Nerve Palsy In Patients Research Articles

Incidence and Risk Factors of Ophthalmic Nerve Palsy in Patients with Tuberculous Meningitis: A Retrospective Study and Literature Review

Abstract Background Tuberculous meningitis (TBM) is a severe form of tuberculosis with significant neurological complications, including ophthalmic nerve palsy (ONP). This study aims to evaluate the incidence and risk factors associated with ONP in TBM patients and systematically review the global situation of optic nerve damage in TBM. Methods This retrospective study included 250 patients diagnosed with TBM at Shanghai Public Health Clinical Center from January 2013 to December 2022. Data on clinical features, imaging results, and treatment outcomes were collected and analyzed, followed by logistic regression analysis to identify key risk factors. Results A total of 250 patients were enrolled in this study. The incidence of ONP was 6.8% (17/250). Patients with ONP had higher intracranial pressure (ICP) (257.69 ± 68.12 mmH2O vs. 191.65 ± 91.58 mmH2O, P = 0.012), higher cerebrospinal fluid (CSF) protein levels (1702.00 [963.70-3074.75] mg/L vs. 967.45 [513.50-1708.73] mg/L, P = 0.016), and more tuberculomas compared to those without ONP (29.4% vs. 10.7%, P = 0.039). Logistic regression analysis identified pre-treatment ICP, CD4 percentage, and presence of tuberculomas as significant risk factors for ONP. Linezolid use was found to be an independent protective factor for the recovery of ONP, with a odds ratio of 16.360 (95% confidence interval: 1.004–266.666, P = 0.050). Conclusion 6.8% (17/250) of patients with TBM developed ONP as a complication. ICP, CD4 counts, and tuberculomas are important predictors of ONP. Linezolid shows potential as a therapeutic agent for improving outcomes in TBM patients with neurological complications, warranting further study.

Isolated Sixth Cranial Nerve Palsy in Patients with Pituitary Apoplexy.

Pituitary apoplexy is an acute clinical syndrome constituted by headache, visual impairment, ophthalmoplegia, and altered mental status. Abducens nerve palsy due to pituitary apoplexy is a significant clinical manifestation in pituitary apoplexy cases.This study aims to investigate the rare occurrence of isolated sixth cranial nerve palsy in patients with pituitary apoplexy, a condition characterized by sudden hemorrhagic or ischemic infarction of the pituitary gland. A search was conducted on major databases, including PubMed, Web of Science, and ScienceDirect, to identify cases of isolated sixth cranial nerve palsy in patients with pituitary apoplexy. Only six cases were found in the available literature. Descriptive statistics were used to summarize the data, and relevant clinical features were compared between the cases. Among the six identified cases, isolated sixth cranial nerve palsy in patients with pituitary apoplexy predominantly affected middle-aged adults, with a prominent male preponderance. Clinical manifestations included acute-onset diplopia and headache, with the most common radiologic finding being pituitary gland enlargement or hemorrhage. Laboratory investigations revealed hormonal dysregulation in some cases. Treatment approaches varied and included conservative management and surgical intervention. Outcomes were generally favorable, with most patients experiencing partial or complete resolution of their cranial nerve palsy. Isolated sixth cranial nerve palsy in patients in the context of pituitary apoplexy is an exceptionally rare occurrence, with only six documented cases in the available literature. Further research and case reporting are essential to better understand this rare clinical entity and guide optimal management strategies.

Enhanced nerve function recovery in radial nerve palsy patients with humerus shaft fracture: a randomized study of low-frequency pulse electrical stimulation combined with exercise therapy.

