Facial Paresis Research Articles

Guided Self-rehabilitation Contract vs conventional therapy in chronic peripheral facial paresis: VISAGE, a multicenter randomized controlled trial

BackgroundOne year after persistent peripheral facial paresis (PFP), prescriptions of conventional rehabilitation are often downgraded into maintenance rehabilitation or discontinued, the patient entering what is seen as a chronic stage. This therapeutic choice is not consistent with current knowledge about behavior-induced plasticity, which is available all life long and may allow intense sensorimotor rehabilitation to remain effective. This prospective, randomized, multicenter single-blind study in subjects with chronic unilateral PFP evaluates changes in facial motor function with a Guided Self-rehabilitation Contract (GSC) vs. conventional therapy alone, carried out for six months.MethodsEighty-two adult subjects with chronic unilateral PFP (> 1 year since facial nerve injury) will be included in four tertiary, maxillofacial surgery (2), otolaryngology (1) and rehabilitation (1) centers to be randomized into two rehabilitation groups. In the experimental group, the PM&R specialist will implement the GSC method, which for PFP involves intensive series of motor strengthening performed daily on three facial key muscle groups, i.e. Frontalis, Orbicularis oculi and Zygomatici. The GSC strategy involves: i) prescription of a daily self-rehabilitation program, ii) teaching of the techniques involved in the program, iii) encouragement and guidance of the patient over time, in particular by requesting a quantified diary of the work achieved to be returned by the patient at each visit. In the control group, participants will benefit from community-based conventional therapy only, according to their physician’s prescription. The primary outcome measure is the composite score of Sunnybrook Facial Grading System. Secondary outcome measures include clinical and biomechanical facial motor function quantifications (Créteil Scale and 3D facial motion analysis through the Cara system), quality of life (Facial Clinimetric Evaluation and Short-Form 12), aesthetic considerations (FACE-Q scale) and mood representations (Hospital Anxiety and Depression scale). Participants will be evaluated every three months by a blinded investigator, in addition to four phone calls (D30/D60/D120/D150) to monitor compliance and tolerance to treatment.DiscussionThis study will increase the level of knowledge on the effects of intense facial motor streng- Facial paralysisthening prescribed through a GSC in patients with chronic peripheral facial paresis.Trial registrationClinicalTrials.gov, NCT04074018. Registered 29 August 2019.Protocol versionVersion N°4.0—04/02/2021.

Audio-Vestibular Manifestations in COVID-19; A Systematic Review and Meta-analysis

Introduction Audio-Vestibular (AV) presentation as a consequence of COVID-19 is a less ventured zone. The aim of the study was systematically review the literature (both studies and case reports) published up to August 2021, in order to provide evidence on audio-vestibular symptoms in SARS-CoV-2, COVID-19 patients. Systematic review and meta-analysis was performed for assessment of prevalence of AV symptoms among COVID-19 patients. Materials and Methods A search of existing literature using key words and MeSH (Medical Subject Headings) terms was done. The methods were developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. 36 qualitative studies were narratively synthesized. Meta-analysis was performed on 18 quantitative studies Results Hearing loss was most commonly reported AV manifestation among case series / case reports. In the quantitative studies, the pooled estimate of Hearing loss, Dizziness and Tinnitus was 4.558%, 4.226% and 5.513% respectively. Other reported AV symptoms included ear ache, aural fullness and facial paresis. Conclusion Prevalence of AV symptoms in COVID-19 differs from that of the published literature. This prevalence of hearing loss is less than that reported amongst the world population. Structured community-based studies with homogeneous working definitions have to be conducted to assess the true prevalence.

