Physiotherapy in Postinfection Injury to Cranial Nerves III, IV, and VI: A Case Study.

The patient with bacterial infection sequelae in the form of damage to cranial nerves III, IV, and VI was followed up. He had exhibited clinical and radiographic signs of paranasal sinusitis. Before his physiotherapy, the patient received standard treatment with natural and synthetic antibiotics and steroids. After acute signs of infection resolved without any functional improvement, the patient was referred to a rehabilitation unit to undergo neuromuscular re-education of the paralyzed extraocular muscles. Periorbital hydrocortisone iontophoresis and visuomotor exercises with intense ideomotor stimulation led to complete and rapid resolution of extraocular muscle paralysis and diplopia. Physiotherapy can be an effective treatment of choice after failed pharmacological treatment in patients with damage to cranial nerves III and VI. It has many theoretical advantages, including noninvasiveness and avoidance of first-pass metabolism of drugs administered systemically.

[Three-month rehabilitation of a patient with the III, IV and VI cranial nerve damage caused by a neurosurgery of the left internal carotid artery aneurysm].

OBJECTIVE: Introduction: Oculomotor nerve palsy is an eye condition resulting from damage to the third cranial nerve or a branch thereof. Third nerve damage weakens the muscles innervated by the nerve . Also adversely affect the fourth and sixth nerve , causing impairment of their activity. Rehabilitation third nerve palsy is rarely described in the available literature . The whole process is very difficult , but the effects of physiotherapy is very beneficial for the patient. The aim:The assessment of the influence of the outpatient rehabilitation on the patient's condition after a three-month treatment and the use of physical therapy. PATIENTS AND METHODS: Material and methods:Case studies of the 38-yerar-old patient after having operated a big aneurism of the left ICA, which was clipped. After the procedure, the III, IV and VI cranial nerves were deeply impaired and the amnesic aphasia occurred. The patient started the rehabilitation a month after the incident. To assess the process of rehabilitation, the own movement examination of the eyeball was implemented. Active and passive exercises, Tigger Point therapy, kinesiotaping, laser and electrostimulation were inserted. RESULTS: Results: The significant improvement of the eyeball movement has been proved on the basis of the same own examination. A physiotherapy has had a positive influence on the speech disorder, namely amnesic aphasia, and after the month of the rehabilitation it has been completely removed. The positive influence of the rehabilitation, which has been pointed out, is clinically essential. CONCLUSION: Conclusions: Obtained results have not been described in literature yet, that is why it is essential to widen further research and emphasise the importance of the rehabilitation, which is rarely implemented in an intense way in such medical conditions.

A case of Vernet syndrome associated with internal jugular phlebectasia.

A 36-year-old woman presented with right shoulder weakness after a left parotid tumor resection. The overall clinical presentation included severe paralysis and atrophy of the right sternocleidomastoid and upper trapezius, an absent right gag reflex, and diminished right posterior tongue pinprick sensation. A diagnosis of right-sided Vernet syndrome (cranial nerve IX, X, XI lesions) was made, presumably from compression of cranial nerves by internal jugular vein phlebectasia. To our knowledge, this is the first case report of spontaneous Vernet syndrome associated with internal jugular vein phlebectasia in the absence of other lesions of the jugular foramen.

Síndrome de Collet-Sicard como forma de presentación de fracturas combinadas del atlas y cóndilos occipitales / Collet-Sicard syndrome as a presentation of combined fractures of atlas and occipital condyles

El síndrome de Collet - Sicard consiste en una afectación unilateral y combinada de los nervios craneales bajos, originado por lesiones en la base craneal. CASO CLÍNICO: Paciente masculino con antecedentes de sufrir accidente del tránsito. A su llegada al hospital refiere dolor cervical alto, voz apagada y dificultad para tragar. Al examen físico se contacta paresia de pares craneales bajos. Se realizan Rx de columna cervical y tomografía axial de región cráneo espinal. Se diagnostica una fractura de los cóndilos occipitales y una fractura tipo II del atlas. Se coloca un Halo chaleco. Se consulta al paciente al final del primer mes de tratamiento con alivio del dolor cervical y sin empeoramiento neurológico. CONCLUSIONES: La afectación de pares craneales bajos puede ser la forma clínica de presentación de las lesiones traumáticas de la región cráneo espinal. Su reconocimiento temprano favorece el pronóstico de estos pacientes

Collet syndrome - Sicard is a combined unilateral involvement and lower cranial nerves, caused by damage to the cranial base. Case report. Male patient with a history of developing traffic accident. Upon arrival at the hospital referred high cervical pain, muffled voice and difficulty swallowing. Physical examination contact lower cranial nerve paresis. Rx are performed CT cervical spine and skull spinal region. Was diagnosed with a fracture of the occipital condyles and type II fracture of the atlas. Place a Halo vest. They see patients at the end of the first month of treatment with cervical pain relief without neurological deterioration. CONCLUSIONS: The lower cranial nerve involvement may be the clinical presentation of traumatic injuries of the skull spinal region. Its early recognition and the prognosis of these patients.

