Transient postsurgical gastroparesis is accompanied by reversible changes of the cervical vagus nerve's morphology after neck dissection - an ultrasound study.

AIMS: During neck dissection (ND), the vagus nerve (VN) may be exposed to manipulation together with common carotid artery and internal jugular vein. The postsurgical gastroparesis was previous related to the VN injury. The aim of our study was to evaluate by ultrasound the VN changes in patients with unilateral and bilateral ND and to establish if there is a relationship between postoperative findings of VN and postsurgical gastroparesis. MATERIAL AND METHODS: Seventeen patients in which 30 ND (4 unilateral and 13 bilateral) were performed, were enrolled in the study. The VN's area and diameter were measured preoperative (baseline), one week (T1) and one month (T2) postoperative. Gastrointestinal symptoms were evaluated at T1 and T2 phases using the patient assessment of the upper gastrointestinal symptom severity index (PAGI-SYM). RESULTS: There was a statistical difference between area and diameters of VN between T1 and baseline (p<0.001), and T1 and T2 phases (p<0.001), respectively. No statistical differences were detected at baseline and T2 phases in areas (p=0.934) and diameters (p>0.999). Gastrointestinal symptoms, found at the T1 phase regressed at T2 phase, were correlated with VN area and diameter changes (p<0.001). CONCLUSIONS: VN ultrasound clearly showed the transient dimensional changes of VN caused by manipulation in ND, which may lead to temporary gastrointestinal symptoms due to reversible dysfunction of VN.

A case of varicella zoster encephalitis with glossopharyngeal and vagus nerve injury as primary manifestation combined with medulla lesion.

Varicella zoster virus (VZV) can invade the brainstem or brain via the glossopharyngeal, vagus , or facial nerve, resulting in brainstem inflammation or encephalitis. We report the case of a 66-year-old male patient with a primary manifestation of medulla injury of the glossopharyngeal and vagus nerves, combined with a medulla lesion, who was misdiagnosed with lateral medullary syndrome. Facial nerve injury and earache subsequently occurred and human herpes virus 3 (VZV) was detected by second-generation sequencing of the cerebrospinal fluid. The final diagnosis was varicella zoster encephalitis, which improved after antiviral therapy.

An Unusual Murder: Vasovagal Death From Atypical Stabbing to the Neck.

Fatalities due to stabbings are usually caused by large blood vessels or organs injuries resulting in hemorrhagic shock. Vagal inhibition from a stab to the neck is an undeniably exceptional event, infrequently described in the literature. In our case report, we describe one such fatality.The body of a deceased 38-year-old man was found near a public garden. According to a bystander, the victim had been assaulted by 2 individuals, sustaining a stab wound to the neck with a broken glass bottle. At the autopsy, there was a large, inverted L-shaped cut wound in the left cervical region, measuring approximately 4.5 × 3 cm. The carotid artery and the jugular vein, as well as their main branches, were uninjured. The trachea and bronchi contained no exudate or blood. There was a hematoma near the trunk of the vagus nerve and its branches.The cause of death was attributed to the deep stab wound to the neck via vasovagal inhibition and parasympathetic nervous system stimulation.

Effect of Vagus Nerve Injury on the Outcome of Antireflux Surgery: An Extensive Literature Review.

BACKGROUND: Vagus nerve injury (VNI) is a feared complication of antireflux surgery (ARS). The impact of VNI on the functional outcomes of ARS has not yet been evaluated systematically. The aim of this review was to evaluate the impact of VNI on functional and clinical outcome of ARS. METHODS: A systematic search was performed until March 2015, using the following online databases: MEDLINE, Embase and the Cochrane Register of Controlled Clinical Trials. Eight studies remained available for assessment. Articles were divided into 2 groups: (a) one with unintended, accidental VNI and (b) one group comparing ARS with and without intended vagotomy. RESULTS: The prevalence of unintended, accidental VNI ranged from 10 to 42% after ARS. No clear differences were seen in outcome for reflux control between the VNI and vagus nerve intact group. A higher prevalence of diarrhea, nausea and vomiting was observed in the VNI group. CONCLUSION: VNI is a feared but neglected complication of ARS. Larger prospective studies that objectively assess vagus nerve integrity before and after ARS are needed.

The role of vagal nerve root injury on respiration disturbances in subarachnoid hemorrhage.

AIM: We examined whether there is a relationship between vagal nerve root injury and the severity of respiration disorders associated with subarachnoid hemorrhage (SAH). MATERIAL AND METHODS: This study was conducted on 20 rabbits. Experimental SAH was induced by injecting homologous blood into the cisterna magna. During the experiment, electrocardiography and respiratory rhythms were measured daily. After the experiment, any axonal injury or changes to the arterial nervorums of the vagal nerves were examined. All respiratory irregularities and vagal nerve degenerations were statistically analyzed. RESULTS: Normal respiration rate, as measured in the control group, was 30 ± 6 bpm. In the SAH-induced group, respiration rates were initially 20 ± 4 bpm, increasing to 40 ± 9/min approximately ten hours later, with severe tachypneic and apneic variation. In histopathological examinations, axon density of vagal nerves was 28,500 ± 5,500 in both control and sham animals, whereas axon density was 22,250 ± 3,500 in survivors and 16,450 ± 2,750 in dead SAH animals. The severity of axonal degeneration of vagal nerves was greater in the six dead animals than in the survivors. CONCLUSION: If vagal nerves are lesioned, the muscles of respiration are paralyzed and respiratory reflexes are disrupted. That the ischemic and mechanical factors created by SAH cause vagal nerve root injury and respiration disorders may be inevitable and fatal.

A case of severe gastroparesis: indigestion and weight loss after catheter ablation of atrial fibrillation.

We describe a patient with gastroparesis after radiofrequency catheter ablation (RFCA) as a result of vagus nerve injury. A 42-year-old man underwent redo-RFCA due to recurrent drug-resistant symptomatic atrial fibrillation. The patient complained of indigestion and early satiety 2 weeks after the second procedure. There was also weight loss of approximately 5 kg for 2 months. He underwent endoscopy during which food material was noticed. In the upper gastrointestinal series, most contrast material still remained in the stomach on the 2-hour delayed images, suggesting delayed gastric emptying time.