Analysis of the Ophthalmological Manifestations of Diagnosed Cases of Idiopathic Intracranial Hypertension

Purpose: The purpose of this study was to explore the ophthalmological involvement in diagnosed cases of Idiopathic Intracranial Hypertension (IIH). Methods: Case series of all patients diagnosed with IIH from October 2012-2014 at the Neurology Department of Amrita Institute of Medical Sciences were prospectively analysed. Analysis was done for 35 patients who fulfilled the updated diagnostic criteria. Results: 80% of the patients were women with a mean age of 34.5. The chief complaint was a throbbing headache in 85.7%.The least common complaints were tinnitus, phonophobia, and photophobia, and one patient had right facial paresis. All patients had well-preserved visual acuity. 30 patients had normal extraocular movements, bilateral abduction restriction was found in 4 patients, and one was reported to be with third and sixth nerve paresis. 22 patients were in Obese class I. CSF opening pressure was elevated in all patients. 80% had Grade 1 papilledema. Enlargement of blindspot and peripheral constriction of fields were commonly seen. 41.4% of patients showed inferior RNFL thickness to be the most affected. A statistically significant association was found between the grade of papilloedema and the visual field. Conclusion: All our patients had papilledema clinically, with well-preserved central vision. Visual field defects were found, which showed a positive correlation with the severity of papilledema, showing the visual field to be a sensitive indicator. Contrary to expectation, an increase in RNFL on OCT was not a universal finding in our patients despite clinically observable papilledema.

Schwannom mastoidního úseku lícního nervu

Summary Facial nerve schwannoma is a rare benign tumour, which originates from the neural sheath of Schwann cells. Schwannoma can affect any part of the nerve from the cerebellopontine angle to the distal extratemporal segment. Intratemporal localization of the tumour is the most common. Localization of the tumour and the extent of nerve affliction are reflected in clinical symptomatology of schwannoma. The case presented is of a patient with facial nerve schwannoma propagating to the external auditory canal, which manifested clinically by progressive facial nerve paralysis. The correct dia­gnosis was made years later because another etiology (stroke) was considered to be the cause of the paresis at first. Key words facial nerve schwannoma – facial nerve paresis

Heerfordtův syndrom – vzácná manifestace sarkoidózy z pohledu ORL lékaře

Summary Sarcoidosis is a systemic granulomatous disease that mainly affects the pulmonary and lymphatic systems. In its rare, acute forms, it can manifest as Lofgren’s syndrome (combination of erythema nodosum, bilateral pulmonary hilar lymphadenopathy, joint pain, fever and general symptoms) and even more rarely as Heerfordt’s syndrome (combination of fever, anterior uveitis, bilateral edema of the parotid area and uni or bilateral facial nerve paresis). Although this dia­gnosis is rare, it belongs to the differential dia­gnosis of sudden paresis of the facial nerve and swelling of the parotic area. In our case report, we describe Heerfordt’s syndrome in a 50-year-old woman. The pathophysiology, symptomatology, dia­gnosis, and treatment of this rare syndrome are discussed. Key words sarcoidosis – uveoparotid fever – facial nerve paresis

Proton Radiotherapy for Vestibular Schwannomas in Patients with NF2-Related Schwannomatosis: A Case Series.

(1) Background: This study aimed to evaluate the efficacy and treatment-related toxicity of proton radiotherapy (PRT) for vestibular schwannoma (VS) in patients with neurofibromatosis type 2-related schwannomatosis (NF2). (2) Methods: Consecutive NF2 patients treated with PRT for VS between 2004 and 2016 were retrospectively evaluated, focusing on tumor volume, facial and trigeminal nerve function, hearing, tinnitus, vestibular symptoms, and the need for salvage therapy after PRT. (3) Results: Eight patients were included (median age 36 years, 50% female). Median follow-up was 71 months. Five (63%) patients received fractionated PRT and three (38%) received PRT radiosurgery for VS. Six patients (75%) received prior VS surgery; three also received bevacizumab. Six patients (75%) did not require salvage therapy after PRT. Two patients (25%) with residual hearing lost it after PRT, and six had already lost ipsilateral hearing prior to PRT. Tumor and treatment-related morbidity could be evaluated in six patients. Following PRT, conditions that occurred or worsened were: facial paresis in five (83%), trigeminal hypoesthesia in two (33%), tinnitus in two (33%), and vestibular symptoms in four patients (67%). (4) Conclusion: After PRT for VS, the majority of the NF2 patients in the cohort did not require additional therapy. Tumor and/or treatment-related cranial nerve deficits were common. This is at least partly explained by the use of PRT as a salvage treatment after surgery or bevacizumab, in the majority of cases. There remains the further opportunity to elucidate the efficacy and toxicity of proton radiotherapy as a primary treatment.

