Suprabulbar Paresis. Congenital suprabulbar paresis and its differential diagnosis, with special reference to acquired suprabulbar paresis.
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Congenital Abnormalities↗
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[Percutaneous determination of the electric nervous stimulation threshold in peripheral facial nerve paresis. Contribution to the therapy and prognosis of facial nerve paresis with special reference to surgical indication].
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Adult↗
[An index for paresis and defective healing--an easily applied method for objectively determining therapeutic results in facial paresis (author's transl)].
Residuals of facial paralysis consist of a great variety of cosmetic and functional anomalies which differ in quality and/or quantity. An internationally standardized evaluation of such defects is mandatory for the assessment of the results of different therapeutic procedures. In the present study, a system has been developed to record the results of facial paralysis following therapy. Such a system does not require specialized training, instrumentation or require significant time for completion. A clearly-defined "Yes-No" evaluation criteria is established which creates a high interscorer reliability. The usefulness of this scoring system was tested by three examiners on 42 patients following facial nerve surgery, with an obtained interscorer reliability of 93%.
Eyelid Diseases↗
Pharyngeal swallowing in patients with paresis of the recurrent nerve.
Pharyngolaryngeal function during swallowing was investigated cineradiographically in 22 patients with paresis of the recurrent nerve. Nineteen of these patients (86%) had defective closure of the laryngeal vestibule: 10 patients had defective apposition of the corniculate cartilages, (paresis of the oblique cricoarytenoid muscle), 9 patients had defective apposition of the arytenoid cartilages, (paresis of the interarytenoid muscle), 13 patients had defective movement of the epiglottis (paresis of, i.a. the thyrohyoid muscle), 1 patient had defective closure of the subepiglottic portion of the vestibule (paresis of the thyroepiglottic muscle), 2 patients had defective closure of the supraglottic portion of the vestibule (paresis of the superior ventricular segment of the thyroarytenoid muscle). Five patients with immobility of the epiglottis also had paresis of the pharyngeal constrictor musculature indicating paresis of the superior laryngeal nerve. Our investigation has shown that patients with paresis of the recurrent nerve who present with dysphagia with or without aspiration should be examined cineradiographically for pharyngolaryngeal function during swallowing.
Adult↗
Motor paresis improved by sympathetic block. A motor form of reflex sympathetic dystrophy?
Four patients had a characteristic motor paresis that was dramatically improved by sympathetic block. The cause of this paresis could not be determined by the usual neurological examinations. It was similar to reflex sympathetic dystrophy in that the patients experienced severe pain, swelling, coldness, and muscle atrophy in the affected limbs or other parts of the body in the course of their illness. However, the motor paresis could precede the pain or develop after the pain had disappeared. Even in the absence of pain, the motor paresis was exacerbated by sympathetic stimulation using epinephrine, norepinephrine (nor-adrenalin), or isoproterenol hydrochloride (Proternol) loading and was improved by regional intravenous infusion of reserpine or by sympathetic ganglion block. Loading with pilocarpine, atropine sulfate (Bosmin), and edrophonium chloride (Antirex) did not influence the paresis. This motor paresis is thought to be due to abnormally increased sympathetic tone and may be considered a motor form of reflex sympathetic dystrophy. However, motor paresis closely related to sympathetic dysfunction is quite a new condition that we call "sympathetic motor paresis." This is important clinically because a long-standing effect can be expected from permanent sympathetic ganglion block with dehydrated ethanol.
Adult↗
Use of 24-F-1,25-dihydroxyvitamin D3 to prevent parturient paresis in dairy cows.