To evaluate the effect of low-frequency pulse electrical stimulation plus exercise therapy on nerve function recovery in patients with radial nerve palsy after humerus shaft fracture. A total of 110 patients with humerus shaft fracture and radial nerve injury admitted to our hospital from January 2017 to December 2021 were recruited. They were randomized to receive either conventional exercise therapy (control group) or conventional exercise therapy plus low-frequency pulse electrical stimulation (study group) according to the random number table method, with 55 cases in each. Clinical efficacy, muscle strength recovery, nerve conduction velocity (MCV), amplitude, wrist joint, and elbow joint activities of patients were analyzed and compared. Patients with low frequency stimulation (LFS) showed significantly higher treatment effectiveness (89.09%) than those with exercise therapy only (69.09%). The incorporation of LFS with exercise therapy provided more enhancement in the muscle strength of wrist extensor and total finger extensor in patients when compared with a mere exercise intervention, suggesting better muscle function recovery of patients produced by LFS. Moreover, a significant increase in MCV and its amplitude was observed in all included patients, among which those receiving LFS showed a greater escalation of MCV and its amplitude. Following a treatment duration of 6 months, more patients in the LFS cohort were reported to achieve a wrist extension and elbow extension with an angle over 45° than the controls. There was no notable variance in adverse responses noted between the two patient groups. In patients afflicted with humerus shaft fracture and radial nerve injury, the amalgamation of exercise therapy with low-frequency pulse electrical stimulation can significantly improve clinical efficacy, promote nerve function, and muscle strength recovery, and features a high safety profile. The combination of exercise therapy and low-frequency pulsed electrical stimulation can notably improve the promotion of neurologic function and muscle strength recovery in patients with humerus shaft fractures and radial nerve injuries with a high degree of safety.Clinical trial registration:https://www.researchregistry.com, identifier researchregistry9461.

A deep learning-based image analysis for assessing the extent of abduction in abducens nerve palsy patients before and after strabismus surgery

PurposeThis study aimed to propose a novel deep learning-based approach to assess the extent of abduction in patients with abducens nerve palsy before and after strabismus surgery. MethodsThis study included 13 patients who were diagnosed with abducens nerve palsy and underwent strabismus surgery in a tertiary hospital. Photographs of primary, dextroversion and levoversion position were collected before and after strabismus surgery. The eye location and eye segmentation network were trained via recurrent residual convolutional neural networks with attention gate connection based on U-Net (R2AU-Net). Facial images of abducens nerve palsy patients were used as the test set and parameters were measured automatically based on the masked images. Absolute abduction also was measured manually, and relative abduction was calculated. Agreements between manual and automatic measurements, as well as repeated automatic measurements were analyzed. Preoperative and postoperative results were compared. ResultsThe intraclass correlation coefficients (ICCs) between manual and automatic measurements of absolute abduction ranged from 0.985 to 0.992 (P＜0.001), and the bias ranged from −0.25 ​mm to −0.05 ​mm. The ICCs between two repeated automatic measurements ranged from 0.994 to 0.997 (P＜0.001), and the bias ranged from −0.11 ​mm to 0.05 ​mm. After strabismus surgery, absolute abduction of affected eye increased from 2.18 ​± ​1.40 ​mm to 3.36 ​± ​1.93 ​mm (P＜0.05). The relative abduction was improved in 76.9% patients (10/13) after surgery (P＜0.01). ConclusionsThis image analysis technique demonstrated excellent accuracy and repeatability for automatic measurements of ocular abduction, which has promising application prospects in objectively assessing surgical outcomes in patients with abducens nerve palsy.

Frequency and Clinical Outcomes of Facial Nerve Palsy at District Level Teaching Hospital, Pakistan