Abstract Number ‐ 269: Brainstem Stroke Secondary to Lyme Neuroborreliosis Vasculitis

Introduction Clinical presentations of Lyme disease are variable. A rash is often the first symptom, subsequently evolving into late complications including arthritic, cardiac, and neurological manifestations. CNS pathologies of Borrelia burgdorferi are diverse and usually include meningitis, encephalitis, strokes, intracranial hemorrhages, and central and peripheral cranial neuropathies. Stroke secondary to Lyme vasculitis is a rare entity as such there are few cases reported in the literature. The presumed mechanism of cerebral ischemia is perivascular and vascular lymphocytic infiltration causing inflammation and vasculitis, resulting in a stroke. Methods We present a case of neuroborreliosis from our stroke service in a patient who presented with sudden onset of right‐sided facial droop, dizziness, and difficulty walking. Results A 53‐year‐old male tobacco smoker (his only known risk factor for stroke) presented to the emergency department with acute onset right‐sided facial paresis, difficulty walking, double vision, and trouble managing his oropharyngeal secretions. CT Head showed no acute intracranial pathology and angiography was negative for proximal large vessel occlusion. He was eligible for and received intravenous alteplase due to concerns for acute ischemic stroke. Notably, he disclosed a history of a tick bite (roughly two and half years prior) and daily headaches (for the past 1.5 months). His exam revealed bidirectional nystagmus, negative head impulse, right LMN facial nerve palsy, left‐sided face and arm numbness, and left‐sided tongue weakness. MRI brain revealed acute infract in the right medulla, leptomeningeal and bilateral cranial (3rd, 5th, and 7th) nerves enhancement. Serum Lyme IgG and IgM antibodies were positive. Lumbar puncture revealed an elevated protein with lymphocytic predominance. CSF Lyme antibody revealed 3 bands of IgG and 1 band of IgM, consistent with Lyme meningitis. Intravenous Ceftriaxone was started and his difficulty walking and cranial neuropathies improved during the hospital course. The patient required g‐tube placement and was discharged to sub‐acute rehab. A four‐month follow MRI brain showed decreased cranial nerve enhancement without new evidence of ischemia. He eventually regained the ability to swallow, and his exam had otherwise returned to baseline. Conclusions The proposed mechanism of ischemic stroke due to Lyme Neuroborreliosis is secondary to localized inflammatory vasculitis. Lyme vasculitis can present with hemorrhagic or ischemic strokes, the latter being more common and usually affecting posterior circulation, as seen in this case. Negative CTA or transcranial Doppler studies do not exclude the diagnosis of arteriopathy as stenosis primarily involves small vessels and is usually segmental. Parenchymal brain imaging often reveals multiple territory strokes, leptomeningeal, and multiple cranial nerves enhancement in contrast studies. A thorough history of tick exposure or symptoms consistent with Erythema Migrans should be obtained in suspicious cases. Notably, patients will often complain of meningitic symptoms (including headache, neck stiffness, and malaise) usually weeks to months before any stroke‐like symptoms or deficits. Our case of Lyme Neuroborreliosis presenting as stroke illustrates the importance of considering rare etiologies in younger patients without any significant cerebrovascular risk factors, especially those residing in or traveling to endemic areas.

Vasculitic Neuropathies, its Varied Manifestations, and Associations

Vasculitic neuropathies are disorders that result from inflammation in the peripheral nerve's vascular supply, resulting in ischemic injury. These disorders may be confined to peripheral nerves or may be a result of systemic inflammation. It is imperative that we recognize these disorders early to prevent morbidity and mortality. Hereby, we describe three cases of vasculitic neuropathy with varied presentations and their outcomes with treatment. A 43-year-old male presented with burning paresthesia of 4-month duration along with facial nerve paresis and black discoloration of toes of lower limbs. On evaluation, he had features of facial palsy along with dry gangrene involving the toes and calf region. A 36-year-old woman presented with features of paresthesia of lower limbs with reduced perception of temperature and distal and proximal muscle weakness. A 49-year-old male presented with features of multisystem involvement including lower respiratory tract infection and gastrointestinal symptoms along with distal and proximal muscle weakness. Nerve, muscle, and skin biopsies in all these three cases confirmed the diagnosis of vasculitic neuropathy. The first two patients were treated with methylprednisolone and cyclophosphamide and showed very good improvement during follow-up. However, the third patient was unwilling to receive treatment. Vasculitic neuropathies present with varied presentations. Therefore, when evaluating patients with peripheral neuropathy, suspicion of vasculitic etiology should be heightened. Timely diagnosis is very important in the management of vasculitic neuropathy and also for a better outcome. It is also important to acknowledge that nerve biopsy is a confirmatory investigation and should be performed in cases of strong suspicion.

