Posterior Cranial Nerve Research Articles

Voice Correction Treatment Promotes Recovery of Vocal Cord Paralysis Caused by Atypical Ramsay-Hunt Syndrome: A Case Report.

Atypical Ramsay-Hunt syndrome is caused by varicella zoster viruses (VZV), without herpes, herpes is not around the ear, or posterior cranial nerve palsy is the first clinical manifestation. In this case, a 60-year-old male patient with VZV invades the branches of the vagus nerve alone. The initial symptoms were in the pharynx and larynx, which presented as mucosal ulcers and voice disorders. The ear symptoms were only otalgia and auricular herpes, without deafness, tinnitus, or peripheral facial palsy. Herpes and ulcers healed with medication, but voice disorders caused by vocal cord paralysis did not return. Voice correction treatment has been implemented to help restore the movement and closure of the vocal cords, with ultimately good results. After voice correction treatment, the patient recovered without residual nerve palsy complications. Voice correction treatment has been shown to be potentially effective and promising in shortening the recovery period and improving the recovery rate for vocal cord paralysis caused by viral infection.

Nervus Intermedius Neuralgia With Vestibular Paroxysmia -A Rare Combination of Nerve Compression Syndromes

Introduction: Posterior cranial fossa nerve compressions in a rare combination are discussed here. Case Reports: 51 year old male with intractable vertigo, vomiting and left ear ache, had left spontaneous nystagmus. Another 25 year old female had recurrent ear ache and vertigo.Both MRI Brain showed compression of VII/VIII nerve complex in the cistern. They were given Ox carbamazepine with supportive therapy tapered with no recurrence in past 1 year. Discussion: The combination of the 7th and 8th cranial neuralgias presents with common symptomatology. The investigation of choice is HR T2 weighted MRI brain (CISS/FIESTA SPACE sequence), treated medically. Surgically, decompression or nerve sectioning are done. Conclusion: Though rare due to different positions of the nerve entry/exit zones of these nerves, this combination of posterior cranial fossa nerve compression syndromes can coexist. Diagnosis can help in the proper management of such patients and even open the hori-zon for surgical options in recalcitrant cases.

The diagnosis and treatment of vagal paraganglioma in the parapharyngeal space

Objective: To study the clinical features, diagnosis and treatment of vagal paraganglioma in parapharyngeal space. Methods: Nine cases with vagal paraganglioma in parapharyngeal space were retrospectively analyzed who were diagnosed and treated between January 2006 and December 2018 in Department of Otorhinolaryngology Head and Neck Surgery, Beijing Friendship Hospital and the First Medical Center, Chinese PLA General Hospital. There were 6 males and 3 females, aged from 24 to 50 years old. The main symptoms in the 9 patients were hoarseness and neck mass, and the secondary symptoms were irritating cough, cough on drinking and dysphagia. The main sign was a well-circumscribed round mass, tough in texture, with or without ipsilateral lateral oropharyngeal wall uplift and vocal cord paralysis. The tumors were located between the bifurcation of the carotid artery and the jugular foramen in 7 cases and intruded into jugular fossa in 2 cases. All the 9 patients underwent head and neck enhancement CT and MRI and 7 cases received digital subtraction angiography (DSA) examination and balloon occlusion test. The imaging features were tumors with rich blood supply in the parapharyngeal space of the upper neck, and the tumors were heterogeneous enhanced with contrast CT scan and enhanced MRI, which were closely related to the internal carotid artery, external carotid artery and jugular vein. Results: Among these 9 patients, 8 underwent surgical resection of tumors, including complete tumor resection in 7 cases and partial tumor resection in 2 case. One patient underwent partial tumor resection after being transferred to vascular surgery. There was no recurrence in 7 patients with complete tumor resection and slow growth was shown in 2 patients with partial tumor resection. Posterior cranial nerve injury occurred in 2 patients and stroke in 1 patient due to intraoperative ligation of internal carotid artery. Conclusions: Vagal paraganglioma in the parapharyngeal space is rich in blood supply and closely related to the internal and external carotid arteries, internal jugular vein and posterior cranial nerves. Surgical resection is the first choice for treatments. Choosing a reasonable operative approach for fully exposing the operative field and completely removing the tumor while protecting the internal carotid artery are the keys to successful surgery.