Background: Facial nerve palsy, characterized by the dysfunction of the seventh cranial nerve, is a common neurological disorder that significantly impacts patients' quality of life. It manifests as unilateral facial weakness or paralysis, with Bell's palsy being the most prevalent cause. This condition requires thorough clinical evaluation and appropriate management to ensure optimal recovery outcomes. Objective: The objective of this study was to determine the frequency and clinical outcomes of facial nerve palsy in patients presenting to a district-level teaching hospital in Lakki Marwat, Pakistan. Methods: A cross-sectional study was conducted from May 2023 to October 2023 at the Physiotherapy Department of District Headquarter Hospital, Lakki Marwat. Patients with a confirmed diagnosis of facial nerve palsy by a neurophysician were included, while those with congenital facial nerve palsy or upper motor neuron lesions were excluded. Ethical approval was obtained, and written informed consent was collected from all participants. Clinical assessments were performed using the House-Brackmann scale to evaluate the severity of facial nerve dysfunction. Data were collected through a semi-structured questionnaire and analyzed using SPSS version 25. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to present the data. Results: Out of 102 patients, 59 (57.9%) were male, and 43 (42.1%) were female, with a mean age of 38.2 ± 10.36 years. The majority of patients (41.1%) were in the 31-40 years age group. Right-side facial palsy was more prevalent, affecting 64 (62.7%) patients. The House-Brackmann grading revealed that 49 (48.2%) patients were in Grade IV, 24 (23.5%) in Grade V, 15 (14.7%) in Grade III, 8 (7.8%) in Grade VI, and 6 (5.8%) in Grade II. Bell’s palsy was the most common cause, accounting for 52 (51%) cases, followed by external trauma in 22 (21.6%) patients, infections in 18 (17.6%) patients, and tumors in 10 (9.8%) patients. Treatment outcomes showed complete recovery in 65 (63.7%) patients, incomplete recovery in 28 (27.5%), and no recovery in 9 (8.8%). Conclusion: Facial nerve palsy was more common in male patients, with the right side of the face being predominantly affected. Bell’s palsy was identified as the leading cause. The study highlights the importance of early diagnosis and intervention, particularly physiotherapy, in managing facial nerve palsy. Further research is recommended to explore long-term outcomes and optimize treatment strategies.

Predictors of Recovery in Facial Nerve Palsy: Insights From an Observational Study in Odisha, India.

Background Facial nerve paralysis, leading to the loss of facial expression, poses significant discomfort to patients. While most individuals exhibit a favorable response to treatment, a subset experiences enduring facial deformities without clearly defined etiology. This study aimed to identify prognostic factors influencing outcomes and quality of life in facial nerve palsy patients, contributing to enhanced clinical management. Methods A prospective observational study was conducted in the Otorhinolaryngology Department of Maharaja Krishna Chandra Gajapati Medical College and Hospital, a tertiary care hospital. We included patients presenting with any clinical variety of facial nerve palsy, irrespective of age and gender. Only moribund and noncompliant cases were excluded. Patients underwent clinical assessment using the House-Brackmann (HB) grading at presentation and were subsequently monitored at three weeks, three months, and six months post-onset to assess recovery. Results Out of 66 patients, 18 (27.27%) fully recovered at three weeks, 50 (75.76%) recovered at threemonths, and 54 (81.82%) at six-month follow-up. Incomplete recovery was observed in 13 (19.69%) patients. Factors associated with favorable outcomes included younger age of onset (p = 0.003), lower baseline HB grade (IV or less) (p = 0.001), Electroneurography Degeneration Index (ENoG DI) of <70% (p < 0.0001), early initiation of treatment (within five days of onset) (p = 0.0003), and absence of comorbid conditions (p = 0.03). Gender and affected side (left or right) did not influence the outcome. Conclusion In summary, age, associated comorbid conditions, baseline HB grade, and extent of facial nerve degeneration are crucial predictors of outcomes in facial nerve palsy. This knowledge can guide clinicians in optimizing treatment strategies for improved patient care.

Eyelid Skin Grafting in Young Patients with Facial Nerve Palsy.

Background: The aim of this study is to report outcomes of eyelid full-thickness skin grafting augmentation in facial nerve palsy (FNP) patients younger than 50 years of age. Methods: In a retrospective, consecutive case series, nine eyelid skin grafts performed on eight FNP patients with skin contraction (five females; median age 42 years [range, 17-47]) are presented. In most cases, upper eyelid skin grafting was combined with levator recession and anterior lamellar repositioning. Lower eyelid skin grafting was combined with lower retractors recession in all cases. Functional and cosmetic outcomes were measured preoperatively and at early (1-3 months), intermediate (3-6 months), and late (≥12 months) follow-up. Results: The corneal score improved at early follow-up (p = 0.03) and remained improved at late follow-up (p = 0.042). The gentle closure lagophthalmos was improved at late follow-up (p = 0.042). (p = 0.048). The grades of graft color, edge/skin interface, and size improved at 3-6 months post-grafting and remained improved at late follow-up (p < 0.05). Over the follow-up, four patients (50%) were recommended to have further surgical procedures. Conclusions: The preliminary results from this small cohort suggest that eyelid skin grafting is a viable option for young patients prioritizing cosmesis. This technique warrants consideration for its functional benefits.

