Peripheral Palsy Research Articles

Galanthamine in Alzheimer??s Disease

Galanthamine (galantamine), a tertiary alkaloid derived from the bulbs of the snowdrop and various Narcissus species, is a selective, centrally active and reversible inhibitor of acetylcholinesterase that is suitable for oral therapy. After a long period during which the investigational and clinical use of the drug was limited to anaesthesia and the treatment of peripheral paralysis syndromes in Eastern Europe, the molecule has now emerged as a promising lead substance for the treatment of cognitive decline in Alzheimer's disease.Galanthamine has similar therapeutic potential to tacrine, but has a significantly more favourable pharmacokinetic and toxicity profile. A chemical synthesis process on the required industrial scale of several tons per year has become available, removing a major obstacle to the development of the drug. Clinical trials published so far are, however, rather limited in terms of both design and patient number. The main reason for this is that there has been a lack of strong support for the drug within the pharmaceutical industry. However, the available data support the notion that this molecule, if properly developed, could be a peer for any second-generation cholinergic drug currently in clinical trials for the symptomatic treatment of Alzheimer's disease.

Current issues of middle ear microsurgery

Ear microsurgery, which has more than 40 years of history, is associated with the name of S. Rosen (1952). To improve hearing in patients with otosclerosis, he proposed an operation to mobilize the stirrup, which led to the rapid development of stapedoplasty. Currently, microsurgical techniques are widely used for atresia, trauma and benign tumors of the external auditory canal, for congenital anomalies, trauma and benign tumors of the middle ear, in addition to otosclerosis and inflammatory pathology, for traumatic fistulas of the labyrinth windows, Meniere's disease, peripheral paralysis of the facial nerve, noise, otogenic liquorrhea, with cochlear implantation, etc.

Infantile progressive spinal muscular atrophy with ophthalmoplegia and pyramidal symptoms

Two siblings presented with identical features of progressive peripheral paralysis of the lower motor neuron type, pyramidal signs, cranial nerve palsy which included external ocular palsy and deafness, and internal ocular palsy; both died before 1 year of age. Pathologic examination of the central nervous system in both patients revealed degeneration and loss of spinal and cranial nerve motor nuclei, including the oculomotor nucleus. In addition, there was degeneration of the Edinger-Westphal nuclei and demyelination of the corticospinal tract under the midbrain. Although spinal cord lesions were indistinguishable from those of Werdnig-Hoffmann disease, the 2 patients are not considered to have Werdnig-Hoffmann disease from the clinicopathologic findings.

A sporadic form of hereditary neuropathy with liability to pressure palsies

We report a patient who had episodes of recurrent peripheral nerve pressure palsies. Electrodiagnostically, we found a clear decrease of nerve conduction velocity in affected and unaffected nerves. All the patient's relatives showed entirely normal clinical and electrodiagnostic findings. Histopathologically, there were extensive irregularities of the myelin sheaths with numerous tomaculous swellings. DNA analysis revealed a deletion for probes flanking the PMP-22 gene at the maternal chromosome 17 in our patient. His mother showed a normal gene dosage for all markers deleted in our patient, indicating a new mutation.

Malignes Melanom des Felsenbeins

The present article describes a case of malignant melanoma with the rare localisation in the right temporal bone. The 79-year old female patient presented a polypous tumour with obturation of the outer ear canal and sanguineous otorrhoea (Fig. 1). The inner ear function was impaired showing a combined defective hearing and complete peripheral palsy of the facial nerve as well as an abducens nerve palsy (Fig. 1) with diplopia. CT and MR imaging showed a tumour destroying the temporal bone up to the apex of the pyramid and the clivus reaching the middle cranial fossa (Fig. 2-3). After palliative radiotherapy with 40 Gy the general condition and clinical symptoms improved. After a period of 8 months with no signs of further tumour progression the patient was admitted again in reduced general condition showing pulmonary and pleural metastases. The patient died 14 days later.