Microvascular decompression for the treatment of neurogenic hypertension with trigeminal neuralgia

BackgroundTo evaluate the efficacy of microvascular decompression (MVD) in reducing hypertension (HTN) in hypertensive patients with trigeminal neuralgia (TN).MethodsThe clinical data of 58 cases of neurogenic HTN with TN treated in our hospital were retrospectively reviewed. Preoperative MR revealed abnormal blood pressure in the left rostral ventrolateral medulla (RVLM) and the posterior cranial nerve root entry zone (REZ). The patients were divided into control group: only trigeminal nerve was treated with MVD; experimental group: trigeminal nerve, RVLM and REZ were treated with MVD at the same time. The patients were followed up for 6 months to 1 year to observe the changes of blood pressure.ResultsThere was no significant difference in gender, age, course of TN, course of HTN, grade of HTN and preoperative blood pressure between the two groups. After operation, the effective rate of HTN improvement with MVD was 32.1% in the control group. There was no significant difference in the preoperative and post operative blood pressure. (P△SBP = 0.131; P△BDP = 0.078). In the experimental group, the effective rate was 83.3%. The postoperative blood pressure was significantly lower than preoperative values. (P△SBP < 0.001; P△DBP < 0.001).ConclusionsMVD is an effective treatment for neurogenic HTN. However, the criteria for selecting hypertensive patients who need MVD to control their HTN still needs to be further determined. Possible indications may include: left trigeminal neuralgia, neurogenic HTN; abnormal blood pressure compression in the left RVLM and REZ areas on MR; and blood pressure in these patients can not be effectively controlled by drugs.

Foodborne Botulism: Neglected Diagnosis.

Botulism is rare neuroparalytic disease caused by botulinum toxin, one of the most toxic substances known. Foodborne botulism is caused by consumption of foods contaminated with botulinum toxin. The clinical manifestations are flaccid, symmetrical, descending paralysis affecting cranial and peripheral nerves. The only specific treatment is botulinum antitoxin. We report the case of a 37-year-old man with gastrointestinal manifestations and posterior cranial nerve palsy who was diagnosed with botulism infection. Clinicians should be aware of rare causes of infection and determine the aetiology of symptoms.LEARNING POINTSBotulism remains a diagnostic challenge.Misdiagnosis of early cases suggests sporadic cases are overlooked.Timely clinical diagnosis is critical for treatment decisions as botulinum antitoxin cannot reverse existing paralysis.

Acute bilateral vision deficit as the initial symptom in Guillain-Barre syndrome: A case report.

Guillain-Barre syndrome (GBS) is a rare autoimmune-mediated peripheral neuropathy with an acute onset. GBS is associated with posterior cranial nerve injury including the facial, oculomotor, glossopharyngeal and vagus nerves. A 43-year-old female presented with worsening blurred binocular vision accompanied by diplopia, bilateral ptosis, speech difficulties, dysphagia, extremity numbness and weakness of the limbs. A neurological examination was conducted along with magnetic resonance imaging of the brain and spinal cord, electromyography, cerebrospinal fluid analysis and visual evoked potential tests, which led to a diagnosis of GBS. Following immunoglobulin administration, the patient's neurological deficiencies were markedly relieved and they were discharged following a 3-week observation period. To the best of our knowledge, this is the first reported case of GBS associated with cranial nerve damage presenting with bilateral visual deterioration as the initial symptom. It is necessary to emphasize that early diagnosis and commencing the immunological treatment in a timely manner resulted in a favorable prognosis for the patient.

Clinicopathological features and microsurgical outcomes for giant pediatric intracranial tumor in 60 consecutive cases.

Giant pediatric intracranial tumor (GPIT) remains to be a challenging disease with high morbidity and mortality. The clinical data of 60 patients under 18years of age operated on with GPIT (≥5cm in diameter) were retrospectively analyzed. Gross total resection was achieved in 46 cases (77%) and subtotal resection was obtained in 14 cases (23%). Ninety percent (47/52) of the cases with obstructive hydrocephalus were resolved remarkably and only 10% (5/52) of the patients needed a ventriculoperitoneal shunt after tumor resection. Postoperative histopathological type revealed malignant brain tumors in 51 cases (85%). The most common neoplasm was medulloblastoma; other types include the following: ependymoma, pilocytic astrocytoma, mixed glioma, primitive neuroectoderm tumor (PNET), subependymal giant cell astrocytoma, gangliocytoma, gliosarcoma, choroid plexus carcinoma, and atypical teratoid rhabdoid tumor (AT/RT). Benign histopathological categories include the following: craniopharyngioma, choroid plexus papilloma, and meningioma. No death or serious complications occurred after the operation. However, transient subcutaneous effusion occurred in 14 patients postoperatively, nerve injury including the posterior cranial nerve in two cases and abduction nerve in one case, and mutism and pulmonary infection were observed in two cases, respectively. The follow-up period ranged from 1 to 72months, with an average of 32months. Poor prognosis occurred significantly in the high-grade malignant tumors and PNET, AT/RT, and gliosarcoma were implicated in the death of patients within 1year. To the best of our knowledge, the present study is the first description of clinicopathological features and the largest case analysis for GPIT. Optimal outcomes for GPIT were achieved by strict evaluation and perioperative management as well as microsurgical skills.

