scholarly journals Left Subclavian Pseudoaneurysm: A Case of Palsies in the Recurrent Laryngeal Nerve, Phrenic Nerve, and Brachial Plexus

2021 ◽  
pp. 014556132199337
Author(s):  
Daniel James Spangler ◽  
Robert Lafitte Eller
Keyword(s):  
Cancer Treatment ◽  
Brachial Plexus ◽  
Recurrent Laryngeal Nerve ◽  
Phrenic Nerve ◽  
Laryngeal Nerve ◽  
Intravascular Catheter ◽  
Voice Change ◽  
Rare Presentation ◽  
Ortner’S Syndrome

A patient developed a subclavian pseudoaneurysm following placement of an intravascular catheter for cancer treatment. The patient presented with palsies in the phrenic nerve, brachial plexus, and recurrent laryngeal nerve. This is a rare presentation, similar to Ortner’s syndrome, which has not been previously presented in the literature. Furthermore, this case highlights the importance of early laryngoscopy in patients with persistent voice change, especially after a neck procedure.

scholarly journals Successful Management of Parsonage–Turner Syndrome with Steroids in the Post-acute Weakness Phase: A Case Report

EMJ Neurology ◽  
2021 ◽  
pp. 81-87
Author(s):  
Mehmood Ahmed Butt ◽  
Kuchalambal Agadi ◽  
Manju Mehmood Butt ◽  
Maliha Mehmood Butt
Keyword(s):  
Brachial Plexus ◽  
Recurrent Laryngeal Nerve ◽  
Turner Syndrome ◽  
Phrenic Nerve ◽  
Laryngeal Nerve ◽  
Left Shoulder ◽  
Nerve Injuries ◽  
Delay In Diagnosis ◽  
Rare Combination ◽  
Progressive Weakness

Introduction: Parsonage–Turner Syndrome (PTS) is a rare disease of the brachial plexus of unclear aetiology. The limited data available typically describes involvement of branches of brachial nerves. The authors present a case of PTS with a rare combination of unilateral brachial plexus, phrenic nerve, and recurrent laryngeal nerve injuries. They also highlight successful treatment with pharmacological intervention despite several months’ delay in diagnosis. The 35-year-old female presented with acute onset of severe left shoulder pain followed by severe progressive weakness of the left shoulder muscles, progressive weakness of her voice, nasal regurgitation of fluids, paroxysmal bouts of coughing, and exertional dyspnoea at rest. The symptoms remained undiagnosed for about 10 months. A clinical diagnosis of exclusion of PTS was finally made, and treatment with steroids, neurotropic drugs, and physiotherapy was started. The patient has recovered significantly since then and continues to improve. Conclusion: The authors presented a case of PTS with a rare combination of brachial plexus, recurrent laryngeal nerve, and phrenic nerve injuries. This case was also remarkable for the significant improvement in her symptoms with treatment, despite the delay in diagnosis. This bears evidence that steroids and adjuvant therapy is useful even months after onset of the disease.

Brachial plexus neuritis and recurrent laryngeal nerve palsy

1988 ◽  
Vol 235 (5) ◽  
pp. 323-323 ◽  
Author(s):  
E. A. C. M. Sanders ◽  
V. M. H. Van den Neste ◽  
T. U. Hoogenraad
Keyword(s):  
Brachial Plexus ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Palsy ◽  
Brachial Plexus Neuritis

scholarly journals A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block

2016 ◽  
Vol 1 (1) ◽  
pp. 30-31
Author(s):  
Sindil Kumar Sahu ◽  
Usha Badole
Keyword(s):  
Brachial Plexus ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Palsy ◽  
Brachial Plexus Block ◽  
Rare Complication ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Plexus Block

ABSTRACT Orthopaedic upper limb surgeries are commonly performed under brachial plexus block. Ultrasound guidance significantly improves the quality of nerve block with lesser number of complications, although complications cannot be eliminated completely. Ipsilateral recurrent laryngeal nerve palsy is a rare complication associated with supraclavicular approach. We report a case of 28 year old female who developed hoarseness of voice following ultrasound guided supraclavicular brachial plexus block. The diagnosis of ipsilateral recurrent laryngeal nerve palsy requires a high index of suspicion and it should always be kept in differential diagnosis when a patient develops hoarseness of voice or respiratory compromise after supraclavicular brachial plexus block. How to cite the article Sahu SK, Badole U. A Rare Complication in Ultrasound-guided Supraclavicular Brachial Plexus Block. Res Inno Anaesth 2016;1(1):30-31.

Responses of bulbospinal and laryngeal respiratory neurons to hypercapnia and hypoxia

1985 ◽  
Vol 59 (4) ◽  
pp. 1201-1207 ◽  
Author(s):  
W. M. St John ◽  
A. L. Bianchi
Keyword(s):  
Spinal Cord ◽  
Recurrent Laryngeal Nerve ◽  
Phrenic Nerve ◽  
Action Potentials ◽  
Respiratory Muscles ◽  
Laryngeal Nerve ◽  
Respiratory Neurons ◽  
Peripheral Chemoreceptor ◽  
Medullary Respiratory Neurons ◽  
Neuronal Groups

The purpose was to evaluate activities of medullary respiratory neurons during equivalent changes in phrenic discharge resulting from hypercapnia and hypoxia. Decerebrate, cerebellectomized, paralyzed, and ventilated cats were used. Vagi were sectioned at left midcervical and right intrathoracic levels caudal to the origin of right recurrent laryngeal nerve. Activities of phrenic nerve and single respiratory neurons were monitored. Neurons exhibiting antidromic action potentials following stimulations of the spinal cord and recurrent laryngeal nerve were designated, respectively, bulbospinal or laryngeal. The remaining neurons were not antidromically activated. Hypercapnia caused significant augmentations of discharge frequencies for all neuronal groups. Many of these neurons had no change or declines of activity in hypoxia. We conclude that central chemoreceptor afferent influences are ubiquitous, but excitatory influences from carotid chemoreceptors are more limited in distribution among medullary respiratory neurons. Hypoxia will increase activities of neurons that receive sufficient excitatory peripheral chemoreceptor afferents to overcome direct depression by brain stem hypoxia. The possibility that responses of respiratory muscles to hypoxia are programmed within the medulla is discussed.

