scholarly journals Lower Cranial Nerve Palsies in the COVID-19 Pandemic: A 10-Case Series of Intensive Care Unit Patients

2021 ◽  
pp. 1-4
Author(s):  
Pierre Decavel ◽  
Olympe Nahmias ◽  
Carine Petit ◽  
Laurent Tatu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prone Position ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Case Series ◽  
University Hospital ◽  
Cranial Neuropathy ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies

<b><i>Introduction:</i></b> A number of neurological complications of COVID-19 have been identified, including cranial nerve paralyses. We present a series of 10 patients with lower cranial nerve involvement after severe COVID-19 infection requiring hospitalization in an intensive care unit. <b><i>Methods:</i></b> We conducted a retrospective, observational study of patients admitted to the post-intensive care unit (p-ICU) of Besançon University Hospital (France) between March 16 and May 22, 2020. We included patients with confirmed COVID-19 and cranial neuropathy at admission to the p-ICU. All these patients were treated by orotracheal intubation, and all but one underwent prone-position ventilation therapy. <b><i>Results:</i></b> Of the 88 patients admitted to the p-ICU, 10 patients (11%) presented at least 1 cranial nerve palsy. Of these 10 patients, 9 had a hypoglossal nerve palsy and 8 of these also had a deficit in another cranial nerve. The most frequent association was between hypoglossal and vagal palsies (5 patients). None of the patients developed neurological signs related to a global neuropathy. We found no correlation between the intensity of the motor limb weakness and the occurrence of lower cranial nerve palsies. All but 2 of the patients recovered within less than a month. <b><i>Conclusion:</i></b> The mechanical compressive hypothesis, linked to the prone-position ventilation therapy, appears to be the major factor. The direct toxicity of SARS-CoV-2 and the context of immune dysfunction induced by the virus may be involved in a multifactorial etiology.

scholarly journals A Case Series of Malignant Otitis Externa Mimicking Malignancy

2021 ◽  
Vol 64 (1) ◽  
pp. 36-41
Author(s):  
Vengathajalam Selvamalar ◽  
Nik Adilah Nik Othman ◽  
Mohd Khairi Daud
Keyword(s):  
Cranial Nerve ◽  
Otitis Externa ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Case Series ◽  
Lower Cranial Nerve ◽  
Cortical Mastoidectomy ◽  
Cranial Nerve Palsies ◽  
Adjacent Structures ◽  
Malignant Otitis Externa

Malignant otitis externa is an inflammation of the external auditory canal with preceding osteomyelitis of the temporal bone and the adjacent structures that could be potentially lethal. Malignant otitis externa may present with cranial nerve involvements and massive spread of disease mimicking nasopharyngeal carcinoma or any other malignancies on imaging. Two elderly patients who presented with severe otalgia and significant facial nerve palsy and lower cranial nerve palsies showing extensive spread of disease are reported in this case series. They both had resolution of disease after a prolonged course of antibiotics and cortical mastoidectomy for disease clearance in one of them.

Vertebral Artery-Posteroinferior Cerebellar Artery Aneurysms: Clinical and Lower Cranial Nerve Outcomes in 52 Patients

Neurosurgery ◽  
2005 ◽  
Vol 56 (1) ◽  
pp. 2-11 ◽  
Author(s):  
Hisham Al-khayat ◽  
Haitham Al-Khayat ◽  
Joseph Beshay ◽  
David Manner ◽  
Jonathan White ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Natural History ◽  
Vertebral Artery ◽  
Nosocomial Pneumonia ◽  
Cranial Nerve ◽  
Lower Cranial Nerve ◽  
Cerebellar Artery ◽  
History Of ◽  
Pica Aneurysms