Electrophysiological Changes on Laryngeal Motor Neuropathways Cause Voice Disorders for Postradiotherapy Patients with Nasopharyngeal Carcinoma

ObjectiveThis study explored electrophysiological changes in the laryngeal motor neuropathway and determined whether lesions in the laryngeal motor cortex (LMC) and its descending tract contribute to voice deterioration and peripheral nerve palsy in patients with nasopharyngeal carcinoma (NPC) post-radiotherapy (RT). Study DesignsProspective cohort study MethodsTwenty-two patients with NPC at 2 to 4 years post-RT (8 female and 14 male), 22 patients with NPC at 8 to 10 years post-RT (8 female and 14 male), and 22 healthy individuals (9 female and 13 male) were selected to test their magnetic evoked potentials (MEP), motor nerve conduction (MNC), and voice quality using transcranial magnetic stimulation (TMS), laryngeal electromyography (LEMG), and the XION DiVAS acoustic analysis software. Three groups were matched according to approximate age. Multiple comparisons were performed among the three groups. ResultsThe voice quality of post-RT patients with NPC deteriorated compared to that of healthy individuals. Bilateral LMC and their corticonuclear tracts to the bilateral ambiguous nuclei of post-RT patients with NPC were impaired according to multi-group comparisons of MEP amplitudes, latencies, and resting motor thresholds (RMT). The vagus and recurrent laryngeal nerves (RLN) of post-RT patients with NPC were impaired according to multi-group comparisons of the amplitude and latencies of the compound muscle action potential (CMAP) and latencies of f-waves. ConclusionsThe voice quality of patients with NPC deteriorated after RT. The pathogenesis of post-RT voice deterioration may involve radiation-induced injuries to the vagus, RLN, and bilateral LMC. Furthermore, radiation-induced injuries to the bilateral LMC may contribute to vagus and RLN palsies. These findings support the use of transcranial approaches to treating voice disorders and peripheral nerve palsies in post-RT patients with NPC.

Techniques of detecting recurrent laryngeal nerve palsy in patients undergoing thyroid surgery: Pearls and pitfalls.

Though permanent vocal cord palsy consequent to recurrent laryngeal nerve (RLN) injury is rare following thyroidectomies, its consequences are grave enough for it to be the most feared complication postoperatively. Anesthesiologists and surgeons take various precautions to prevent its occurrence and employ various methods for its early detection. They include direct visualization of the nerve intraoperatively, use of intraoperative nerve monitoring, and post-extubation visualization of vocal cord mobility by use of direct or indirect methods. In the present narrative review, we aim to discuss the clinical evidence pertaining to the various methods adopted for the prevention and early detection of RLN palsy during thyroidectomy.

Torsion and clinical features in patients with acquired fourth cranial nerve palsy

This retrospective study aimed to compare objective/subjective torsion and other clinical characteristics of patients with acquired trochlear nerve palsy. This study included 82 consecutive patients who were diagnosed with acquired fourth cranial nerve palsy between 2014 and 2021 and who were followed up for ≥ 6 months. The etiologies, ocular deviation, objective and subjective torsions were reviewed. The etiologies were classified as ischemic, traumatic, brain lesion, idiopathic, or other. The patients were classified into two groups according to the recovery state: full recovery and partial/no-recovery. We compared the torsion and clinical features based on the etiology and recovery state. The average age was 59.1 ± 11.1 years, and 58 (71.0%) of the patients were male. The most common cause was ischemic (n = 49, 59.7%) and other common causes included traumatic (n = 16, 19.5%), brain lesion (n = 8, 9.8%), idiopathic (n = 5, 6.1%) and others (n = 4, 4.9%). Of the 82 patients, 56 (68.3%) were assigned to the full recovery group, and 26 (31.7%) were assigned to the partial/no-recovery group. The average age and number of patients with ischemic causes of palsy were greater in the full recovery group (p = 0.026 and p < 0.000, respectively). The vertical deviation angle, tilted angle on the Lancaster red-green test (LRGT), proportion of patients who experienced subjective torsion on the LRGT, and head tilt were smaller in the full recovery group (p = 0.037, 0.042, 0.045, and 0.006, respectively). Ischemic trochlear nerve palsy, advanced age, a small deviation angle at the primary position, and few cases of excyclotorsion on LRGT were characteristic of the full recovery group of acquired unilateral trochlear nerve palsy patients.

