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Wernicke Encephalopathy as the First Presentation of Neuromyelitis Optica Spectrum Disorder With Horizontal Nerve Palsy

Supahiah P, Thomas BHI, Zhen PC, Aris AM, Abdul-Jalil F, Din NM

J Neuroophthalmol, 2023 Dec 01;43(4):e293-e295.
PMID: 34924530 DOI: 10.1097/WNO.0000000000001444
Matched MeSH terms: Paralysis
Vocal Fold Injury Following Intubation

Mohd Umbaik NA, Mohamad I, Nik Hassan NFH

J Craniofac Surg, 2020 10;31(7):2064-2065.
PMID: 32890162 DOI: 10.1097/SCS.0000000000006839
Matched MeSH terms: Vocal Cord Paralysis*
Vincristine-induced vocal cord palsy: case report and review of the literature

Latiff ZA, Kamal NA, Jahendran J, Alias H, Goh BS, Syed Zakaria SZ, et al.

J Pediatr Hematol Oncol, 2010 Jul;32(5):407-10.
PMID: 20505534 DOI: 10.1097/MPH.0b013e3181e01584

Vincristine-induced vocal cord paralysis is a rare but serious complication. We report 2 patients with acute lymphoblastic leukemia who developed progressive stridor during induction chemotherapy. There were no clinical features of peripheral or autonomic neuropathy. Flexible laryngoscopy confirmed the diagnosis of bilateral vocal cord palsy; interestingly, the nerve conduction test revealed axonal motor neuropathy involving the median and common peroneal nerves in both patients. The first patient required prolonged ventilatory support necessitating unilateral cordectomy before extubation, whereas the second only required supplemental oxygen therapy. There was resolution of stridor in the first patient after cordectomy and gradual clinical improvement in the second. These cases illustrate that a high index of suspicion of vincristine-induced vocal cord palsy with prompt otolaryngology consultation for laryngoscopy is required in the diagnostic evaluation of a patient who has received vincristine.

Matched MeSH terms: Vocal Cord Paralysis/chemically induced*; Vocal Cord Paralysis/drug therapy
Fulltext Unilateral adductor vocal cord palsy treated with the titanium vocal fold medializing implant (TVFMI)

Irfan M, Shahid H, Baharudin A, Friedrich G

Med J Malaysia, 2009 Mar;64(1):89-90.
PMID: 19852333 MyJurnal

Vocal cord palsy secondary to recurrent laryngeal nerve injury may be attributable to trauma, infiltrating neoplasm, congenital cardiac anomaly and others. Regardless the causes, majority of unilateral adductor palsy cases are usually managed by speech rehabilitation in order to allow compensation. In selected cases, medialization procedure may be required to achieve a complete glottal closure during phonation. Multiple techniques have been developed to achieve this goal. This case report illustrates the recent advancement in vocal fold medialization procedure, which has not been widely practiced in Malaysia.

Matched MeSH terms: Vocal Cord Paralysis/surgery*
Fulltext Ultrasonic scissors-assisted 'open-book' thyroidectomy in massive goiter compressing airway and causing unilateral vocal cord paralysis

Irfan M, Yaroko AA, Soleh MN, Periasamy C

Med J Malaysia, 2013 Apr;68(2):183-5.
PMID: 23629575

A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62- year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.

Matched MeSH terms: Vocal Cord Paralysis*
Total paralysis regime in severe tetanus

Alhady SMA, Bowler DP, Reid HA, Scott LT

Br Med J, 1960;1:540-545.

Tetanus may be mild, moderate, severe, or inevitably fatal. Our clinical experience suggests it may be classified as severe (or, maybe, inevitably fatal) when a tetanic spasm stops respiration. Ten patients with severe tetanus were treated by the total paralysis regime (T.P.R.), consisting of tracheostomy, curarization, and intermittent positiveor positive/negative-pressure respiration. Two of the patients were saved by T.P.R. and therefore only limited effectiveness can be claimed for the regime. In inevitably fatal cases survival can be prolonged by T.P.R. so that further effects of tetanus toxin emerge. Of these, the most important appears to be direct damage to the myocardium.