Forty-one aged Jersey cows were fed a high Ca diet prior to parturition to predispose them to parturient paresis. Twenty-one of the cows were treated with 24-F-1,25-dihydroxyvitamin D3, a synthetic analogue of 1,25-dihydroxyvitamin D3, 7 d before the expected parturition. Treated cows received either 100 micrograms (n = 7) or 150 micrograms (n = 14) of 24-F-1,25-dihydroxyvitamin D3, intramuscularly at 7-d intervals until the cow calved. Incidence of parturient paresis among untreated animals was 85% (17/20). Injections of 100 micrograms of 24-F-1,25-dihydroxyvitamin D3 reduced the incidence of parturient paresis to 43% (3/7), whereas 150 micrograms injections of 24-F-1,25-dihydroxyvitamin D3 reduced the incidence of parturient paresis to 29% (4/14). Plasma concentrations of hydroxyproline were not elevated prior to parturition in 24-F-1,25-dihydroxyvitamin D3-treated cows, indicating that treatment did not stimulate bone resorption and that the ability of 24-F-1,25-dihydroxyvitamin D3 to prevent parturient paresis likely resides in its ability to stimulate intestinal Ca absorption prior to parturition. Further, cows treated with 24-F-1,25-dihydroxyvitamin D3 that developed parturient paresis had lower than normal plasma concentrations of 1,25-dihydroxyvitamin D, indicating that 24-F-1,25-dihydroxyvitamin D3 treatment impairs the metabolism of 25-hydroxyvitamin D in response to hypocalcemia. These data suggest that injection of 24-F-1,25-dihydroxyvitamin D3, delivered at 7-d intervals prior to parturition, can effectively reduce incidence of parturient paresis in dairy cows.
Animals↗
The prophylactic use of vitamin D3 in parturient paresis in the cow in a practice district in eastern Norway. A retrospective investigation.
The prophylactic effect in parturient paresis of an intramuscular injection of 10 million i.u. vitamin D3 one week prior to the expected calving date, was investigated in 84 cows which had previously suffered from parturient paresis. Clinical observations in connection with the development of parturient paresis after injection of vitamin D3 were compared with corresponding observations made on cows within the same population at the previous calving when no vitamin D3 was administered. The incidence of clinical parturient paresis in cows given vitamin D3 was 44.3 per cent. There were no significant differences in the incidence of parturient paresis in cows injected with vitamin D3 during the periods less than 2, 2--4, 5--8 and greater than 8 days before parturition. Average plasma calcium levels (mg/100 ml) before first calcium treatment, results of treatment, and the incidence of retained placenta in vitamin D3 injected cows did not differ significantly from corresponding data for cows with clinical parturient paresis which had not been given vitamin D3 before calving. It is concluded that vitamin D3 does not have any prophylactic effect in parturient paresis in cows in Eastern Norway.
Animals↗
[Herpes zoster paresis. A review of the literature and case reports].
The incidence of paresis due to herpes zoster (HZ) infections are reported very differently in the literature with rates varying from 0.5 to 31%. Many of the paresis are presumed to be undiagnosed on account of topographic dissociation, variable periods from the cutaneous affection to the muscular involvement, masking of the paresis by pain, paresis of the intercostal and abdominal muscles which are not obvious and difficulties in correlating the visceral symptoms with a herpes zoster eruption. Paresis of the cranial nerves are easily diagnosed and 50% of all HZ paresis are diagnosed from this region. Early acyclovir treatment has improved the prognosis. Four cases of hypotonic herpes zoster paresis in immunocompetent persons are described and the diagnostic difficulties are discussed.
Acyclovir↗
Recurring hypocalcemia of bovine parturient paresis is associated with failure to produce 1,25-dihydroxyvitamin D.
