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.

Anatomical factors associated with periesophageal vagus nerve injury after catheter ablation of atrial fibrillation.

BACKGROUND: The periesophageal vagus nerve plexus controls the kinetics of the stomach, digestive tract, and gallbladder, and catheter ablation of atrial fibrillation (AF) can cause vagus nerve injury (VNI). We sought to clarify the incidence, clinical course, and anatomical factors related to periesophageal VNI. METHODS: The present study included 257 consecutive patients with AF (mean age, 62±11 years) who underwent catheter-based pulmonary vein isolation. With 64-slice computed tomographic images, the left atrium (LA)-esophageal contact length, LA diameter, and distances between each mediastinal structure were compared between patients with VNI and those without VNI. RESULTS: VNI occurred in 5 patients (1.9%), gastric hypomotility in 3 patients, and acalculous cholecystitis in 2 patients, within 3 days after ablation, and all patients recovered completely within 2 weeks. Compared with patients without VNI, those with VNI more frequently underwent ablation at the mitral isthmus (p=0.03) and inside the coronary sinus (p=0.03). On computed tomographic images, the esophagus was closer to the aorta than to the spine in 67% of patients and was defined as an aorta-sided esophagus. In patients with VNI, the distance from the LA to the spine or the descending aorta (in patients with an aorta-sided esophagus) was shorter (p=0.03), and the transverse LA-esophageal contact length was longer (p=0.01). CONCLUSION: Acalculous cholecystitis, as well as gastric hypomotility, can develop as a result of periesophageal VNI in patients undergoing AF ablation. The anatomical relationships among the LA, esophagus, spine, and descending aorta may influence the occurrence of VNI.