AbstractOBJECTIVE:To identify factors predictive of postoperative lower cranial nerve palsy (LCNP) among patients undergoing surgery for vertebral artery (VA)- posteroinferior cerebellar artery (PICA) aneurysms. The natural history of this LCNP is defined, and its effect on postoperative patient course is analyzed. No similar study has been described in the literature.METHODS:Fifty-two patients with VA-PICA aneurysms, who were treated surgically between 1996 and 2002, were retrospectively studied to identify factors contributing to postoperative LCNP. The effect of LCNP on intensive care unit stay and development of nosocomial pneumonia also was analyzed. All analyses were performed with Fisher's exact test.RESULTS:Postoperative LCNP occurred in 25 patients (48.1%) with VA-PICA aneurysms. Of the factors investigated, the use of temporary or total occlusion was associated with increased incidence of postoperative LCNP (P &lt; 0.001). The average length of stay in the intensive care unit was 13.8 days for patients with LCNP defined as moderate to severe, compared with 7.92 days for patients with LCNP defined as none or mild (P = 0.0014). Nosocomial pneumonia occurred only in patients with moderate to severe LCNP (P = 0.022). Postoperative LCNP resolved completely within 3 months in 12 patients (48%) and within 6 months in 19 patients (76%).CONCLUSION:The results of this study can help to identify the effect and natural history of LCNP after surgical clipping of VA-PICA aneurysms. This information may assist neurosurgeons in expediting treatment, decrease the cost and length of hospital stays, and result in improved outcomes.

scholarly journals Tongue Tied after Shoulder Surgery: A Case Series and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Molly B. Kraus ◽  
Rachel B. Cain ◽  
David M. Rosenfeld ◽  
Renee E. Caswell ◽  
Michael L. Hinni ◽  
...  
Keyword(s):  
Literature Review ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Case Series ◽  
Patient Positioning ◽  
Shoulder Surgery ◽  
Beach Chair Position ◽  
Tapia’S Syndrome ◽  
Cranial Nerve Palsies ◽  
Beach Chair

This article presents three cases of cranial nerve palsy following shoulder surgery with general anesthesia in the beach chair position. All patients underwent preoperative ultrasound-guided interscalene nerve block. Two cases of postoperative hypoglossal and one case of combined hypoglossal and recurrent laryngeal nerve palsies (Tapia’s syndrome) were identified. Through this case series, we provide a literature review identifying postoperative cranial nerve palsies in addition to the discussion of possible etiologies. We suggest that intraoperative patient positioning and/or airway instrumentation is most likely causative. We conclude that the beach chair position is a risk factor for postoperative hypoglossal nerve palsy and Tapia’s syndrome.

Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy

2002 ◽  
Vol 116 (7) ◽  
pp. 556-558 ◽  
Author(s):  
R. G. Rowlands ◽  
G. K. Lekakis ◽  
A. E. Hinton
Keyword(s):  
Skull Base ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Jugular Foramen ◽  
Radiological Investigation ◽  
Lower Cranial Nerve ◽  
Skull Base Osteomyelitis ◽  
Cranial Nerve Palsies ◽  
Focus Of Infection

Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.

Active surveillance management of head and neck paragangliomas: case series and review of the literature

2017 ◽  
Vol 131 (7) ◽  
pp. 580-584 ◽  
Author(s):  
L Harrison ◽  
R Corbridge
Keyword(s):  
Head And Neck ◽  
Cranial Nerve ◽  
Relevant Literature ◽  
Case Series ◽  
Surgical Excision ◽  
Major Surgery ◽  
Review Of The Literature ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Head And Neck Paragangliomas

AbstractBackground:Head and neck paragangliomas are rare. They are usually slow-growing, benign, non-catecholamine secreting tumours, traditionally treated with surgical excision. Complications of surgical excision include lower cranial nerve palsies, stroke and death.Method:A retrospective case note analysis was conducted of patients with head and neck paragangliomas treated with a watch-and-scan policy from March 2003 to September 2015, and the relevant literature was reviewed.Results:Fifteen head and neck paragangliomas were identified. None of the patients developed a new lower cranial nerve palsy or progression of their presenting hearing loss during the follow-up period. Five patients displayed an increase in maximum linear dimension of 4 mm over an average of 57.4 months. A review of the literature showed that a watch-and-surveillance scan policy is evolving as a treatment option for head and neck paragangliomas without malignant risk factors.Conclusion:Readily available surveillance scanning in head and neck paragangliomas enables the monitoring of head and neck paragangliomas, which may allow for avoidance of major surgery.

