[A case of facial-onset sensory and motor neuronopathy (FOSMN) with cerebellar ataxia and abnormal decrement in repetitive nerve stimulation test].

A 59-year-old woman presented with a 7-year history of facial numbness on the left side, and gradual worsening of symptoms. Over several years, facial muscle weakness, dysarthria, tongue atrophy and fasciculation had progressed. Then, she developed cerebellar ataxia affecting the left extremities, in addition to earlier symptoms. Brain MRI revealed cerebellar atrophy, and 99mTc-SPECT depicted cerebellar hypoperfusion. A repetitive nerve stimulation test (RNS) indicated abnormal decrement in the nasalis and trapezius muscles on the left side. Facial-onset sensory and motor neuronopathy (FOSMN) was diagnosed. Administration of intravenous immunoglobulin resulted in improvement of some symptoms. Although cerebellar ataxia is not a common symptom of FOSMN, a case showing TDP-43-positive glial cytoplasmic inclusions in cerebellar white matter has been reported. Therefore, it is possible that FOSMN may cause cerebellum impairment in some patients. Furthermore, RNS positive rate in the trapezius muscle is known to be high in amyotrophic lateral sclerosis (ALS) patients. It is speculated that RNS of the affected muscles in FOSMN may show abnormal decrement by the same mechanisms as ALS.

[Analysis of facial far-infrared thermogram of patients with acute facial neuritis].

OBJECTIVE: In order to provide an objective observational index for facial neuritis, the authors monitored the changes of facial far-infrared thermogram in patients with acute facial neuritis. METHODS: A total of 23 patients with acute facial neuritis were enrolled from Department of Acupuncture and Moxibustion, Chinese PLA General Hospital. Another 21 healthy participants were selected as the control group. Focal plane thermal imaging system (thermal sensitivity 0.05 degrees centigrade) was applied to collect facial far-infrared thermogram. Temperature differences in the thermogram of both sides of the cheeks, inner canthus, supraorbitals and forehead of the same patient were compared separately and statistically and analyzed by software provided by the imaging system. RESULTS: Results of far-infrared thermography of the patients displayed obvious temperature differences ranging from 0.01 to 0.26 degrees centigrade between two sides of the cheeks, inner canthus, supraorbitals and forehead areas. In the control group, far-infrared thermogram showed that there were no obvious temperature differences between two sides of the cheeks, inner canthus, supraorbitals and forehead. There were significant differences in temperature difference in the four monitoring areas between the two groups (P<0.01). Among the 23 patients, there were 14 patients with congestive change, 7 with ischemic change and 2 with both congestive and ischemic changes. CONCLUSION: The facial far-infrared thermogram of patients with acute facial neuritis is characterized mainly by congestive changes. Far-infrared thermography can objectively reflect the changes of blood-supply status in patients with facial neuritis.

Estimulación eléctrica del nervio facial con función pronóstica en la cirugía de parótida / Electrical stimulationof the facial nerve with a prognostic function in parotid surgery

Introducción. La electromiografía continua durante la parotidectomía y la estimulación directa del nervio facial como técnica de identificación intraoperatoria disminuyen la morbilidad postoperatoria significativamente. Objetivo. Determinar la utilidad de los parámetros neurofisiológicos intraoperatorios obtenidos mediante estimulación eléctrica del nervio facial como valores predictivos del tipo de lesión y pronóstico funcional. Pacientes y métodos. Serie correlativa de 20 casos de parotidectomía monitorizada. Se compara la función facial postoperatoria, tipo de lesión y su pronóstico con las variaciones de latencia/amplitud de la respuesta muscular entre dos estimulaciones del nervio facial pre y posresección, además de la ausencia o presencia de respuesta muscular a la estimulación posresección. Resultados. Todos los pacientes menos uno presentaron potencial evocado motor (PEM) a la estimulación posresección. El 55% obtuvo indemnidad facial postoperatoria y el 45% presentó algún tipo de paresia. La caída de amplitud del PEM intraoperatorio del 21% y el aumento de la latencia media del 13,5% se corresponden con las lesiones axonales y desmielinizantes, respectivamente, con un tiempo medio de recuperación de tres y seis meses. El único caso de ausencia de respuesta a la estimulación posresección presentó una paresia permanente. Conclusiones. La presencia del PEM tras resección no asegura la indemnidad funcional del nervio. Sin embargo, puede considerarse un dato que sugiere menor grado de afectación en el caso de haberlo y mejor pronóstico. Las variaciones de latencia y amplitud de los PEM tienden a ser parámetros indicadores del grado de afectación intraoperatorios y del pronóstico funcional (AU)