Prognostic value of pretreatment and recovery duration of cranial nerve palsy in nasopharyngeal carcinoma.

BACKGROUND: The purpose of this study was to evaluate the prognostic value of cranial nerve (CN) palsy in nasopharyngeal carcinoma (NPC) patients. METHODS: A retrospective analysis was performed on CN involvement using medical records of 178 consecutive patients with histologically diagnosed, non-disseminated NPC. RESULTS: In 178 NPC patients with CN palsy, the 5-year survival rates were as follows: overall survival (OS), 61.0%; disease-specific survival (DSS), 69.6%; local relapse-free survival (LRFS), 75.2%; distant metastasis-free survival (DMFS), 73.4%; and disease-free survival (DFS), 55.3%. Significant differences were observed in the 5-year OS rates between patients with single and multiple CN palsy (69.8% vs. 54.3%; P=0.033) and the OS rates between patients with different pretreatment durations (68.7% vs. 43.3%, P=0.007). However, no significant differences were observed in OS, DSS, LRFS and DFS rates between patients with upper and lower CN palsy (P=0.581, P=0.792, P=0.729 and P=0.212, respectively). The results showed that recovery duration was an independent prognostic factor for OS (HR=2.485; P<0.001), DSS (HR=2.065; P=0.016), LRFS (HR=3.051; P=0.001) and DFS (HR=2.440; P<0.001). CONCLUSIONS: Recovery duration is an independent prognostic factor for NPC patients with CN palsy and is related to recurrence, which leads to poor survival. Recovery duration requires close surveillance and different treatment regimens.

Scleral contact lens management of bilateral exposure and neurotrophic keratopathy.

We report an interesting case of therapeutic scleral lens management of bilateral exposure and neurotrophic keratopathy resulting from bilateral cranial nerve (CN) palsies including V, VI and VII, which caused lagophthalmos and anaesthetic corneas. Subsequent development of severe exposure keratitis with vascularisation and keratinisation of the inferior cornea was previously treated with intensive ocular lubrication, botulinum toxin injections to the upper eyelid levator muscle, temporary tarsorrhophies, bilateral amniotic membrane grafts, punctal plugs, lid taping, gold eyelid weights and soft bandage contact lenses. Corneal integrity was re-established but visual acuity remained significantly compromised by corneal vascularisation, scarring and keratin deposits. Visions on presentation to the contact lens department were R 1.90 logMAR, L 1.86 logMAR. Therapeutic, high Dk, non-fenestrated, saline filled, scleral lenses were fitted. Daily wear of these lenses have protected and hydrated the cornea, enabling corneal surface recovery whilst retaining visual and social function. The visual acuities 6 months post-scleral fitting with lenses in situ are R 0.90 logMAR and L logMAR 0.70.

Giant prolactinoma causing cranio-cervical junction instability: a case report.

Prolactinomas are common secretory pituitary tumours, usually managed with dopamine agonists. There have previously been case reports of rarer giant prolactinomas causing invasion of surrounding structures. We describe a case report of an exceptionally aggressive giant prolactinoma that eroded the occipital condyles causing cranio-cervical joint instability mandating surgical fixation.

Rehabilitation after cranial base surgery.

Recent advancements in skull base surgery to remove or diminish the size of cranial base tumors allow more to be done than ever before to preserve life for patients who have tumors in anatomic locations once considered unreachable without causing massive functional impairment or death. Nonetheless, the resulting outcome has a direct and serious impact on the quality of life of the patient. In this article on palliation, the authors focus on the rehabilitative techniques used in patients who have undergone extensive cranial base resection. These techniques can also be used to improve the life of patients who have not undergone surgery but suffer from poor quality of life because of the natural growth of the tumor.

Laryngeal and cranial nerve involvement after carotid endarterectomy.

CONCLUSIONS: Laryngeal and/or cranial nerve involvement after CEA surgery is not a rare condition, occurring in almost half of operated subjects. However, in most cases the functional deficit is transient and does not need any particular form of treatment. In this study, specific rehabilitative procedures were needed in only a relatively small number of cases (9%). A routine ENT examination has also proved to be extremely useful for detecting slight functional deficits which may occur following CEA surgery, bearing in mind that possible permanent lesions may require a rehabilitative procedure. OBJECTIVE: To identify, by means of a careful otolaryngologic examination, the incidence and degree of cranial nerve deficit related to carotid endarterectomy (CEA), starting from the first postoperative days. MATERIAL AND METHODS: A consecutive cohort of patients with symptomatic and asymptomatic carotid artery stenosis who underwent CEA was carefully followed on the basis of possible laryngeal and/or cranial nerve involvement. An ENT examination was carried out preoperatively (phase I) and at different times [3 (phase II) and 15 days (phase IIIa)] after surgery; in addition, patients with persisting neurological lesions were also checked 60 days after surgery (phase IIIb). RESULTS: In 59% of the patients, isolated or associated forms of deficit were found. Only 17.5% of these deficits did not appear to be transient, but rehabilitative procedures for voice or swallowing impairments were only needed in 9% of them.