Induction intra‐arterial cisplatin and bleomycin in head and neck cancer

Fifty-two consecutive patients, affected by large T2 (greater than 3 cm), T3, T4, N0, or N1 previously untreated squamous cell carcinoma of the head and neck, entered this phase I-II study. Treatment consisted of a continuous 8-day infusion on the following daily schedule: cisplatin 25 mg and bleomycin 15 mg administered for 4 and 20 hours, respectively. Technical-related toxicities were 1 case each of coagulation and displacement of the catheter and 1 case of reversible monoparesis of the contralateral arm. Drug-related relevant toxicities accounted for 4 cass of grade 3 or 4 leukopenia and 2 cases of peripheral palsy of the 7th and 12th cranial nerve, respectively. Forty-five of 50 evaluable patients obtained an objective response. In particular, 13 patients obtained a complete response, 22 a partial response greater than or equal to 75%, and 10 a partial response greater than or equal to 50%. Furthermore, 5 of 31 patients showed a complete pathologic disappearance of the tumor, whereas in 12 of 31 only a microscopic residue was found.

Follow-up Study of Peripheral Nerve Paralysis Associated with Fracture or Fracture dislocation of the P roximal Humerus and Dislocation of the Should Joint.

Follow-up Study of Peripheral Nerve Paralysis Associated with Fracture or Fracture dislocation of the P roximal Humerus and Dislocation of the Should Joint.

Peripheral nerve lesions of experimental leprosy in monkeys. V. Histopathological finding of cutaneous nerves and cutaneous sensory organs

The skin samples of each palm side and dorsum side of finger, nose and peripheral nerves running under the finger skin at the area between proximal phalanx and distal phalanx of mangabey monkey A022 and rhesus monkey A125 were studied by histopathological methods (semithin section and light microscopic findings). Results found about this study were as follows. 1. In spite of the existence of a large amount of leprosy bacilli at the areas of corium and subcutis, some of Meissner's corpuscles, Vater-Pacinian corpuscles (or Golgi-Mazzoni's corpuscles) and Krauze's end bulbs-like structures were observed. 2. Occasionally, several intracytoplasmic foamy structures containing a large amount of leprosy bacilli were observed at the shallow and deep layers of stratum papillare of corium, where leprosy bacilli were not so remarkable as shown on Figure 4. So, it was thought that the affinity of leprosy bacilli to free nerve endings should be exist there. 3. Some of M. arrector pili were kept in good condition in spite of the existence of multiplying leprosy bacilli around the hair follicles. 4. It was thought that the histopathological findings of the fascicles of cutaneous nerves were classified to 4 patterns. The first pattern of histopathological finding of the cutaneous nerve was shown as A on Figure 25. In this pattern observed in almost of all the fascicles locating at the subcutis, no leprosy bacillus was observed inside the fascicles, and the nerve fibers were kept in good condition. The second pattern observed in almost of all the fascicles located at the corium, was shown as B on Figure 25. In this pattern, a large amount of leprosy bacilli were observed inside the fascicles, and the nerve fibers were often kept in good condition. The third pattern observed in almost of all the fascicles located at the deep layer of corium and subcutis, was shown as C on Figure 25. In this pattern, not only multiplying leprosy bacilli but also remarkable fibrosis were found inside one fascicle, and many nerve fibers disappeared by the existence of the bacilli and fibrosis. The final pattern observed in almost of all the fascicles located at the deep layer of corium and subcutis, was shown as D on Figure 25. In this pattern, remarkable fibrosis was observed inside the fascicles, and the nerve fibers often disappeared by the existence of fibrosis.(ABSTRACT TRUNCATED AT 400 WORDS)

Long-term modifications of vertical and horizontal vestibulo-ocular reflex dynamics in man. I. After acute unilateral peripheral vestibular paralysis.

