelines concerning thyroid cancer care recommend a lobectomy as the first-line treatment strategy for low-risk unifocal mPTC but often results in aggressive overtreatment. Thyroid surgery comes with significant costs and morbidity rates caused by iatrogenic hypothyroidism and recurrent laryngeal nerve damage, resulting in poor quality of life, justifying the growing search for minimally invasive and effective methods in the treatment of mPTC and in this context Radiofrequency thermal ablation (RFA), a minimally invasive treatment that preserves thyroid function have been proposed for patients with low-risk mPTC. Clinical case: From April 2018 to January 2024, 143 patients with mPTC, were submitted to RFA and patient's follow-up were dated 1, 3, 6, 12 and 18 months after the procedure. During the follow-up we observed 3 (2%), complications, 1 case of permanent paralysis unilateral vocal cord, 1 Horner Syndromes and 1 case of transient paralysis, with total reversal. In all cases there was a reduction in the volume of the node after 6 months of the procedure. Conclusion: The reported incidence rate of postoperative hypothyroidism in patients underwent hemithyroidectomy is 10.9-48.8%, therefore, risks of complications with radioablation in our series were lower than those previously described during hemithyroidectomy. Radiofrequency thermal ablation (RFA) is a minimally invasive treatment that preserves thyroid function with a lower incidence of complications compared to thyroidectomy or lobectomy, and and should be considered the selection procedure for low-risk thyroid microcarcinomas. Presentation: 6/3/2024

A Unique Case of Hypokalemic Periodic Paralysis with Resolution after Successful Surgery for Cervical Stenosis

A Unique Case of Hypokalemic Periodic Paralysis with Resolution after Successful Surgery for Cervical Stenosis

A rare case of peripheral facial paralysis associated with meningococcal meningitis - case report

Introduction. Meningococcal meningitis is a severe form of bacterial meningitis caused by the bacterium Neisseria meningitidis (N. meningitidis). It is a medical emergency and requires prompt treatment to prevent severe complications or death. Peripheral facial paralysis is one of the rare complications that can occur in this condition. Aim. This paper aimed to draw attention to the possibility of an unexpected complication in a child with meningococcal meningitis, which requires prompt clinical and paraclinical management. Materials and methods. We present the case of a 2-year and 8-month-old female patient who, in the context of meningococcal meningitis, develops peripheral facial paralysis, a very rare complication, especially in the pediatric population. Results. The patient initially presented with clinical and paraclinical signs of a respiratory viral infection. However, in a febrile context, she has two generalized tonic-clonic paroxysmal episodes, characterized by gaze fixation, each lasting 2-3 minutes, followed by spontaneous recovery. Laboratory tests revealed neutrophilia, anemia, and elevated inflammatory markers, while the cranio-cerebral CT scan showed no structural changes. Blood cultures were also collected, and treatment was initiated with third-generation cephalosporin antibiotics, along with supportive and symptomatic therapy. The following day, the patient exhibited signs of right-sided peripheral facial paralysis, and intravenous corticosteroid therapy was added to the treatment. Approximately 24 hours after admission, the blood culture tested positive for gram-negative cocci, suggesting meningococcal meningitis. A cerebral MRI was performed, revealing changes indicative of acute meningoencephalitis. The clinical and paraclinical course was slowly favorable, with a slight persistence of facial asymmetry and intermittent ataxic syndrome. Conclusions. Meningococcal meningitis remains a relevant pathology in the pediatric population, able of causing severe complications that can result in long-term disability for the patient. Prompt treatment is crucial when this condition is suspected.

Routine Dental Procedure Induced Hemifacial Paralysis—Case Report

Routine Dental Procedure Induced Hemifacial Paralysis—Case Report

The utility and outcomes of the temporalis muscle flap for palate reconstruction after maxillectomy for malignancy

Back groundA common pedicled facial technique in head and neck reconstruction is the TMF It can be utilised to replace missing tissues in a variety of conditions, including oral deformities of the hard and soft palate.Aim of the study was to document the utility and outcomes with the reconstruction of the palate using TM flaps following Maxillectomy For maxillary sinus malignancies MethodologyThe study included 24 patients who were operated on for cancer maxilla and eligible for maxillectomy and reconstruction of the Palate using temporalis flap. Follow-up was planned for at least 12 months postoperative. Postoperative physical and speech therapy are initiated to help improve speech and swallow outcomes and to prevent trismus ResultsThe current study included 24 cases with Maxillary sinus cancer with a mean age of 42.34±4.67. The mean operative time was 5.4±1.22 hours with no reported intraoperative bleeding or injury of important structures .No cases of facial palsy or trismus were reported while partial flap loss was reported in one case where oronasal fistula was evident. The donor site complications were minimal where seroma occurred in two patients and alopecia , wound infection and dehiscence were reported in one case each. The donor site depression was evident in 25% of cases ConclusionTMF is an excellent option for the reconstruction of many craniofacial defects, it is easy to be harvested with good blood supply with minimal postoperative complications