Telemedicine for patients with facial palsy : Current developments and options in otorhinolaryngologic treatment

Digitalization is also becoming increasingly important in medicine. The COVID-19 pandemic has further accelerated this process and politicians are trying to create aframework for successful knowledge transfer and better digital medical care. This article describes the role of telemedicine in the treatment of patients suffering from facial nerve palsy. Facial nerve palsy has awide range of effects, from limitations in facial mobility to psychological sequelae. While many of the acute, idiopathic facial nerve palsies improve after afew weeks, around athird of those affected develop synkinesis, involuntary movements that have lifelong functional and psychological consequences. Treatment includes various modalities, from medication and surgery to movement training. Telemedicine offers innovative solutions in cases of regional underuse, but also in the treatment of chronic facial nerve palsies. The article defines the term "telemedicine" in the current context and presents different types of application. Adetailed analysis of the application scenarios of telemedicine in facial nerve palsy patients shows that despite alack of evidence, many potentially useful concepts exist.

Radial nerve palsy in patients presenting with fentanyl/xylazine wounds of the dorsal forearm: A case series

IntroductionThe presence of synthetic compounds like xylazine in the illicit opioid supply of the United States has led to presentations of unique upper extremity wounds in persons who inject drugs. As an alpha-2 adrenergic receptor agonist, xylazine causes local vasoconstriction of blood vessels as well as central nervous system depression. With increased vasoconstriction, patients experience more issues with adequate perfusion which is hypothesized to cause nerve deficiencies near injection sites. MethodsThree patients presenting with a history of deep upper extremity forearm wounds secondary to injection with xylazine and fentanyl had clinically significant radial nerve palsies. Each patient's presentation and clinical course was observed and reported. ResultsIn all three cases, patients presented with chronic necrotic forearm wounds that required repeated surgical debridement and wound care. There was evidence of weakness in the radial nerve distribution, with patients exhibiting dysfunction of the extrinsic digital and wrist extensors. ConclusionProviders should be aware of a common manifestation of radial nerve deficiency in upper extremity wounds in patients with a history of fentanyl-xylazine injections. While surgical management of nerve palsies such as tendon transfers are options for treatment, successful long-term treatment must also rely on multidisciplinary care for addiction and psychosocial support for ideal functional outcomes.

Preserving vocal cord function: Continuous intraoperative vagus nerve monitoring in total thyroidectomy

A 42-year-old female patient who underwent left hemithyroidectomy for a benign thyroid nodule, was referred for further management, as histology revealed a minimally invasive follicular carcinoma requiring completion thyroidectomy as recommended by Oncologists. She had developed unilateral vocal card palsy following the initial hemithyroidectomy. Pre operatively vocal cord function was evaluated by fibre optic laryngoscopy, which confirmed a left vocal cord palsy. During the completion thyroidectomy, continuous intraoperative nerve monitoring was done using an electrode attached to endotracheal tube. A delta electrode was attached to the Vagus nerve and continuous monitoring of the Vagus nerve was done while performing intermittent monitoring of the Recurrent Laryngeal nerve. Stimulation was performed using a current of 1–2 mA. According to the International Nerve monitoring Study Group (INMSG) guidelines initial amplitude value of at least 500 μV was considered as the normal value.According to INMSG guide lines, change of EMG signal curve amplitude below 100 μV was considered as loss of signal during the operation. Post-operative period of the patient was uneventful and the right vocal cord function was confirmed as normal by fibre optic endoscopic examination. Even though intraoperative nerve monitoring is a useful procedure for all the thyroidectomy surgeries it is documented to be more beneficial during revision surgeries, thyroid malignancies and pre-operative unilateral nerve palsy patients.