Horizontal (HOR) and vertical (VERT) vestibulo-ocular reflex (VOR) responses to whole-body triangular velocity profiles with constant accelerations of 10, 15 and 20 deg/s2 were studied in two populations: normals, and patients with acute unilateral peripheral vestibular paralysis. The effect of this type of unilateral deficit on VOR gain and long time constant were determined as well as the time course of the compensation processes for HOR and VERT VOR dynamics. In the patient population, HOR VOR gain was asymmetric post deficit, being, on average, 50% and 75% of normal for rotations toward and away from the deficit, respectively. For the VERT VOR, on average, a symmetric 66% reduction occurred. The VERT VOR time constant was marginally affected by the deficit. HOR time constants were reduced for both directions of rotation. HOR and VERT VOR gain was within normal limits 1-3 months following an acute paralysis; time constants required a longer recovery period. Our results indicate that a unilateral deficit causes a markedly different alteration for HOR VOR dynamics compared to the effect on VERT VOR.

Cardiovascular determinants of the hemodynamic response to acute endotoxemia in the dog

The cardiovascular changes that occur early in hyperdynamic, hypotensive septic shock are poorly understood. In a splenectomized but otherwise intact pentobarbital-anesthetized canine model (n = 11), we simultaneously characterized the determinants of ventricular and peripheral vascular function in response to a bolus infusion of E. coli endotoxin (1.0 mg/kg). Right-ventricular (RV) and left-ventricular (LV) stroke volumes were measured by electromagnetic flow probes. Instantaneous RV function and venous return curves 1,2 and steady state arterial pressure-flow (P/Q) and LV function curves were generated by incremental volume loading both before (control) and 30 minutes after (endo) endotoxin infusion. Blood volume (BV) was determined by indicator dilution. Within five minutes of endotoxin infusion, hypotension and hypoperfusion developed because of a decrease in mean systemic pressure (P ma ) with no change in ventricular function of the arterial P/Q relation. However, after 30 minutes endo, compared with control, cardiac output increased (2.4 ± .3 to 3.2 ± .3 L/min, x̄ ± XE. P < .05); arterial pressure fell (132 ± 10 to 87 ± 10 mm Hg, P < .01), while the arterial P/Q slope was unchanged. BV remained constant (2,051 ± 149 to 1,942 ± 194 mL, NS), but P ma decreased further (11.3 ± 0.9 to 9.5 ± 0.9 mm Hg, P < .01). For the same BV, peripheral vascular compliance (ΔBV/ΔP ma ) was unchanged. Ventricular stroke volumes at similar filling pressures were increased ( P < .05), while calculated stroke work was unchanged. The arterial P/Q relation and peripheral vascular compliance were unaffected by subsequent beta-adrenergic blockade, though ventricular function was depressed. We conclude that acute endotoxemia causes a biphasic hemodynamic response comprising an early, disproportionate reduction in venous return and a later, progressive peripheral vasomotor paralysis.

Separation of the motor consequences from other actions of unilateral 6-hydroxydopamine lesions in the nigrostriatal neurones of rat brain

Male rats showed a clear preference for one forepaw when they were trained to press a lever for food reward. The preference was then changed by training, by local anaesthetic injection into the preferred paw, by lesions in the striatal output pathways in the brain, or by neurotoxin injection into the striatum contralateral to the side of the preferred paw. The pressing rate was not changed in spite of the change in paw use in any of these operations. This result is in marked contrast to the effect of reducing the dopamine concentration on the side contralateral to the preferred paw; in this case a marked reduction in responding is seen as well as the change in paw use. Thus medial forebrain bundle 6-hydroxydopamine lesions are more debilitating than either striatal damage or peripheral paralysis at least in the short term.

Reconstructive Surgery and ADL of Spastic Talipes Equinovarus Associated with Hemiplegia

There are lots of cases of walking disturbance caused by talipes equinovarus and hammer toe deformity which are associated with hemiplegia due to cerebral vascular disease. Deformities such as this kind of spastic paralysis are different from those of peripheral flaccid paralysis or of congenital secondary talipes equinovarus. Because these deformities of spastic paralysis become apparent in dynamic state, even if they are not recognized in static state.Therefore the main purpose of reconstructive surgery for these deformities is the restoration of the ability to support the body as well as the correction of the deformities and the removal of the contracture.We studied (1) the method of surgery and (2) the improvement in deformities, walking ability and ADL after surgery. The 36 patients were selected as those who had been observed for more than 6 months following reconstructive surgery for talipes equinovarus, out of 344 inpatients suffering from hemiplegia between August 1977 and December 1983. A remarkable improvement in ADL was observed after operation with respect to gait pattern and independency. The 12 patients who became free from equipment or were able to reduce the frequenciy of use of such equipment were mostly satisfied.