Resection of Low-Grade Gliomas in the Face Area of the Primary Motor Cortex and Neurological Outcome.

During surgery on low-grade gliomas (LGG), reliable data relevant to the primary motor cortex (M1) for the face area are lacking. We analyzed the impact of tumor removal within the M1 face area on neurological deficits. We included LGG patients with resection within the M1 face area between May 2012 and November 2019. The primary endpoint was postoperative facial motor function. Secondary endpoints were postoperative aphasia, dysarthria, and dysphagia. Surgery was performed either with the awake protocol or under anesthesia with continuous dynamic mapping. The alarm criteria were speech arrest or a mapping threshold of 3 mA or less. Resection was completed in five patients. The resection was stopped due to the alarm criteria in three patients and for other reasons (vascular supply, patient performance) in four patients. A total of 66.7% (n = 8) presented with new-onset facial paresis (62.5% left LGG) and 41.7% (n = 5) with aphasia (all left LGG) postoperatively. After one year, all eight patients had recovered from the facial paresis. Tumor removal within the M1 face area was not associated with permanent facial motor deficits.

Facial nerve paralysis in nasopharyngeal carcinoma: a case report

Nasopharyngeal carcinoma (NPC) is cancer originating from the mucosal lining of nasopharynx, with the highest predilection in the fossa of Rosenmüller. One-fifth of NPC cases have cranial nerve complications. The location of Rosenmüller's fossa which is adjacent to foramen lacerum and middle base of the cranium allows the tumor to extend directly into the cranium and surrounding cranial nerves. This paper reported a case of facial nerve paralysis in NPC. A 55-year-old man came to the Ear-Nose-Throat (ENT) Clinic at Dr. Kariadi General Hospital, Semarang with complaints of facial pain on the right side, headache, a lump on the left neck, fullness in ears, and nosebleed. However, the patient did not complain of double vision. After a thorough history taking, physical examination, radiology, and histopathology tests, the patient was diagnosed with WHO 3 ECOG I T3N2M0 stage III NPC with House Brackmann III facial nerve paresis at the level of Mastoid segment. The patient was treated using chemotherapy treatment by an ENT specialist with a chemotherapy regimen of paclitaxel-cisplatin for 6 cycles. In conclusion, although rare, NPC can cause facial nerve paralysis.

Correlation of Lacunar Infarct on Head Ct Scan with Dysarthria in Haji Adam Malik General Hospital in 2019

Introduction: Stroke is the main cause of mortality and morbidity in Indonesia. Dysarthria is a symptom that can be seen from stroke. These symptoms occur in 15% of stroke events. Dysarthria is a motor speech disorder. Atypical lacunar stroke (ALS) is a stroke subtype that rarely occurs in one in 14 lacunar strokes or occurs in 6.8% of lacunar strokes, where isolated dysarthria or dysarthria facial paresis is the most common form of presentation. Method: This study is an observational analytic study with a case-control type of research with the aim of knowing the relationship between CT scan images of lacunar infarcts and dysarthria in ischemic stroke patients. The population in this study were all medical records of stroke patients who went to the Department of Neurology at the Haji Adam Malik General Hospital (RSUPHAM) Medan for a period of one year from January 1, 2019 to December 31, 2019 who underwent a head CT scan for 18 patients. Results: The subjects on the CT scan results of lacunar infarction with dysarthria 18 people (72%), and 7 people (28%) on the CT scan results there is no lacunar infarction. The same number and percentage were also found in the non-chivalrous control group. The test results obtained p value = 1,000 and odd ratio = 1.00, in other words there is no significant relationship between lacunar infarct and dysarthria. Conclusion: No significant relationship was found between the incidence of lacunar infarction and the incidence of dysarthria. The population with the most lacunar infarcts is men, hypertension, obesity, hypercholesterolemia, smoking and diabetes.