scholarly journals Vocal Cord Palsy as a Complication of Epidural Anaesthesia

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Laura Mc Loughlin ◽  
Orla Young
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Epidural Anaesthesia ◽  
Cranial Nerve ◽  
Cranial Nerve Palsy ◽  
Nerve Palsy ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies

Cranial nerve palsy is a rare but recognised complication of epidural anaesthesia, most commonly presenting as diplopia secondary to abducens nerve palsy. While upper cranial nerve palsies have been documented on numerous occasions, lower cranial nerve palsies, including recurrent laryngeal nerve palsy, are exceedingly rare. This case describes a 37-year-old female who, following epidural anaesthesia for spontaneous vaginal delivery of her first child, presented with dysphonia. Flexible laryngoscopy confirmed a left vocal cord palsy, and computed tomography ruled out any mass lesions along the course of the recurrent laryngeal nerve. Here, we discuss a case of vocal cord palsy secondary to epidural anaesthesia, an extremely rare complication. We also discuss the proposed etiology, treatment, and outcomes in patients with this condition. Cranial nerve palsy should be an important differential in patients presenting with dysphonia following spinal or epidural anaesthesia.

scholarly journals Meningiomas of the ventral foramen magnum

1999 ◽  
Vol 6 (6) ◽  
pp. E7 ◽  
Author(s):  
Kenan I. Arnautovic ◽  
Ossama Al-Mefty ◽  
Muhamed Husain
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Foramen Magnum ◽  
Karnofsky Performance Scale ◽  
Recurrent Tumor ◽  
Lower Cranial Nerve ◽  
Cranial Nerve Palsies ◽  
Favorable Influence ◽  
Prolonged Hospital

Meningiomas of the ventral foramen magnum are rare lesions that account for less than 3% of all meningiomas. Their treatment remains one of the most challenging among all meningiomas. The authors comprehensively analyzed multiple features in the series of patients who harbored these lesions. The authors conducted a retrospective study of 18 patients who harbored lesions in the ventral foramen magnum (mean follow up 40 months) in whom surgery was performed via a transcondylar approach. Sixteen patients underwent surgery for the first time: in 12 patients (75%) gross total, in two (12.5%) near total, and in two (12.5%) subtotal tumor removal was achieved. The remaining two patients were treated for a recurrent tumor. Karnofsky Performance Scale (KPS) scores obtained at follow-up review demonstrated statistically significant improvement compared with those obtained preoperatively. The extent of surgical resection and preoperative KPS score were variables that demonstrated statistically significant favorable influence on outcomes. Ninth and 10th cranial nerve palsies were the most common complication that contributed to the prolonged hospital stay; six patients who experienced nerve palsy preoperatively worsened postoperatively, and four other patients developed nerve palsy after surgery. There were no perioperative deaths. Four patients died during the follow-up period. One patient died of multiple myeloma; another, who underwent surgery for a recurrent tumor, died 3 years after this second surgery from new tumor recurrence at 80 years of age; and the remaining two patients died 1.5 and 5 months postsurgery of pulmonary embolus and endocarditis, respectively. Meningioma of the ventral foramen magnum can be radically removed in a majority of patients in whom complications will be frequent but transient, resulting from lower cranial nerve palsies. The radical removal of a recurrent tumor provides for the patient a relatively long, stable follow-up period. Patients presenting with a low KPS score have a poor prognosis. Early diagnosis and treatment are recommended.

scholarly journals CLINICAL SPECTRUM AND OUTCOME OF PATIENTS WITH TUBERCULOUS MENINGITIS AT A TERTIARY CARE HOSPITAL OF PAKISTAN