Incidence of Nerve Palsies During Pavlik Harness Treatment for Developmental Dysplasia of the Hip: A Retrospective Cohort Study.

The Pavlik harness has been used for approximately a century to treat developmental dysplasia of the hip (DDH). Femoral nerve palsy is a documented complication of Pavlik harness use, with an incidence ranging from 2.5% to 11.2%. Rare reports of brachial plexus palsy have also been documented. The primary purpose of the current study was to evaluate the incidence of various nerve palsies in patients undergoing Pavlik harness treatment for DDH. Secondary aims were to identify patient demographic or hip characteristics associated with nerve palsy. We performed a retrospective review of patients diagnosed with DDH and treated with a Pavlik harness from February 1, 2016, to April 1, 2023, at a single tertiary care orthopaedic hospital. Hip laterality, use of a subsequent rigid abduction orthosis, birth order, breech positioning, weight, and family history were collected. The median (and interquartile range [IQR]) or mean (and standard deviation [SD]) were reported for all continuous variables. Independent 2-sample t tests and Mann-Whitney U tests were conducted to identify associations between the variables collected at the initiation of Pavlik harness treatment and the occurrence of nerve palsy. Three hundred and fifty-one patients (547 hips) were included. Twenty-two cases of femoral nerve palsy (4% of all treated hips), 1 case of inferior gluteal nerve palsy (0.18%), and 2 cases of brachial plexus palsy (0.37%) were diagnosed. Patients with nerve palsy had more severe DDH as measured by the Graf classification (p < 0.001) and more severe DDH as measured on physical examination via the Barlow and Ortolani maneuvers (p = 0.003). Nerve palsies were associated with more severe DDH at the initiation of Pavlik harness use. Upper and lower-extremity neurological status should be scrutinized at initiation and throughout treatment to assess for nerve palsies. The potential for femoral, gluteal, and brachial plexus palsies should be included in the discussion of risks at the beginning of treatment. Families may be reassured that nerve palsies associated with Pavlik harness can be expected to resolve with a short break from treatment. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Oculomotor outcomes of cranial nerve palsy in patients with skull base tumors.

Skull base tumors, can cause oculomotor dysfunction, presenting a management challenge given their proximity to cranial nerves. This study investigated the oculomotor outcomes in patients with skull base tumors presenting cranial nerve palsy due to tumor compression and aimed to identify associated factors. This retrospective observational cohort study enrolled patients diagnosed with primary skull base tumors who exhibited cranial nerve palsy due to tumor compression, confirmed by magnetic resonance imaging treated at Asan Medical Center between January 2011 and December 2022. Patients were assessed for oculomotor function pre- and post-treatment, and categorized into recovery and non-recovery groups based on outcomes. Factors associated with oculomotor outcomes were also analyzed. Fifty-six patients were enrolled, with the majority (n = 37, 66.1%) demonstrating recovery in oculomotor function post-treatment. The duration from symptom onset to treatment initiation was short in the recovery group, suggesting that early treatment may contribute to improved oculomotor outcomes. The type of tumor was significantly associated with oculomotor outcomes, with patients with pituitary adenoma exhibiting better outcomes. In the recovery group, 19/37 (51.4%) patients underwent surgical resection alone. In contrast, in the non-recovery group, 17/19 (89.5%) patients received primary or adjuvant radiosurgery or radiation therapy. Approximately 70% of patients with skull base tumors experienced recovery in oculomotor function post-treatment. The duration before treatment and the type of tumor were significantly associated with the oculomotor outcome. These findings aid neuro-ophthalmologists in predicting oculomotor outcomes for patients with skull base tumors, guiding management strategies for oculomotor dysfunction.