The new target population of stroke awareness campaign: Kindergarten students

<p>&nbsp;Thrombolysis and/or thrombectomy have been proven effective in the treatment of acute ischemic stroke. Due to the narrow time window, the number of patients suitable for these treatments is low. The main limitation is the pre-hospital stage, few people call an ambulance in time. The delay may be caused by the population&rsquo;s insufficient health knowledge, but also by the loneliness and isolation of the population most prone to stroke. Among the latter, there are many grandparents who spend considerable time with their grandchildren. This gave rise to the idea of educating even younger children about the symptoms of a stroke, enabling them to call an ambulance if necessary. To this end, we adapted the Angels Initiative project previously tested in Greece. The Hungarian pilot study Budapest District XII. took place in district kindergartens. The Angels&rsquo; original role-playing program could not be implemented due to the COVID epidemic, so the necessity called for a new, Hungarian version: the online &ldquo;Stroke Ovi&rdquo; program. We introduced this in several stages, and in the third we also carried out an impact study.</p>. <p>&nbsp;We adapted the Angels Initiative&rsquo;s international program and its Hungarian translation to our program. We prepared the original, live role-playing form, with a parent meeting in the selected &ldquo;test kindergarten&rdquo;. Due to the uncertainly lingering impact of the COVID epidemic, we reevaluated our plan, using the Hungarian storybook and take-home workbook created in the meantime, we developed our own online version in several kindergartens in Budapest. We held 10 and then 25 minute sessions a week for 5 weeks. In the third educational cycle, which always targets new groups, we already examined the impact of the program by taking pre- and post-tests, in which not only the children but also their parents participated. In addition to neurologists and kindergarten teachers, we also included psychologists and speech therapists in our work, because we believed that in a social environment that includes parents and children, results can only be achieved through multidisciplinary cooperation.</p>. <p>&nbsp;In the third cycle of the program, tests were taken before (pre-test) and after (post-test) among children and their parents. We only took into account those answers where we received an evaluable answer in the survey before and after the program. Our most important results: 1. there was no negative change in any question, so it was not the case that the total score of any question in the pre-test was higher than in the post-test. 2. The children learned that not only adults can call the ambulance. 3. Before the program, all children were already aware that if &ldquo;someone is very ill&rdquo;, the ambulance should be called. 4. Among the questions about stroke symptoms, it is important that hemiparesis, facial paresis and speech/language disorder are clear symptoms for children. Based on the parental questionnaires, the knowledge of the adults can be judged to be very good. The same number of correct answers were received during the pre-test and the post-test, on the basis of which we could not calculate a transfer effect. However, it is important that the parents considered the program useful, motivating and important for the children, so cooperation can be expected in the future.</p>. <p>The Hungarian &ldquo;Stroke Ovi&rdquo; program has so far proven to be clearly effective. This was proven by the impact assessments even if, instead of the original role-playing game, we implemented it &ldquo;only&rdquo; online due to the COVID epidemic. This constraint also forced and created a new &ldquo;Hungarian version&rdquo;. Despite the small number of samples caused by the circumstances, we consider this positive effect to be measurable. However, as the main result and evidence, we evaluated the children&rsquo;s reaction, which took shape in spontaneous drawings and displayed professional values in addition to positive emotional reactions, such as the drawing of ambulances, the recurring representation of the 112 number. With the involvement of the media, we think online education is also a good option in the series of stroke campaigns, but we think the original role-playing form is really effective. At the same time, we can see that the application of the new method requires great caution due to the education of developing children. For this reason, results can only be achieved through social and multidisciplinary cooperation involving neurologists, psychologists, kindergarten teachers, and parents.</p>.

