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To analyze the clinical characteristics between neurogenic and non-neurogenic cause of vocal cord immobility (VCI).
The researchers retrospectively reviewed clinical data of patients who underwent laryngeal electromyography (LEMG). LEMG was performed in the bilateral cricothyroid and thyroarytenoid muscles. A total of 137 patients were enrolled from 2011 to 2016, and they were assigned to either the neurogenic or non-neurogenic VCI group, according to the LEMG results. The clinical characteristics were compared between the two groups and a subgroup analysis was done in the neurogenic group.
Among the 137 subjects, 94 patients had nerve injury. There were no differences between the neurogenic and non-neurogenic group in terms of demographic data, underlying disease except cancer, and premorbid events. In general characteristics, cancer was significantly higher in the neurogenic group than non-neurogenic group (p=0.001). In the clinical findings, the impaired high pitched ‘e’ sound and aspiration symptoms were significantly higher in neurogenic group (p=0.039 for impaired high pitched ‘e’ sound; p=0.021 for aspiration symptoms), and sore throat was more common in the non-neurogenic group (p=0.014). In the subgroup analysis of neurogenic group, hoarseness was more common in recurrent laryngeal neuropathy group than superior laryngeal neuropathy group (p=0.018).
In patients with suspected vocal cord palsy, impaired high pitched ‘e’ sound and aspiration symptoms were more common in group with neurogenic cause of VCI. Hoarseness was more frequent in subjects with recurrent laryngeal neuropathy. Thorough clinical evaluation and LEMG are important to differentiate underlying cause of VCI.
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To investigate the relationship between motor evoked potential (MEP) response and the severity of motor paralysis, evaluated according to the Korean disability evaluation system in patients with spinal cord injury (SCI).
We analyzed 192 lower limbs of 96 SCI patients. Lower limbs were classified according to their motor scores, as determined by the International Standards for Neurological Classification of Spinal Cord Injury: motor score <10 (group 1); ≥10 and <15 (group 2); ≥15 and <20 (group 3); and ≥20 (group 4). MEP responses were classified as ‘normal’, ‘delayed’ or ‘absent’, based on their onset latency, which was compared between the different motor score groups.
MEP responses and limb motor scores were highly correlated (p<0.001). There was a significant difference of MEP responses between the motor score groups (p<0.001). MEP response was markedly poorer in motor group 1 (limb motor score <10) than in the other three groups (p<0.0001). However, there were no differences between the three groups with motor scores of 10 or above.
Clinical utility of MEP as a complimentary tool to manual muscle tests could be limited to discriminating motor score groups with severe paralysis, i.e., single lower limb motor power grades of 0 or 1, and from grade 2, 3, and 4, or above, in the Korean disability evaluation system.
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Churg-Strauss syndrome (CSS) is a rare systemic necrotizing vasculitis. Cranial nerve involvement is very rare in CSS. A 59-year-old woman had complained of both hearing impairments for eight months and left facial palsy for three months. Left facial and cochlear neuropathies were detected in electrodiagnostic studies. Paranasal sinus computed tomography (CT) showed chronic pansinusitis. Chest CT revealed eosinophilic infiltration in the right upper lobe. Tissue biopsy of the right inferior turbinate displayed necrotizing vasculitis with eosinophilic infiltration. She was diagnosed as CSS, based on the presence of eosinophilia, pulmonary infiltration, paranasal sinusitis, and biopsy containing blood vessels with extravascular eosinophils. She was treated with intravenous and oral steroids and azathioprine, showing relatively good prognosis on facial palsy and hearing impairment. We report a very rare case of CSS presented with hearing impairment and facial palsy.
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It can be difficult for clinicians to distinguish a paradoxical response to antituberculous therapy, worsening of an existing lesion despite adequate treatment, treatment failure, and drug resistance. We report a case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. She had been suffering for 1 month from low back pain, due to tuberculous spondylitis. Her low back pain improved after antituberculous therapy. The low back pain, however, reappeared 2 months after treatment, accompanied by newly developed lower extremity weakness. Imaging studies showed an increased extent of her previous lesions. Consequently, the patient underwent a vertebral corpectomy with interbody fusion of the thoracolumbar spine. Histopathological examination showed chronic inflamed granulation tissue with no microorganisms. Although the antituberculous medication was not changed, the patient's symptoms and signs, including the paralysis, resolved after surgery.
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We report a case of a 44-year-old patient with paralysis of the left leg who had a thoracic epidural catheterization after general anesthesia for abdominal surgery. Sensory losses below T10 and motor weakness of the left leg occurred after the surgery. Magnetic resonance image study demonstrated a well-defined intramedullary linear high signal intensity lesion on T2-weighted image and low-signal intensity on T1-weighted image in the spinal cord between T9 and L1 vertebral level, and enhancements of the spinal cord below T8 vertebra and in the cauda equina. Electrodiagnostic examination revealed lumbosacral polyradiculopathy affecting nerve roots below L4 level on left side. We suggest that the intrinsic spinal cord lesion and nerve root lesion can be caused by an epidural catheterization with subsequent local anesthetic injection.