2021 ◽  
Vol 71 (3) ◽  
pp. 771-74
Author(s):  
Atifa Gilani ◽  
Zahid Hassan ◽  
Khurram Haq Nawaz ◽  
Muhammad Babar Khan ◽  
Saeed Arif ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tuberculous Meningitis ◽  
Cranial Nerve ◽  
Neurological Complication ◽  
Tertiary Care ◽  
Military Hospital ◽  
Care Hospital ◽  
Female Ratio ◽  
Cranial Nerve Palsies

Objective: To assess the clinical profile and outcome of patients admitted with the diagnosis of tuberculous meningitis (TBM) at neurology unit of a tertiary care teaching hospital of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Neurology department, Pak Emirates Military Hospital Rawalpindi, from Dec 2018 to Jun 2019. Methodology: This study was conducted on 69 patients of tuberculous meningitis admitted. Demographic profile included age, gender, and the symptoms with which the patient presented. Neurological complications were also documented among the target population. Outcomes included recovery, shifting to intensive care unit and death. Results: A total of 69 patients admitted in neurology ward diagnosed and managed as tuberculous meningitis in the study duration time. Male to female ratio was 1.4:1. Mean age of patients diagnosed with tuberculous meningitis in our study was 34.23 ± 3.915 years. Most of the patients presented with the fever followed by headache. Out of 69 patients, 41 (59.4%) recovered, 22 (31.9%) were shifted to the intensive care unit and 6 (8.7%) died. Seizures were the commonest neurological complication faced by the patients followed by cranial nerve palsies. Conclusion: Fever and headache were common symptoms with which patients of tuberculous meningitis presented in our study population. Most of the patients recovered in the ward but a high percentage required intensive care unit admission as well. Seizures and cranial nerve palsies were commonly experienced complication by patients included in our study.

scholarly journals A study of Guillain–Barré syndrome with reference to cranial neuropathy and its prognostic implication

2014 ◽  
Vol 05 (S 01) ◽  
pp. S043-S047 ◽  
Author(s):  
Amita Bhargava ◽  
Basavaraj F. Banakar ◽  
Guruprasad S. Pujar ◽  
Shubhakaran Khichar
Keyword(s):  
Cranial Nerve ◽  
Nerve Palsy ◽  
Ventilatory Support ◽  
Clinical Profile ◽  
Cranial Neuropathy ◽  
Cranial Nerve Involvement ◽  
Prognostic Implication ◽  
Vestibulocochlear Nerve ◽  
Nerve Involvement ◽  
Cranial Nerve Palsies

ABSTRACT Background: Focused studies on cranial neuropathy in Guillain–Barrι syndrome (GBS) and its prognostic implication are not done previously. Aim: To study the clinical profile of GBS patients with special reference to cranial neuropathy and its prognostic implication. Materials and Methods: The study included 61 patients with GB syndrome, fulfilling Asbury Cornblath’s criteria for GB syndrome. A pre-designed semi-structured questionnaire was used to obtain data regarding demographic profile and clinical profile. All patients underwent detailed neurological examination, investigations including nerve conduction studies and CSF examination and treated according to the severity of the illness. Patients were followed up for 6 months. During analysis two groups were made depending on cranial nerve involvement, and compared with respect to various parameters. Results: Out of 61 patients 38 (62.3%) patients had cranial nerve palsies, in that 25 had multiple cranial nerve palsies, and 13 had single isolated nerve palsy. A majority of 30 (49.2%) had bulbar palsy, 28 (46%) had facial nerve palsy, and all had bilateral involvement except 3 patients who had unilateral palsy. Hypoglossal nerve involvement was seen in six (10%) patients and four (6.5%) patients had ophthalmoplegia. Only one had bilateral vestibulocochlear nerve palsy. On comparing various clinico-electrophysiological parameters among patients of GB syndrome with and without cranial nerve involvement, the presence of respiratory paralysis, IVIg and ventilatory support requirement had significant association with cranial nerve involvement in GBS. Conclusion: Our study found a correlation between cranial nerve palsies and severity of the illness. Cranial nerve innervated muscles recover earlier as compared to distal limb muscles. No association was found between outcome at 6 months and cranial nerve involvement.

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