Application effect of standard aspiration prevention system in patients with neural tumor

Objective To establish a scientific, practical, systematic prevention group of patients with cranial nerve injury after neurosurgery aspiration to standardize nursing system, and reduce the incidence of aspiration pneumonia. Methods From January to December 2014, 226 cases of posterior fossa tumor patients were selected as the control group and received routine nursing. The risk factors of occurrence of aspiration pneumonia were retrospectively analyzed, and standard aspiration prevention system was built, which consisted of aspiration risk screening, effective communication among medical staff and patients, the standardized management of airway, the standardized management of enteral nutrition, rehabilitation guidance, etc., and this system was applied to the clinics in January 2015. 237 cases of posterior fossa tumor patients admitted in our hospital from January to December 2015 were selected as the intervention group, and were given standard aspiration prevention. The incidence of aspiration pneumonia in two groups was compared before and after the implementation of standard aspiration prevention system. Results The incidence of aspiration pneumonia was 4.4% in the intervention group, and it was 0.8% in the control group (χ2=5.882, P<0.01). Conclusions Standard aspiration prevention system can help nursing staff to master preventive measures of system, effectively prevent and reduce the incidence of aspiration pneumonia in patients with posterior cranial nerve injury, and to ensure patients′ safety. Key words: Department of Neurosurgery; Respiratory aspiration; Prevention; Posterior group cranial nerve injury

Whole Course Neuroendoscopic Resection of Cerebellopontine Angle Epidermoid Cysts.

Background Epidermoid cysts are the third most common tumor of the cerebellopontine angle (CPA). Diagnosis often occurs after involvement of the sulci and cisterns that surround nerves and blood vessels, making complete resection highly challenging. Objective To determine the efficacy of whole course neuroendoscopic surgery in the management of CPA epidermoid cysts. Methods We performed a retrospective analysis of clinical data of 13 male and 17 female patients (mean age: 42.4 ± 11.4 years) who presented with a CPA epidermoid cyst and underwent whole course neuroendoscopy. Complications and tumor recurrence were assessed at follow-up. Results Clinical manifestations included an initial symptom of headache (n = 21), gait instability (n = 6), intracranial hypertension (n = 13), posterior cranial nerve symptoms (n = 6), ataxia (n = 5), and hydrocephalus (n = 1). All patients tolerated tumor resection with subsequent symptomatic improvement, and the results of the postoperative magnetic resonance imaging scan did not show any remnants of tumor. Mean duration of surgery was 2.61 ± 0.47 hours, mean loss of blood was 96.8 ± 35.4 mL, and the mean duration of hospitalization was 7.5 ± 2.25 days. Postoperative complications (8 of 30 [26.7%]) included fever (n = 5), communicating hydrocephalus (n = 1), facial nerve paralysis (n = 1), and abducens nerve palsy (n = 1). Tumor recurrence was observed in two patients (6.7%). No deaths or intracranial hemorrhage was reported. Conclusions The characteristics of epidermoid cysts make them amenable to whole course neuroendoscopic resection. Use of physiologic/pathologic interspaces and neuroendoscopic angulations decreases traction on the brain, improves complete resection rates, and decreases postoperative complications.