Parturient paresis (milk fever) is a hypocalcemic disorder caused by the onset of lactation in the dairy cow. In most cows a complete recovery follows a single iv calcium treatment to correct the acute hypocalcemia. However, about 20% of cows treated for parturient paresis experience recurring episodes of hypocalcemia (relapses) requiring further treatment. Analysis of plasma from 8 nonrelapsing parturient paretic and 11 relapsing parturient paretic cows revealed differences in plasma 1,25-dihydroxyvitamin D [1,25-(OH)2D] concentrations before and during the development of hypocalcemia. In nonrelapsing cows, plasma 1,25-(OH)2D increased to 4- to 5-fold as plasma calcium concentrations declined during the first stage of parturient paresis. In relapsing cows, decreases in plasma calcium concentrations during the first stage of parturient paresis were accompanied by just a 2- to 2.5-fold increase in plasma 1,25-(OH)2D. Plasma 1,25-(OH)2D eventually increased 4- to 5-fold in the relapsing cows, but this response was delayed 24-48 h compared with the response in the nonrelapsing cows. Plasma PTH concentration profiles were similar in relapsing and nonrelapsing cows, suggesting that renal 25-hydroxyvitamin D 1 alpha-hydroxylase was temporarily refractory to stimulation by PTH in the relapsing cows. In both groups of cows recovery from parturient paresis began about 12-24 h after plasma 1,25-(OH)2D concentrations had increased 4- to 5-fold. These data imply that lack of production of 1,25-(OH)2D is an important factor in predisposing the cow to relapses of parturient paresis and is critical for recovery from the hypocalcemia associated with the onset of lactation.
Animals↗
Arm and leg paresis as outcome predictors in stroke rehabilitation.
I used leg and arm paresis to predict outcome measured as extremity function in a prospective study of 75 consecutive hemiplegic patients admitted to an inpatient stroke rehabilitation unit. In each patient, extremity paresis was quantified according to the five-point scoring system advised by the Medical Research Council, upper extremity function was quantified using the Barthel Index subscore for feeding and dressing the upper body, and lower extremity function was quantified according to a five-point scoring of the ability to walk. Improvement was recorded for upper extremity function in 52% of the patients and for lower extremity function in 89%. Best extremity function was reached a mean +/- SEM of 9 +/- 3 and 10 +/- 4 weeks after stroke for the upper and lower extremities, respectively. In patients experiencing complete recovery, this occurred a mean +/- SEM of 7 +/- 2 weeks (for both upper and lower extremities) after the stroke. Only 8-11% of the patients with paresis scores of less than or equal to 2 regained independent extremity function after rehabilitation. Half of the patients with paresis scores of greater than or equal to 3 regained independent extremity function after rehabilitation, while the other half were able to perform extremity function with only minimal assistance. As predictors of extremity function, the Barthel Index subscore was slightly better (r = 0.64) than paresis score (r = 0.58). However, because evaluation of extremity paresis is easy, it appears to be useful as a preliminary predictor of outcome following stroke.
Arm↗
[The determination of the sum potential amplitude for the prognostication of facial paresis of viral etiology].
In 29 patients with facial pareses of viral etiology the sum potential amplitude of the M. orbicularis oris was determined in a comparison of the two sides for prognostication purposes. If the sum potential amplitude is reduced by less than 70 per cent a return of good functions can be expected within 6-8 weeks. If the reduction of the sum potential amplitude lies between 70 and 95 per cent, a reliable prognosis is not possible, whereas with values below 95 per cent the paresis does not improve at all or hardly improves within 6-8 weeks. An evaluation of the returned function, about 1 year after the beginning of the paresis, i.e. at a time when the regeneration is basically completed, shows that all cases with an originally poor function (judged 6-8 weeks after onset of paresis) had changed into cases with a moderate function, and all cases with an originally moderate function had turned into cases with a good function. In another study concerning patients with idiopathic facial paresis the same method yielded results comparable to those of the above-mentioned study, so that the conclusion can be drawn that in the prognostication of the peripheral facial paresis by means of determining the sum potential amplitude-regardless of whether the facial paresis is of viral or idiopathic etiology-the same yardsticks have to be applied.
Action Potentials↗
[The relationship between low pH in the umbilical cord artery in neonates and later development of cerebral paresis].