Introduction. Continuous electromyography during parotidectomies and direct stimulation of the facial nerve as an intraoperative identification technique significantly lower the rate of post-operative morbidity. Aim. To determine the usefulness of intra-operative neurophysiological parameters registered by means of electrical stimulation of the facial nerve as values capable of predicting the type of lesion and the functional prognosis. Patients and methods. Our sample consisted of a correlative series of 20 cases of monitored parotidectomies. Post-operative facial functioning, type of lesion and its prognosis were compared with the variations in latency/amplitude of the muscle response between two stimulations of the facial nerve before and after resection, as well as in the absence or presence of muscle response to stimulation after resection. Results. All the patients except one presented motor evoked potentials (MEP) to stimulation after resection. There was no facial damage following the operation in 55% of patients and 45% presented some kind of paresis. The 21% drop in the amplitude of the intra-operative MEP and the mean increase in latency of 13.5% correspond to axonal and demyelinating insult, respectively, with a mean recovery time of three and six months. The only case of absence of response to the post-resection stimulation presented permanent paresis. Conclusions. The presence of MEP following resection does not ensure that functioning of the nerve remains undamaged. Nevertheless, it can be considered a piece of data that suggests a lower degree of compromise, if it is present, and a better prognosis. The variations in latency and amplitude of the MEP tend to be intra-operative parameters that indicate the degree of compromise and functional prognosis (AU)

[Aspects of diagnosis and treatment of the facial nerve neuropathy]. / Nekotorye aspekty diagnostiki i lecheniia nevropatii litsevogo nerva.

As many as 86 patients with neuropathy of the facial nerve complicated by development of postneuritic muscular contractures were examined. Based on the clinical-and-neurophysiological investigation, findings from rheoencephalography, electroencephalography, echoencephaloscopy, electrodiagnosis of the facial nerve, clinical variants of the facial nerve function return to normal were defined together with causes of development of muscular contractures. Efficiency is shown of use of acupuncture and magnetotherapy combined in treatment of the above trouble.

[The combination of reflexotherapy and homeopathy in treating patients with facial nerve neuropathy]. / Poiedannia refleksoterapiï ta homeopatiï pry likuvanni khvorykh z nevropatiieiu lytsevoho nerva.

Used in a multiple-modality treatment of 103 patients presenting with facial nerve neuropathy were infrared laser puncture and homeopathy. The former treatments were administered with the aid of the apparatus [symbol: see text] 001 at wave-length 890 nm, average power 15 mW/cm2. Homeopathy therapy was with those drug preparations meant to deal with constitutional and symptomatic problems. As many as 103 patients with facial nerve neuropathy derived apparent benefit from treatment, which fact was confirmed by electrophysiological findings as was by those from acupuncture diagnosis techniques.

[A differentiated approach to laser puncture in facial neuritis by using the methods of acupuncture diagnosis]. / Dyferentsial'nyi pidkhid do lazeropuntury pry nevryti lytsevoho nerva z vykorystanniam metodiv akupunkturnoï diahnostyky.