Intraoperative EMG monitoring for protection of the posterior cranial nerves nucleus

Objective In order to protect the posterior cranial nerves nucleus,the intraoperative EMG monintoring was used during the surgical resection of brain tumors related to the forth ventrical floor.Method 23 brain tumors were surgically removed in our hospital from February 2007 to April 2008, which including 8 case of medulloblastoms, 7 enpendymomas, 3 brain stem gliomas.All the tumors were microsurgical removed and intraoperative EMG monitoring was applied during the operation. The dates of the posterior cranial nerves function,the surgical procedure and EMG monitor changes were analyzed in order to find their relationship.Results 17 tumors were totally removed and 6 subtotally removed.The patients posterior cranial nerves function were protected well in 6 cases, 13 cases of slight dysfunction and 4 cases of moderate dysfunction.There was no serious damage in our group.The myoelectricity induced by the posterior cranial nerve nucleus stimulation could be recorded successfully under normal anesthesia condition.Conclusion The intraoperative EMG monitoring could avoid posterior cranial nerves nucleus damage and provide objective judgment for resection strategy of tumors related to the forth ventrical floor. Key words: Brain stem neoplasms; Microsurgery; Intraoperative EMG monitor

Cranial Nerve Involvement in Nasopharyngeal Carcinoma: Response to Radiotherapy and its Clinical Impact

To evaluate the cranial nerve (CN) palsy associated with nasopharyngeal carcinoma (NPC), we studied factors that influenced the neurologic outcome of radiotherapy (RT), and the patterns and time course of neurologic recovery of CN palsy. Between July 1987 and July 1989, 93 patients who presented with CN palsy at the time of diagnosis of NPC were studied. All patients underwent external-beam RT with either cobalt-60 or 6-MV photon beams to a dose of 69 to 84 Gy at 2 Gy per fraction. The time course and pattern of neurologic recovery (complete, partial, or none) from CN palsy were evaluated. Age, sex, stage, histology, incidence and distribution of types of CNs involved, duration of CN palsy, and time course of tumor response during RT were correlated with the patterns and the time course of neurologic CN recovery by univariate and multivariate analyses. The cases of CN palsy most commonly involved CN V (38%), CN VI (26%), and CN XII (11%), which accounted for the majority of the cases (75%). The time course of CN recovery was variable and protracted. Most patients showed significant improvement upon completion of RT (51%, 19%, and 30% complete, partial, and no recovery, respectively) and further improvement 6 months after RT (58%, 17%, and 25%, respectively). Cranial nerves V, VI, and XII accounted for 75% of cases with no recovery. Recovery was best for CNs II, IX, and XI and the sympathetic nerve (100%, 87%, 100%, and 100%, respectively) and worst for CNs IV, VII, and XII (67%, 60%, and 40%, respectively, with no recovery). Neurologic CN recovery correlated significantly with the pretherapy duration (<3 months versus > or =3 months) of CN palsy (88% versus 62%; p = .002, multivariate analysis), the time course of clinical tumor regression, and neurologic symptom improvement during RT. Age, sex, T stage, N stage, histology, anterior versus posterior CN palsies, and base of skull involvement were not significant. According to our limited data, most patients with CN palsy respond well to RT. That the time course of neurologic recovery is variable and can be protracted indicates a need for continuous and close neurologic surveillance. The poorer neurologic outcome associated with a longer duration of CN symptoms may be related to a more severe longterm CN compression that results in irreversible damage. Timely diagnosis of NPC and fast institution of therapy are therefore critical to improving the neurologic outcome.

めまいと顔面神経麻痺で発症した急性リンパ性白血病の後頭蓋窩浸潤例

A 15-year-old male complained of vertigo and was brought to our clinic on April 3, 2002. He showed rightward nystagmus with right fixation and rightward spontaneous nystagmus. Caloric test showed canal paresis of the left ear. Although there was a past history of acute lymphocytic leukemiam, he was in complete remission. Therefore, he was diagnosed as having vestibular neuritis of the left ear and treated with prednisolone. Balance problem improved for one week. However, he complained of recurrent dizziness on April 26, and left facial palsy on April 30. MRI showed enhancement in the posterior cranial fossa and cranial nerve (III, V, VI, VII, VIII, X nerve). He was diagnosed as having having relapsing leukemia with involvement of the central nervous system, and treated with intraspinal administration of methotrexate (MTX). Thereafter, dizziness and facial palsy were improved. In this case, lesion of the cranial nerve demonstrated on MRI differed from neurological symptoms. When patient having a past history of leukemia complain of vertigo, we must suspect relapse of leukemia, even if he/she was in complete remission.