Traumatic subarachnoid hemorrhage

One hundred and ninety-seven cases with closed head injury were encountered from April 1980 to December 1982. Computerized tomography (CT) scans of these cases showed traumatic intracranial organic lesions such as epidural hematoma, subdural hematoma, and brain contusion. Among these cases, 23 (11.7%) had only subarachnoid hemorrhage on CT scan, which was performed within several hours of the injury. The five adult patients whose CT scans showed massive subarachnoid hemorrhage in the basal, prepontine, and perimesencephalic cisterns had severe brain-stem damage, and their outcomes were poor. Four adult patients whose CT scans showed moderate subarachnoid hemorrhage in the basal cistern had disturbances of consciousness without brain-stem dysfunction, and their outcomes were fair. Impact sites of injury in the seven of 10 patients with small subarachnoid hemorrhage localized in the ambient and/or quadrigeminal cisterns, were face or forehead. This suggested that subarachnoid hemorrhage was produced by shear strain at the craniocervical junction due to hyperextension of the head or by impact at the tentorial notch. All of these cases recovered, but three of the 10 patients had peripheral oculomotor palsy. The four children had relatively good outcomes compared with the adult cases. The outcomes of the 23 cases as measured 3 months after injury according to the Glasgow Outcome Scale were as follows; good recovery 13, moderate disability 4, severe disability 1, vegetative 1, and dead 4.

Clinical Study of Acute Peripheral Vestibular Palsy

昭和55年から3年間の vestibular neuronitis と同じ病像を呈する突発性前庭障害例51名の臨床的検討を行い, 次の結果を得た.(1) 疫学的事項(1) 男性に多く, 全体として30歳以上に多かった.(2) 患側は全例一側性で左右差なく, 両側性はなかった.(3) 発症季節には特徴的なことはなかった. 発症時間は朝が多かった.(4) 発症前に感冒に罹患していた例は多くなかった. 誘因としては過労が多かった.(5) めまいは回転性が多く, 1日以上持続するのが多かった.(2) 温度反応消失例は15.7%あった.(3) 素因検査では感冒に罹患していなかった例では, 健康成人より循環系異常 (起立試験陽性), 代識系異常 (脂質異常) を示したものが多かった.(4) 血清ウイルス抗体価は1名に風疹抗体価が2回目の検査で上昇し, 不顕性感染であったが感染と発症の時期が同じであり本疾患の病因として何らか関与していると疑われた.(5) 電気眼振検査は発症に近い時期でないが4名に行い, 全例電気眼振は正常に発来した. 発症時から正常で前庭神経終末, 神経節は障害されていなかったか, 回復したかのいずれかが考えられた.(6) 温度反応の予後はCP100%例について検討した. 完全回復14.3%, 軽度回復42.9%, 回復せず42.9%であった. 不可逆的でなく回復する例は存在するが, 完全に回復することは困難であることが示された.以上, 本疾患の臨床的検討を行ったが今後さらにその病態, 予後について検討をつづける予定である.

ATRACURIUM: ITS SPEED OF ONSET. A COMPARISON WITH SUXAMETHONIUM

Forty healthy pauents were randomly selected to receive either atracurium 0 6 mg kg-1, or summethonium 1 mg kg-1. Onset of neuromuscular blockade and the time to full peripheral paralysis were measured using a train-of-four stimulus repeated once every 12 s. Atracurium appeared to be a potent non-depolanzmg muscle relaxant, with a rapid onset of action. However, full peripheral paralysis took longer to achieve than with suxamethonium. There were no significant problems with recovery.