Etiology of Isolated Third, Fourth, and Sixth Cranial Nerve Palsies with a Cancer History

Purpose: To investigate the causes of isolated ocular motor nerve palsy in patients with a history of cancer.Methods: The charts of 30 patients with cancer diagnosed with isolated acquired third, fourth, and sixth cranial nerve palsies from March 2013 to December 2021 were retrospectively reviewed. Sex, age of onset, underlying disease and causes of cranial nerve palsy were analyzed.Results: Sixth cranial nerve palsy (n = 18, 60.0%) was the most common. Brain metastasis (n = 13, 43.3%) was the most common etiology, followed by microvascular causes (n = 11, 36.7%), radiation-induced neuropathy (n = 2, 6.7%), and undetermined (n = 4, 13.3%). Among the 13 patients with palsies due to brain metastasis, only one (7.7%) had been in complete remission for more than 1 year. Of the remaining 17 patients with other causes, seven (41.2%) had been in complete remission of a previously diagnosed cancer for more than 1 year.Conclusions: In patients with a history of cancer, cranial nerve palsy due to brain metastasis was the most common cause, and it was more likely if the primary cancer had not been in remission for more than 1 year. Brain magnetic resonance imaging should be performed as soon as possible to confirm brain metastasis and a differential diagnosis including various other causes is also important.

Ocular motor nerve palsy in patients with diabetes: High-resolution MR imaging of nerve enhancement

To evaluate the extent of signal abnormality in impaired ocular motor nerves using high signal and spatial resolution MRI sequences and to discuss the involvement of inflammatory or microvascular impairment in patients with diabetic ophthalmoplegia. We conducted a retrospective study of 10 patients referred for acute ocular motor nerve palsy in the context of diabetes mellitus from September 15th, 2021 to April 24th, 2022. 3T MRI evaluation included diffusion, 3D TOF, FLAIR, coronal STIR and post-injection 3D T1 SPACE DANTE sequences. Ten patients were included: 9 males and 1 female aged from 46 to 79 years. Five patients presented with cranial nerve (CN) III palsy, and 5 presented with CN VI palsy. Third nerve palsy was pupil-sparing in 4 patients and pupil-involved in 1 patient. Pain was associated in all patients with CN III deficiencies and in 2 patients CN VI deficiencies. In all patients, MRI sequences ruled out mass effect and vascular pathology, such as acute stroke or aneurysm. Eight patients presented with STIR hypersignals, some with enlargement of the involved nerve. The diagnosis was confirmed through a post-injection 3D T1 SPACE DANTE sequence, which showed extended enhancement along the abnormal portion of the nerve. High-resolution MRI evaluation of diplopia in diabetic patients is used to rule out a diagnosis of acute stroke and contributes to the positive diagnosis of ocular motor nerve impairment, possibly combining the influences of inflammatory and microvascular phenomena. Dedicated MR imaging should be included in the initial diagnosis and longitudinal follow-up of patients with diabetic ophthalmoplegia.

Surgical management and side effects of parotid gland surgery for benign lesions: a retrospective analysis of our experience from 2012 to 2021

Surgery is the treatment of choice for tumours in the parotid gland. We evaluated complications following parotid surgery. We conducted a retrospective study on 554 patients undergoing parotid surgery for benign parotid tumours from 2012 to 2021. We analysed complication rates between extracapsular dissection (ECD) and superficial parotidectomy (SP). We found 19 capsular ruptures in patients undergoing ECD (5.34%) and five among those undergoing SP (2.52%) [p < 0,05]; 16 cases of temporary facial paralysis among those undergoing ECD (4.49%) and 35 in patients undergoing SP (17.67%) [p < 0,05]; and eight instances of permanent facial nerve paralysis in patients undergoing ECD (2.25%) [p > 0,05] and 13 in patients undergoing SP (6.56%). Among the mid-term complications described were: 22 salivary fistulas among patients operated with ECD (6.18%) [p > 0,05] and 17 in patients with SP (8.58%) 17 sialoceles in those who underwent ECD (4.77%) and seven with SP (3.53%) [p > 0,05]. Regarding late complications, we found: surgical wound dehiscence, pathological scarring (keloid), Frey's syndrome, and recurrence, which affected 45 patients with ECD (12.64%) and 21 with SP for dehiscence (10.6%) [p < 0,05]; 28 keloids in patients with ECD (7.86%) and 15 in patients with SP (7.57%) [p > 0,05]; 12 cases of Frey's syndrome in patients with ECD (3.37%) and 36 with SP (18.18%) [p < 0,05]; and finally 22 recurrences in patients who underwent ECD (6.18%) and 13 in patients who underwent SP (6.56%) [p > 0,05], including 30 in the 273 patients with pleomorphic adenoma and five in the 214 patients with Warthin’s tumour. We can conclude that the onset of the different complications after parotid gland surgery are related to the surgery performed. Our data confirm that there is a tight relationship between type of surgery performed and type of complication.