Treatment of Orofacial Granulomatosis—9-Month Follow-up: A Case Report

Orofacial granulomatosis is a condition that manifests clinically as painless labial enlargement, perioral and mucosal edema, oral ulcers, and gingivitis. It is characterized by non-necrotizing granulomatous inflammation of the oral and maxillofacial region. When the swelling only affects the lips, the pathology is called Miescher's granulomatous cheilitis; however, when it also causes facial paresis and lingua plicata, it is known as Melkersson-Rosenthal syndrome. We report a case that was successfully treated with a combination of a local (intralesional) steroid, a systemic antibiotic, and a systemic steroid. After 6 months of therapy, we observed improvement in gingival hyperplasia and buccal mucosa and lip edema.

Moebius Syndrome: An Updated Review of Literature.

Moebius Syndrome, is a rare, non-progressive congenital neuropathological syndrome characterized primarily by the underdevelopment of the facial (CN VII) and abducens nerve (CN VI). Other features of Moebius Syndrome include facial nerve paresis, ophthalmoplegias, orthodontic deficiencies (including crowded dentition, swollen and hyperplastic gingiva, dental calculus, etc.), musculoskeletal abnormalities, and impaired mental function. Due to the rarity of the disorder, very few case studies have been reported in the literature. This article summarizes the significant features of the disease according to commonalities in reported cases, along with several newly recognized features cited in recent literature. We have explored the different diagnostic criteria and the newly recognized imaging modalities that may be used. Understandably, the condition detrimentally affects a patient's quality of life; thus, treatment measures have also been outlined. This study aims to provide updated literature on Moebius Syndrome MBS and improve understanding of the condition.

Interposition and transposition techniques of vascular decompression for hemifacial spasm

To analyze the vessels compressing facial nerve root exit zone and efficacy of interposition and transposition techniques of vascular decompression for hemifacial spasm. Vascular compression was evaluated in 110 patients. Implant interposition between vessels and nerve was performed in 52 cases, transposition of arteries without contact between implants and nerve - in 58 patients. Compressing vessels were anterior (44), posterior (61) inferior cerebellar, vertebral (28) arteries and veins (4). Multiple compressing vessels were found in 27 cases. Premeatal meningioma and jugular schwannoma were accompanied by vascular compression in 2 cases. Immediate regression of symptoms was observed in 104 patients, partial regression - in 6 patients. Transient facial paresis (4) and impaired hearing (5) were noted after implant interposition. Redo vascular decompression was performed in one case. The most common compressing vessels were cerebellar arteries, vertebral artery and veins. Transposition of arteries is highly effective technique with low incidence of VII-VII nerve dysfunction but relatively slow regression of symptoms.

Deceptive Appearances - Spastic Paretic Hemifacial Contractures in Cases of Seventh Nerve Involvement 'Inside' and 'Outside' the Brainstem.

Spastic paretic hemifacial contracture (SPHC) is a rare clinical phenomenon characterized by facial weakness and simultaneous well-sustained contraction of the unilateral half of the face, mimicking a paresis of the normal contralateral side on casual inspection. We present three cases with such phenomenon and have postulated the underlying mechanisms. One patient had intrinsic brainstem glioma, and the others were operated for extra-axial lesions compressing the pons. The former presented with SPHC, whereas the latter two gradually developed this phenomenon following postoperative facial paresis. This condition is possibly due to denervation hyper-excitability of the facial supranuclear pathway or an aberrant regeneration secondary to nerve injury leading to functional facial-nerve nuclear reorganization. SPHC occurrence is not limited to intra-axial lesions but can also be seen after partial injury to the facial nerve beyond its exit from the brainstem.