Ocular Manifestations and Treatment of Syphilis

Syphilis is a sexually transmitted, chronic, systemic infection caused by the spirochete Treponema pallidum. If left untreated, the disease progresses through four stages, with the potential to cause significant morbidity to any major organ of the body. Frequent syphilitic ocular manifestations, which can occur at any stage of the disease, include interstitial keratitis, anterior, intermediate, and posterior uveitis, chorioretinitis, retinitis, retinal vasculitis and cranial nerve and optic neuropathies. Diagnosis is centered around a high level of clinical suspicion and includes treponemal specific and non-treponemal serologic tests. All patients with newly diagnosed syphilis should be tested for co-infection with human immunodeficiency virus, as the risk factors are similar for both diseases. Additionally, all patients with ocular syphilis should be tested for neurosyphilis. The preferred treatment for all stages of syphilis remains parenteral penicillin G. With proper diagnosis and prompt antibiotic treatment, the majority of cases of syphilis can result in a cure.

Important prognostic factors in patients with skull base erosion from nasopharyngeal carcinoma after radiotherapy

Purpose: To evaluate the long-term outcome and prognostic factors in patients with skull base erosion from nasopharyngeal carcinoma after initial radiotherapy (RT).Methods and Materials: From January 1985 to December 1986, 100 patients (71 males, 29 females) with a diagnosis of nasopharyngeal carcinoma were found on computed tomography (CT) to have skull base erosion. The mean age was 41 years (range 16–66). Ninety-six patients had World Health Organization type III undifferentiated carcinoma, and 4 had type I. The metastatic workup, including chest radiography, liver ultrasound scanning, and liver function test was negative. All patients underwent external beam RT (EBRT) alone to 66–80 Gy during 6–8 weeks. A daily fraction size of 2 Gy was delivered using 60Co or a linear accelerator. No patient received chemotherapy. All patients were followed at regular intervals after irradiation. The median follow-up was 22.3 months (range 2–174). Survival of the cohort was computed by the Kaplan-Meier method. The potential prognostic factors of survival were examined. Multivariate analyses were performed using the Cox regression model.Results: The 1, 2, 5, and 10-year overall survival rate for the cohort was 79%, 41%, 27%, and 13%, respectively. However, the subgroup of patients with both anterior cranial nerve (I–VIII) and posterior cranial nerve (IX–XII) involvement had a 5-year survival of only 7.7%. A difference in the time course of local recurrence and distant metastasis was observed. Both local recurrence and distant metastasis often occurred within the first 2 years after RT. However, local relapse continued to occur after 5 years. In contrast, no additional distant metastases were found after 5 years. The causes of death included local recurrence (n = 59), distant metastasis (n = 21), both local recurrence and distant metastasis (n = 1), and unrelated causes (n = 5). After multivariate analysis, complete recovery of cranial nerve involvement, cranial nerve palsy, and headache after irradiation were found to be independent prognostic factors in this cohort.Conclusions: We present one of the longest follow-ups of patients with nasopharyngeal carcinoma invading the skull base. Our results demonstrate the importance of cranial nerve involvement, recovery of headache, and cranial nerve palsy. These factors should be carefully evaluated from the history, physical examination, and imaging studies. A subgroup of patients with skull base involvement had long-term survival after RT alone. The findings of this study are important as a yardstick against which more aggressive strategies, such as combined radiochemotherapy and altered fractionation RT can be compared.

The cochlear nuclei of some turtles

Histological sections of the brains of eight species of turtles representing six different families were studied in order to delineate the cochlear nuclei. In addition, the posterior eighth cranial nerve root and its ganglion were sectioned in 15 specimens of Kinosternon leucostomum, and the distribution of the degenerated nerve fibers and terminals was determined. Two primary and one probably secondary nuclei were demonstrated by the terminal degeneration pattern of the cochlear fibers. A spherical nucleus angularis and an elongated nuclus magnocellularis together form a column of primary cochlear nuclei in the dorsal alar lamina of the medulla. Heavy terminal degeneration is seen associated with these cells following transection of the posterior eighth nerve and ganglion. Nucleus magnocellularis is probably homologous with the nucleus magnocellularis medialis of lizards and crocodiles, and has been described in turtles as nucleus dorsalis magnocellularis by previous authors. A probably secondary cochlear nucleus, nucleus laminaris, lies just ventral to the nucleus magnocellularis. It is associated with the nucleus magnocellularis throughout its length but is shorter. Nucleus laminaris remains free of terminal degeneration after destruction of the posterior eighth nerve and ganglion. The cochlear nuclei of other turtle species were very similar to those of Kinosternon leucostomum.