Prosthodontic management of a patient with neurological disorders after resection of an acoustic neurinoma: a clinical report.

This clinical report describes the treatment of an edentulous patient who had undergone resection of an acoustic neurinoma and subsequently developed neurological problems. A replacement maxillary denture combined with a mandibular denture placed in the neutral zone was selected as the treatment of choice. A simple procedure for recording the neutral zone is presented.

Rehabilitation of lower cranial nerve deficits.

Lower cranial nerve deficits following skull base surgery can be accompanied by significant morbidity, especially if the vagus nerve has been sacrificed or injured. Loss of pharyngeal function and glottic closure can result in dysphagia and aspiration. Left untreated, these can result in the major morbidity for the patient following skull base surgery. The authors discuss the management of lower cranial nerve deficits, with emphasis on rehabilitation of swallowing function and prevention of aspiration following vagal injury.

Rehabilitation of the lower cranial nerves.

Brain stem lesions frequently cause dysfunction of the lower cranial nerves. Even with successful treatment, dysfunction may remain. Various methods for rehabilitating the patient with persistent lower cranial nerve dysfunction are presented.

Accessory nerve injury: conservative or surgical treatment?

In order to clarify the functional prognosis of accessory nerve injury after nerve repair and nonsurgical treatment, 27 of our cases with accessory nerve injury were studied. 20 cases were followed up for more than 8 months. In ten cases treated conservatively, the dull feeling and hypaesthesia did not improve. However, pain and dysfunction of the shoulder improved in half of these cases. In ten cases treated surgically, nerve suture was performed in two cases, nerve graft in five cases and neurolysis in three cases. In the surgically treated group, subjective complaints disappeared in all cases, but hypaesthesia or contracture of the shoulder persisted in three cases. Surgical treatment of the accessory nerve is recommended in fresh cases with complete paralysis and in cases in which there is no sign of nerve recovery within one year after the original injury.

Spinal accessory nerve palsy: an unusual complication of coronary artery bypass.

The neurologic complications of coronary artery bypass surgery have been well documented, with a reported incidence of 61% in one large study. Most injuries to the peripheral nervous system involve the brachial plexus. We report the first case of a spinal accessory nerve lesion after coronary bypass surgery. The patient presented with progressive right shoulder weakness. Electrodiagnostic studies revealed a partial lesion of the right spinal accessory nerve. Physical therapy, including strengthening, range of motion, and electric stimulation to the right shoulder, was prescribed to assist recovery of strength and function. Repeat electrodiagnostic studies confirmed nerve regeneration. Prompt recognition of spinal accessory nerve damage after coronary bypass surgery is essential. Early rehabilitation will improve the chances of a better functional outcome.

[Problems of deglutition disorders]. / Problématique des troubles de la déglutition.

Disorders associated with swallowing often appear with difficulty in swallowing or with a cough when food goes down the wrong way. However, a detailed analysis of such disorders shows some distinctive characteristics based on neurological or surgical etiologies. Identification of the physiopathological mechanisms of the different types of deglutition allows for the elaboration of the appropriate rehabilitation strategies.

[Rehabilitative treatment in functional disorder of the oculomotor nerve in patients with intracranial arterial aneurysm]. / Vosstanovitel'noe lechenie pri narushenii funktsii glazodvigatel'nogo nerva u bol'nykh s vnutricherepnymi arterial'nymi anevrizmami.

Data are reported by the authors on electric stimulation of the oculomotor muscles in 26 patients who underwent the operation of endovascular occlusion of saccular aneurysms of the supraclinoid portion of the internal carotid artery. This method of rehabilitation treatment proved effective and is recommended for wider use.

[Occupational and social integration of patients following cerebral cortex tumor operations]. / Die beruflich-soziale Integration von Patienten nach Grosshirntumoroperationen.

The aim of the surgeon to achieve complete health and well-being with full professional fitness cannot be reached in many cases or only partially. Since the postoperative psychophysical capacity of compensation and maximum stress is expressed in the form of the psychosocial integration in the professional and family life, we have tried to explain on the basis of 204 ketamnestically observed surgically treated patients wheter and in which way these sociological spheres are disturbed and what parameters disturb the invalidation behaviour. After clearing up these factors it was our concern to again point out the necessity of a complete rehabilitation under consideration of a multifactorial genesis of these psychic disturbances.