Routine determination of the pH in umbilical arterial blood immediately after delivery is a commonly employed variable for assessing the risk of subsequent cerebral paresis caused by hypoxia. Opinions differ regarding the lower limit for normal NS-pH (acidosis limit) and this is due mainly to variable conceptions of what a normal delivery is. Lower limits from 7.04 to 7.14 are thus observed if the limit -2 SD is chosen. Even if the limit of 7.04 is chosen, only very few of the infants who are acidotic on delivery subsequently develop cerebral paresis. The most important reason for this is that the prevalence of cerebral paresis developed as a result of hypoxia during delivery is very low and that a low NS-pH value most probably originates from a neonate who recovers without cerebral paresis. Another reason is that the relationship between the pH value and the degree of hypoxia is far from perfect and this holds also true for the relationship between the degree of hypoxia and cerebral paresis. It is therefore concluded that in connection with cerebral paresis, NS-pH does not fulfill the requirements of a diagnostic test. Determination of NS-pH may, on the other hand, be of significance for neonatal treatment as the combination of a low Apgar score and NS-pH is a reasonable predictor for the neonatal morbidity.
Cerebral Palsy↗
Use of 1alpha-hydroxycholecalciferol in the prevention of bovine parturient paresis.
A synthetic biologically active derivative of vitamin D (350 microgram of 1alpha-hydroxycholecalciferol [1alpha(OH)CC]) was injected into 2 nonlactating 7-year-old Israeli-Friesian cows. Plasma calcium values increased after 24 hours, peaked at 48 hours, and returned to base-line values 120 hours after injection. An injection of 350 microgram of 1alpha(OH)CC was given to 23 parturient-paresis-prone Israeli-Friesian cows from 7 days to 6 hours prepartum; 13 cows were injected once, 6 were injected twice, and 4 were injected 3 times, all at 48-hour intervals. Parturient-paresis-prone cows (n = 23) of the same breed were used as controls. Within 0 to 36 hours postpartum, plasma calcium concentrations were found to be higher in cows injected with 1alpha(OH)CC than in the control cows. The increase was highly significant (P less than 0.01) in cows injected at least twice. None of the cows injected with 1alpha(OH)CC, within 72 to 24 hours prior to calving developed parturient paresis; but 9 of 23 control cows developed parturient paresis. Prior to calving, none of the injected cows developed hypercalcemia and there was no local or systemic clinically detectable signs of toxiosis. When given at the right time prepartum, 1alpha(OH)CC is considered to be an improvement over previous methods of preventing bovine parturient paresis.
Animals↗
Transcranial magnetic stimulation in pontine infarction: correlation to degree of paresis.
Transcranial magnetic stimulation was performed in 20 patients with pontine infarction who had initially some degree of hemiparesis. Only patients with a well defined lesion on magnetic resonance imaging that was appropriate for the neurological signs were included. Recordings were made from the abductor pollicis brevis muscle (APB) bilaterally. The degree of hand paresis was estimated clinically and related to the following parameters: central motor conduction time (CMCT), interside latency difference of total latency, and amplitude ratio of affected to unaffected side. Increasing degree of paresis was associated with increasing latency parameters and decreasing amplitude ratio. In the four patients with severe paresis a low amplitude response could be evoked and CMCT was delayed by up to 10 ms. When the paresis had resolved at the time of transcranial magnetic stimulation CMCT was normal. However, amplitude ratio was less than 100% in all but one patient, with most of the values ranging between 40% and 60%, which indicates a subclinical pyramidal tract lesion. Median nerve sensory evoked potentials (SEP) and related interside latency difference to amplitude ratio N20/P25 were also recorded. In contrast to TCMS, decreased amplitude ratio of SEP was not associated with delayed latency. Clinically, the mild degree of and good recovery from paresis in ventral pontine infarction was remarkable.
Adult↗
[Treatment of intestinal paresis in children].