Recovery and functional outcome after radial nerve palsy in adults with a humeral shaft fracture: a multicenter prospective case series

The consequences of radial nerve palsy associated with a humeral shaft fracture are unclear. The aim of this study was to examine the functional recovery of radial nerve palsy, at presentation or postoperatively, in patients with a humeral shaft fracture. Data from patients who participated in the HUMeral shaft fractures: measuring recovery after operative versus non-operative treatment (HUMMER) study, a multicenter prospective cohort study including adults with a closed humeral shaft fracture Arbeitsgemeinschaft für Osteosynthesefragen (AO) type 12A or 12B, and had radial nerve palsy at presentation or postoperatively, were extracted from the HUMMER database. The primary outcome measure was clinically assessed recovery of motor function of the radial nerve. Secondary outcomes consisted of treatment, functional outcome (Disabilities of the Arm, Shoulder, and Hand and Constant-Murley Score), pain level, quality of life (Short Form-36 and EuroQoL-5D-3L), activity resumption, and range of motion of the shoulder and elbow joint at 12 months after trauma. Three of the 145 nonoperatively treated patients had radial nerve palsy at presentation. One recovered spontaneously and 1 after osteosynthesis. Despite multiple surgical interventions, the third patient had no recovery after entrapment between fracture fragments. Thirteen of the 245 operatively treated patients had radial nerve palsy at presentation; all recovered. Nine other patients had postoperative radial nerve palsy; 8 recovered. One had ongoing recovery at the last follow-up, after nerve release and suture repair due to entrapment under the plate. At 12 months, the functional outcome scores of all patients suggested full recovery regarding functional outcome, pain, quality of life, activity resumption, and range of motion. Radial nerve palsy in patients with a humeral shaft fracture at presentation or postoperatively functionally recovers in 94% and 89%, respectively.

Incidence and Risk Factors of Cranial Nerve Palsy in Patients with Tuberculous Meningitis: A Retrospective Evaluation.

Tuberculous meningitis (TBM) is a common form of central nervous system (CNS) tuberculosis (TB). Cranial nerve palsy is a serious complication of TBM. Literature regarding this subject is still limited in China. This study evaluated the incidence of cranial nerve palsy in patients with TBM in South China, its association with the clinical forms of TB, and other patient characteristics. A retrospective chart review of patients with a diagnosis of TBM between January 2004 and December 2019 was conducted, and the demographic characteristics, clinical characteristics, and laboratory results of 114 patients were collected and followed up for 3 months. A multivariate logistic regression analysis model was used to explore the risk factors of cranial nerve palsy in patients with TBM. A total of 114 patients were enrolled in this study. Cranial nerve palsy was observed in approximately 38 (33.3%) of TBM patients. Among them, 13 (28.3%) had optic nerve palsy, 24 (52.2%) had oculomotor nerve palsy, 5 (10.9%) had abducens nerve palsy, 2 (4.3%) had auditory nerve palsy, 1 (2.2%) had glossopharyngeal nerve palsy, and 1 (2.2%) had vagus nerve palsy. Using logistic regression analysis, focal neurological deficit, extracranial TB and cerebrospinal fluid (CSF) total white cell count (WCC) were shown to be risk factors for cranial nerve palsy. The prevalence rate of cranial nerve palsy was 33.3% in patients with TBM. Focal neurological deficits, extracranial TB and CSF total WCC are important predictors of cranial nerve palsy in patients with TBM.