Chorea as a rare neurological complication of hyperglycaemia

Chorea is a hyperkinetic movement disorder characterised by brief involuntary, random, and irregular contractions. It’s caused by multiple conditions, including neurodegenerative diseases, cerebrovascular disease, structural damage to deep brain structures, neoplastic diseases, or metabolic derangements, such as hyperglycaemic states. We present a case of an 81-year-old woman, with a history of long-term poorly controlled type 2 diabetes mellitus, admitted to the emergency department with hyperkinetic delirium in the last 48h. At examination, she presented with mild right central facial paresis, and involuntary bilateral movement of the four limbs, more prominent on the right side. Laboratory tests showed hyperglycaemia of 799 mg/dl with ketonemia of 5.2 mg/dL and glycated hemoglobin of 11%. Computed tomography (CT) scan of the brain showed bilateral hyperdensity of the corpus striatum. The treatments included glycemic control with insulin, intravenous fluids, and anti-epileptic drugs. A clinical improvement was observed however, the patient continued to show chorea-like movements of the four limbs. The magnetic resonance imaging (MRI) showed a T2-flair and T2-weighted area of hypo-intensity involving bilaterally the striatum corpus and the corresponding signal in T1. She was then diagnosed with hyperglycaemia-associated chorea and improved significantly after initiation and titration of clonazepam and tetrabenazine. This case report pretends to highlight the importance of considering a rare manifestation of a very common disease. A hyperglycaemic state that can lead to cerebral lesions and specific neurological manifestations.

Effects of ELF-EMF Treatment on Depression

A 50-year-old male with no relevant clinical history presented sudden headache accompanied by nausea, which evolved with facial paresis and drowsiness with a computed tomography (CT) showing bilateral subarachnoid bleeding, being admitted to the intensive care unit. We performed a transcranial doppler ultrasonography (TCD) that showed the presence of a rounded image at M2 portion of the right middle cerebral artery (rMCA) that measured 20 mm × 21 mm with a positive color Doppler signal Figure 1.

Facial palsy in a newborn: A case report

Unilateral congenital facial palsy in the newborn occurs more often as isolated than in the context of syndromes or developmental defects. Recognition of the etiological factor, the severity of the clinical presentation, the dynamics of recovery are a guide for a multidisciplinary approach, a range of investigations and treatment. In a non-therapeutic approach, unsupported by sufficiently reliable data from the literature, there is a dilemma whether and how long one has to wait and observe the improvement of clinical results, before determining the range of examinations in the newborn. In facial paresis of prenatal or perinatal origin, identical to non-congenital Bell's palsy, infectious and anatomical-structural causes should initially be excluded. This paper presents a case of a symmetrical hypotrophic premature infant with a manifestation of acute Bell's palsy at birth, with negative biomarkers for infectious etiology and a normal brain ultrasound. The newborn underwent a special neonatal care with targeted local treatment. Towards the end of the first postnatal week, there was an evident withdrawal of clinical symptomatology.&#x0D;

Is Preoperative Facial Palsy a Deterrent to Facial Nerve Preservation after Gross-Total Removal of Giant Vestibular Schwannomas?

Abstract Background Although rare in small vestibular schwannomas, preoperative facial nerve paresis is often present in giant schwannomas. Preserving facial nerve function in these cases remains a herculean task. This study evaluates the facial functions after complete tumor removal and whether preoperative facial nerve involvement affects postoperative functional status. Methods This retrospective study from January 2014 to August 2021 excluded nongiant tumors (&lt; 4 cm), neurofibromatosis type 2 cases, incomplete removals, redo surgeries, deaths, and cases done without nerve monitoring. These were grouped into preoperative facial palsy present (PFP) and no preoperative facial palsy (NFP). Facial nerve functions were assessed on first postoperative day, at the time of discharge, and at last follow-up and dichotomized into two groups: nondisfiguring (House–Brackmann [HB] grades I–III) and disfiguring (HB grades IV–VI). The cohort outcomes of patients with nondisfiguring PFP (HB grades I–III) were also analyzed. Results There were 88 cases (PFP, n = 57; NFP, n = 31). Facial nerve was preserved anatomically in 62 (70.45%) patients (PFP, n = 38; NFP, n = 24) without any statistical difference (p = 0.29). Statistically significant disfiguring facial outcomes (HB IV, V, VI) were seen in patients with preoperative facial palsy (p = 0.01); however, a comparison of facial functions in patients with only nondisfiguring PFP with those in NFP group did not show the statistical difference (p = 0.12). Conclusions Facial nerve palsy present before surgery does not seem to be a deterrent to intraoperative preservation of facial nerve during complete removal of giant vestibular schwannomas. Patients with nondisfiguring facial palsies have postoperative facial functions comparable to those without facial palsy.