In the paper, a clinical experience with treatment of intestinal paresis in 545 children, aged from 1 day to 13 years, including 225 children operated upon for peritonitis is summarized. The authors differentiate 3 stages in the development of intestinal paresis depending on the degree of intensity of systemic and local disturbances. The employed methods of treatment in intestinal paresis were classified by the principle of their effect as 3 groups. Application of some or other method of the paresis therapy is determined by the stage of its development. In treatment of postoperative intestinal paresis a continuous peridural blockade is considered to be the method of choice. Utilization of the latter enabled the authors to reveal a number of postoperative complications: mechanic intestinal obstruction, incompetent anastomosis, etc.
Adolescent↗
Head-shaking nystagmus: associations with canal paresis and hearing loss.
In 108 patients referred for caloric testing, head-shaking nystagmus (HSN) was noted in 37 electronystagmography (ENG) recordings. A canal paresis was found in 31 patients and a sensorineural or mixed hearing loss in one or both ears was found in 45 patients. Both HSN and canal paresis were insensitive predictors of either hearing loss or of each other. HSN was less sensitive as well as less specific than canal paresis for hearing loss. These data suggest that HSN is not as powerful a test as canal paresis in detecting lesions of the 8th nerve.
Adult↗
Effect of subcutaneously released 24F-1,25-dihydroxyvitamin D3 on incidence of parturient paresis in dairy cows.
Twenty-one aged Jersey cows were fed a high calcium diet prior to parturition to predispose them to parturient paresis. Eleven cows were implanted subcutaneously with pellets containing 24F-1,25-dihydroxyvitamin D3 7 d before the expected date of parturition and thereafter at 7-d intervals until parturition. Ten cows were left untreated to serve as controls. Incidence of parturient paresis among control animals was 80% (8/10). Treatment reduced the incidence of parturient paresis to 9% (1/11). The mean observed plasma calcium concentration nadir of implanted cows was 6.61 +/- .40 mg/dl, which was significantly greater than the plasma calcium nadir of 4.45 +/- .39 mg/dl observed in the control cows. Two steers were implanted with and three nonpregnant, nonlactating cows received intramuscular injections of 24F-1,25 dihydroxyvitamin D3 to contrast circulating plasma concentrations achieved by the two routes. Intramuscular injection and implantation resulted in plasma 24F-1,25 dihydroxyvitamin D3 concentrations above 300 pg/ml for the first 48 h after administration. From d 4 until d 11 after administration, plasma concentration was maintained between 164 and 89 pg/ml in the implanted steers. Plasma concentration was undetectable 7 d after an intramuscular injection. These data indicate that, with refinement, sustained release of 24F-1,25 dihydroxyvitamin D3 can be successfully used to reduce the incidence of parturient paresis.
Animals↗
[A case of general paresis with marked improvement of cerebral blood flow after antiluetic therapy--case report].
Although the incidence of neurosyphilis has declined dramatically after the World War II because of the development of antibiotics, it is recently increasing a little bit. There has been few reports on the neuroimaging of general paresis. We studied a fresh case of general paresis by X-ray CT (XCT), MRI and PET scans, and report the changes of neuroimages before and after the therapy. A 38-year-old man was admitted with disorientation, thought disorder and personality change. He also had insomnia and megalomania. There were neither obvious neurological signs nor particular changes of the XCT scan abnormalities on admission. His clinical symptoms were gradually worsened within three months, when the XCT and MRI scans showed moderate brain atrophy especially in the frontal and temporal lobes with mild dilatation of the lateral ventricles. In the PET study, the cerebral blood flow was decreased in the entire brain, especially in the frontal lobes, although the thalamus and the basal ganglia had normal levels. By immunological procedures and the cerebrospinal fluid (CSF) studies, the diagnosis of general paresis was made. He was treated with penicillin G and other antibiotics. In one year after his first therapy, many symptoms vanished. Although the cerebral atrophy was a little advanced, the cerebral blood flow was dramatically increased. As far as we know, this is the first PET study of general paresis before and after penicillin treatments.
Adult↗