Overall 87 patients with neuritis of the facial nerve were studied by making use of methods of acupuncture diagnosis as recommended by Nakatani and Akabane. The parameters under investigation included the level of physiologic corridor, left-right asymmetry, the Yang and the Yin meridians sum ratio, maximum deviation from the physiological corridor in certain meridians. The results obtained permitted the identification of three groups of patients depending on the duration of their illness. This permitted the differentiated approach to the use of laser puncture in these patients securing good results of treatment which were confirmed by both the positive dynamics of acupuncture methods of investigation and data supplied by the electrophysiological techniques (EMG, EEG). With the purpose of performing laser puncture, the infrared laser puncture apparatus Biomed-001 (wavelength 0.89, average laser emissive power 20 mw) was employed.

MRI of inner ear and facial nerve pathology using 3D MP-RAGE and 3D CISS sequences.

The aim of this study was to evaluate 3D CISS, unenhanced 3D MP-RAGE and contrast enhanced 3D MP-RAGE for the diagnosis of neoplastic, vascular and inflammatory lesions of the cerebellopontine angle, the inner auditory canal, the labyrinth and the facial nerve 42 MR examinations were performed on a total of 38 patients (25 males, 13 females; aged 1-77 years, mean age 43 +/- 20 years) using a 1.5 T MR unit. A T2* weighted 3D CISS sequence (TR 14.65 ms, TE 21 ms, flip angle 65 degrees, voxel size 0.7 x 0.7 x 0.7 mm3) and a T1 weighted 3D MP-RAGE sequence (TR 12.5 ms, TE 5 ms, T1 300 ms, flip angle 15 degrees, voxel size 1.0 x 0.9 x 0.9 mm3) with and without contrast medium (gadolinium-DTPA, 0.1 mmol kg-1 body weight) were used. Results of contrast enhanced 3D MP-RAGE-pathological enhancement was found in the following lesions: schwannomas of the cerebellopontine angle (CPA) and the internal auditory canal (IAC), 4; schwannomas of the IAC, 7 and labyrinthine tumours, 3; posterior fossa lymphoma, 1; meatal meningioma, 1; acute labyrinthitis, 15 and neuritis of the seventh cranial nerve, 10. Results of 3D CISS-filling defects were found with the following lesions: schwannomas of the CPA, the IAC or labyrinth, 14; lymphoma, 1; meningioma, 1; labyrinthine fibrosis, 13 and scar in the IAC, 4. These results suggest that unenhanced and contrast enhanced 3D MP-RAGE and 3D CISS are complementary MR imaging modalities. T1 weighted 3D MP-RAGE is preferred to T1 weighted 2D (turbo) spin echo sequences because of the multiplanar reconstruction possibilities of 3D sequences, which are very useful in the case of the inner ear and facial nerve.

[Early diagnosis and immunocorrective therapy of recurrent facial neuritis as a manifestation of Melkersson-Rosenthal syndrome in adults and children]. / Ranniaia diagnostika i immunokorrigiruiushchaia terapiia retsidivi- ruiushchego nevrita litsevogo nerva kak proiavlenie sindroma Mel'kerssona-Rossolimo-Rozentalia u vzroslykh i detei.

Clinical and immunological examinations of adults and children with Melkersson-Rossolimo-Rosenthal syndrome have revealed immunity deficiency: a decrease of the number of T and B cells, a low immunoglobulin content and the presence of the ++neuro-allergic syndrome according to the increased level of cerebral antibodies. The role of deembiogenetic stigmas in the diagnosis establishment has been demonstrated. The authors suggest the use of immunomodulating therapy including interferogens and immunostimulants of T and B cells (galascorbin and myelopide). Provide evidence for the efficacy of the treatment elaborated.

The effect of unilateral corneal anesthesia on the Schirmer test.

Unilateral corneal anesthesia (or hypesthesia) caused by trigeminal nerve disease has an unknown effect on the Schirmer test. Using topical anesthesia, we found that unilateral corneal anesthesia reduces tearing bilaterally, with a greater decrease on the anesthetized side. Clinicians should be aware that trigeminal nerve deficit may alter Schirmer test results, and use bilateral topical corneal anesthesia or alternative methods to stimulate tearing in these cases.