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Ramsay-Hunt syndrome is caused by varicella zoster virus infection in the geniculate ganglion of the facial nerve. It is characterized by facial palsy, otic pain, and herpetic vesicles around the auricle and external auditory canal. Additionally, symptoms may develop related to other cranial nerve involvement, such as dizziness or hearing loss by the vestibulocochlear nerve being invaded. We report a rare case of a Ramsay-Hunt syndrome patient who developed dysphagia due to multiple cranial nerve involvement including the glossopharyngeal nerve and vagus nerve.
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Multiple system atrophy (MSA) is an idiopathic neurodegenerative disorder involving many neuronal structures. It is a heterogeneous system disorder affecting extrapyramidal, cerebellar and autonomic nervous system. Only a minority of MSA patients are diagnosed before reaching the full blown stage. Its autonomic features like orthostatic hypotension, vocal cord paralysis are directly related to mortality.
Up to now, rehabilitation of MSA patients had been rarely reported. Early, proper diagnosis and comprehensive rehabilitation for their heterogeneous clinical features are important. We experienced 54 year old hemiplegic paient who overlaps MSA. He showed some improvement in ADL and cerebellar symptoms after comprehensive rehabilitation programs. (J Korean Acad Rehab Med 2002; 26: 94-98)
Objective: To know if changes in compound muscle action potential (CMAP) of human extensor digitorum brevis (EDB) muscle can be enhanced by increase in dilution volume of botulinum toxin type A.
Method: In 11 healthy volunteers, 2.5 U of botulinum toxin (BotoxⰒ, Allergen Inc.) in a volume of 0.1 ml normal saline was injected in EDB muscle and the same dose with the dilution volume of 0.5 ml was injected in the opposite side. We measured the pre- and post-injection M-wave amplitude and area of EDB muscle.
Results: The mean post/pre injection amplitude ratio of CMAP were 0.49⁑0.21 with the 0.1 ml of dilution volume and 0.40⁑0.12 with the 0.5 ml of dilution volume. The mean post/pre injection area ratio of CMAP were 0.51⁑0.18 with the 0.1 ml of dilution volume and 0.44⁑0.15 with the 0.5 ml of dilution volume. There was no significant difference between the two dilution volumes.
Conclusion: Five fold increase in dilution volume did not enhance the paralyzing effect of botulinum toxin type A in human EDB muscles.
Melkersson-Rosenthal (M-R) syndrome consists of a triad of (1) recurrent peripheral facial nerve paralysis which develops alternatively on both sides of face, (2) non-inflammatory facial edema, and (3) furrowed tongue.
Since the cause of M-R syndrome is unknown, various forms of therapy have been tried, but there were no conclusive evidence that they altered the course of the disease.
A 27-year-old female and a 44-year-old male patient with recurrent facial nerve paralysis were diagnosed with M-R syndrome.
We report the two cases of M-R syndrome with the brief review of literatures.
Tuberculous spondylitis occurs commonly by the hematogenous spread of infectious organism, Mycobacterium tuberculosis, from the primary foci of the pulmonary and genitourinary systems. Spinal involvement is the most common among tuberculosis of the musculoskeletal system. Tuberculous spondylitis is not easily diagnosed in its early stages and furthermore it is hard to know whether or not the vertebrae are involved by simple X-ray study. The incidence of neurologic deficits varies from 4 to 50%. If the disease is not diagnosed and treated promptly, paraplegia may occur from vertebral collapse. A retrospective study was performed to evaluate the clinical features of tuberculous spondylitis in 51 patients (male 25, female 26), age range of 4-79 years (mean, 36.2⁑18.7). Clinical symptoms, signs, radiological findings and laboratory findings were reviewed. The latest follow ups were done with telephone interviews to evaluate their general improvement and neurological recoveries.
Back pain was the most frequent symptom, followed by sensory disturbance and gait difficulty. Twenty one patients had kyphotic deformity, 7 had lower extremity paralysis, and 29 patients were accompanied by pulmonary tuberculosis. The involved spinal segments were C2 through S1 with the most common site of thoracolumbar spines. The average erythrocyte sedimentation rate (ESR) was 42.1⁑23.5 mm/hour before medical or surgical treatment and 19.6⁑12.6 mm/hour after treatment. The acid-fast bacillus test was positive in only 6 patients. Electrodiagnostic studies and bone scans showed positive findings in 75% and 86%, respectively. Back pain was relieved in 90% of the patients with medical or surgical treatment. In patients with paralysis, initial kyphotic angle and degree of vertebral body loss were significantly greater than in patient without paralysis. When treated surgically early after the leg paralysis, patients with paralysis improved their neurologic deficits and gait better than when treated after 2 months.
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