The course and relations of the hypoglossal nerve and the occipital artery

Three main types of variations in the relations of the occipital artery and the hypoglossal nerve found in 42 dissected specimens are described, according to the level at which the nerve crosses the external carotid artery and the point of origin of the occipital artery. In Type I, the hypoglossal nerve crosses the external carotid artery inferior to the origin of the occipital artery; in Type II, the nerve crosses the external carotid artery at the level of origin of the occipital artery; and in Type III, it crosses superior to that level. In Type III the occipital artery makes a loop around the hypoglossal nerve and is in a position to pull and exert pressure on the nerve. This possibility should be taken into consideration in the diagnosis of peripheral paresis or paralysis of the tongue and during surgery in this area.

Peripheral and midbrain oculomotor palsies from operations for basilar bifurcation aneurysm in a series of 31 cases

We evaluated oculomotor complications that occurred following surgical treatment of basilar bifurcation aneurysms in a series of 31 patients at the University of California Medical Center, San Francisco. Twenty-one of these patients developed an oculomotor palsy following operation. In 9 patients, the oculomotor palsy was the only complication. In 3 others, the oculomotor palsy was bilateral, suggesting injury to the oculomotor nucleus. In 9 additional patients, the oculomotor palsy was accompanied by a hemiparesis, indicating vascular injury to the peduncle. Recovery from isolated oculomotor palsy was excellent; when injury to the brain stem accompanied the oculomotor palsy, recovery was incomplete.

Human Botulism Caused by Clostridium Botulinum Type E: The Birmingham Outbreak

Four elderly patients developed botulism following ingestion of tinned Alaskan salmon contaminated with Clostridium botulinum type E. Severe skeletal muscle paralysis, occurring within 18 hours in peripheral, respiratory and facial, extrinsic ocular and pharyngeal muscles, resulted in progressive respiratory failure, ptosis, loss of eye movements, dysphonia and dysphagia. In addition, the development of intestinal ileus, loss of vagal cardiac control, hypotension and lack of vasomotor response to either postural change, stimulation by cold or the Valsalva manoeuvre indicated dysfunction of both parasympathetic and sympathetic nervous systems. Sensation was unimpaired and no alteration of consciousness occurred despite the presence of extensive abnormal delta activity in the EEGs of all patients. The diagnosis of botulism was confirmed by demonstration of Cl. botulinum type E toxin in the serum of all four patients and in salmon remnants from the suspect tin, in which Cl. botuilnum type E spores were also identified. Standard supportive intensive care and antitoxin therapy were complemented by the use of a novel neuromuscular blockade antagonist, 4-aminopyridine. This agent was shown by electromyography to be effective in restoring neuromuscular transmission and, clinically, to produce almost complete reversal of peripheral paralysis. However, this effect was transient and there was no detectable effect on respiratory muscle. Administration of 4-aminopyridine by constant infusion produced sustained improvement in peripheral muscle power, but there was no additional effect on respiratory muscle, and convulsive phenomena occurred following treatment. Despite these latter problems, 4-aminopyridine produced a greater response in peripheral muscle than might have been expected with guanidine and further studies, possibly with less neurotoxic analogues, are indicated.

The opercular syndrome–diagnostic trap in facial paralysis

We describe a patient with a left facial paralysis and hemotympanum following left parieto-occipital skull trauma. The initial admission diagnosis of intratemporal facial nerve injury secondary to temporal bone fracture was incorrect. Normal facial movements during involuntary activity (yawning, laughing at a joke) and focal seizure activity on the paralyzed side of the face, seen subsequently, indicated the site of lesion as supranuclear. The diagnosis of opercular syndrome was made. This syndrome can result when the contralateral frontal lobe is injured. Supranuclear weakness of muscles supplied by the hypoglossal or spinal accessory nerves is also present. Unlike other central paralyses, the facial paralysis in operculum syndrome may not demonstrate "forehead sparing" and consequently it may be mistaken for a peripheral paralysis. The neuroanatomic basis for the syndrome is discussed. Signs and symptoms are outlined to help the otolaryngologist avoid this diagnostic pitfall.

Acupuncture in two cases of peripheral nerve paralysis

Acupuncture in two cases of peripheral nerve paralysis