Ortner's syndrome revisited

1998 ◽  
Vol 112 (4) ◽  
pp. 377-379 ◽  
Author(s):  
A. Sengupta ◽  
S. P. Dubey ◽  
D. Chaudhuri ◽  
A. K. Sinha ◽  
P. Chakravarti
Keyword(s):  
Pulmonary Hypertension ◽  
Heart Disease ◽  
Recurrent Laryngeal Nerve ◽  
Mitral Stenosis ◽  
Primary Pulmonary Hypertension ◽  
Case Reports ◽  
Cor Pulmonale ◽  
Laryngeal Nerve ◽  
Left Recurrent Laryngeal Nerve ◽  
Ortner’S Syndrome

AbstractHoarseness of voice due to paralysis of the left recurrent laryngeal nerve caused by a dilated left atrium in mitral stenosis as discussed by Ortner, is a subject of controversy. Different authors have cited different mechanisms as explanation. A variety of cardiac problems such as primary pulmonary hypertension, ischaemic heart disease, various congenital heart disorders can all lead to paralysis of the left recurrent laryngeal nerve. Most authors believe that pressure in the pulmonary artery causes the nerve compression. In Papua New Guinea cor pulmonale and rheumatic heart disease are the commonest cardiac disorders seen. Ortner's syndrome is a rarity and has never been reported from here before. Here three different case reports are presented with mitral stenosis, primary pulmonary hypertension and combined mitral stenosis and regurgitation and the pathogenesis of hoarseness is discussed.

scholarly journals Hoarseness of Voice following Left Supraclavicular Brachial Plexus Block: A Case Report

2021 ◽  
Vol 59 (241) ◽  
pp. 925-928
Author(s):  
Subin Shrestha ◽  
Sadikshya Regmi ◽  
Gopendra Deo ◽  
Indra Narayan Shrestha
Keyword(s):  
Brachial Plexus ◽  
Recurrent Laryngeal Nerve ◽  
Brachial Plexus Block ◽  
Rare Complication ◽  
Local Anaesthetics ◽  
Laryngeal Nerve ◽  
Ultrasound Guided ◽  
Supraclavicular Brachial Plexus Block ◽  
Supraclavicular Block ◽  
Plexus Block

Supraclavicular brachial plexus block is extensively used for primary regional anaesthesia as well as postoperative analgesia for the surgical procedures of the upper limb. The evidence for the use of ultrasound in supraclavicular brachial plexus is growing day by day as it has the advantage of allowing real time visualisation of the plexus, pleura and vessels along with the needle and local anaesthetics spread. Despite this, complications can even arise with ultrasound guided supraclavicular brachial plexus block. Hoarseness of voice due to recurrent laryngeal nerve block is a rare complication of supraclavicular brachial plexus block. There are few reported cases of hoarseness of voice following the right supraclavicular block. There is only one reported case of hoarseness of voice following the left supraclavicular block. Here, we report a case of a 16-year-old boy who developed hoarseness of voice due to left recurrent laryngeal nerve following ultrasound guided left supraclavicular brachialplexus block.

scholarly journals Recurrent laryngeal nerve and voice preservation: routine identification and appropriate assessment – two important steps in thyroid surgery

2011 ◽  
Vol 93 (1) ◽  
pp. 49-53 ◽  
Author(s):  
Ravindra Singh Mohil ◽  
Pragnesh Desai ◽  
Nitisha Narayan ◽  
Maheswar Sahoo ◽  
Dinesh Bhatnagar ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Thyroid Surgery ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Voice Change ◽  
Routine Identification ◽  
Before And After ◽  
Voice Preservation

INTRODUCTION The aims of this study were to assess and compare vocal cord functions before and after thyroid surgery after intra-operative identification of recurrent laryngeal nerve. PATIENTS AND METHODS Recurrent laryngeal nerve (RLN) is seen intra-operatively in all cases undergoing thyroid surgeries. Vocal cord functions including any voice change were evaluated by indirect laryngoscopy (I/L) and direct laryngoscopy (D/L) before and after surgery. RESULTS Prospective study on 100 patients over 18 months with a total of 146 nerves at risk (NAR). Majority were women (n = 86) with mean age of 37.48 years (range, 13–60 years). RLN was seen in all patients and 19 patients complained of some change in quality of their voice after surgery. Evaluation by I/L and D/L at 6 weeks showed recurrent laryngeal nerve palsy (RLNP) in nine (47.36%) and five (26%) of these 19 patients respectively. Analysed according to total NAR, the incidence of voice change and temporary RLN palsy (I/L and D/L) at 6 weeks was still less at 13.01%, 6.16% and 3.42%, respectively. Voice change improved in all cases at 3 months with no RLNP palsy by I/L or D/L. All these 19 patients had undergone difficult or extensive surgery for malignancy, large gland, extratyhroidal spread or fibrosis. CONCLUSIONS Despite identification and preservation of RLN, patients can develop postoperative voice change and RLNP although all voice change cannot be attributed to damaged RLN. Proper assessment of vocal cord functions by I/L and D/L laryngoscopy is required to rule out injuries to these nerves. Risk of damage is higher in patients undergoing more difficult surgery.

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