Matched MeSH terms: Paralysis
Thyrotoxicosis presenting as hypokalaemic paralysis and hyperlactataemia in an oriental man

Al-Jubouri MA, Inkster GD, Nee PA, Andrews FJ

Ann. Clin. Biochem., 2006 Jul;43(Pt 4):323-5.
PMID: 16824287 DOI: 10.1258/000456306777695681

A 35-year-old Malaysian man presented with rapid onset of flaccid quadriparesis associated with nausea and vomiting. General blood tests revealed severe hypokalaemia (serum potassium 1.5 mmol/L) and hypophosphataemia (serum phosphate 0.29 mmol/L) as a potential cause of the flaccid paralysis. Arterial blood gases showed mixed acid base disturbance of respiratory alkalosis and metabolic acidosis with hyperlactataemia. Thyrotoxic periodic paralysis (TPP) was suspected as the underlying cause of this presentation and thyroid function tests showed severe hyperthyroid results (free T4 > 77.2 pmol/L, free T3 19.3 pmol/L, thyroid-stimulating hormone [TSH] < 0.05 mIU/L). Treatment with intravenous potassium and phosphate infusion and oral propranolol resulted in rapid resolution of his symptoms. A discussion of the clinical and pathophysiological features and treatment of TPP (a very rare encounter in UK clinical practice) is presented, and to our knowledge associated hyperlactataemia has not been previously described.

Matched MeSH terms: Hypokalemic Periodic Paralysis/complications; Hypokalemic Periodic Paralysis/diagnosis*; Hypokalemic Periodic Paralysis/ethnology
Fulltext Thyrotoxic periodic paralysis: a report of 3 Malaysian cases and a review of its pathology

Sthaneshwar P, Prathibha R, Yap SF

Malays J Pathol, 2005 Jun;27(1):29-32.
PMID: 16676690

Thyrotoxic periodic paralysis (TPP) is a medical emergency characterised by sudden onset of muscle weakness with hypokalemia that resolves with the treatment of hyperthyroidism. We report three cases of thyrotoxic periodic paralysis seen at the Accident and Emergency Care Department, University of Malaya Medical Centre in a period of four months. We also review the clinical presentation, pathophysiology, biochemical features and management of TPP. All three patients were young Asian males, presenting with muscle weakness of sudden onset. The first patient presented with lower limb weakness and had symptoms of thyrotoxicosis and goitre. He had a previous similar episode which resolved spontaneously. The second patient presented with quadriplegia, respiratory acidosis and had no signs and symptoms of thyrotoxicosis. The electrocardiogram of this patient showed normal sinus rhythm with U wave in V3 and a flat T wave, which are characteristic of hypokalaemia. The third patient, who was a known case of thyrotoxicosis, was admitted thrice for hypokalemic paralysis during the study period. All cases had low serum potassium, suppressed TSH and elevated T4 confirming thyrotoxic periodic paralysis. Potassium therapy was useful during the crisis; however prophylactic potassium has not been shown to prevent attacks as seen in one of our cases.

Matched MeSH terms: Hypokalemic Periodic Paralysis/pathology*; Hypokalemic Periodic Paralysis/physiopathology
Thyrotoxic periodic paralysis and intravenous propranolol in the emergency setting

Birkhahn RH, Gaeta TJ, Melniker L

J Emerg Med, 2000 Feb;18(2):199-202.
PMID: 10699522

A 27-year-old male of Malaysian descent presented to the Emergency Department (ED) with rapidly progressive flaccid paralysis that quickly compromised his respiratory effort. The patient was found to have a serum potassium of 1.9 meq/L, and was diagnosed as having an acute paralytic episode secondary to thyrotoxic periodic paralysis. The paralytic attack was aborted with a combination of potassium replacement and parenteral propranolol in large doses. We report the use of a rarely described, yet possibly more effective, therapy for an acute attack of thyrotoxic periodic paralysis.

Matched MeSH terms: Paralysis/drug therapy*; Paralysis/etiology*
Fulltext Thoracic aortic aneurysm presenting as vocal cord paralysis

Norly, S., Noorizan, Y., Ros’aini, P.

International Medical Journal Malaysia, 2013;12(1):67-68.
MyJurnal

We present a case of 80-year-old man with two-year history of hoarseness of voice secondary to left vocal cord paralysis. CT scanning revealed a saccular thoracic aneurysm compressing the left recurrent laryngeal nerve. A review of literature on Ortner's or cardiovocal syndrome is presented.

Matched MeSH terms: Vocal Cord Paralysis
Fulltext The dilemma of diagnosing wound botulism in an infant: A rare case of paralysis with topical application of honey

Mohd Tamrin MI

Int J Infect Dis, 2020 Jun;95:157-159.
PMID: 32220630 DOI: 10.1016/j.ijid.2020.03.044

Botulism is a form of paralysis caused by a neurotoxin produced by the bacterium Clostridium botulinum. It is well known that natural honey contains Clostridium botulinum spores; controversy arises when a honey-related product is being used for wound care, where the possibility occurs of applying these spores to an open wound. To our knowledge, no reported cases of medical-grade honey have been associated with wound botulism. Given this fact, do we feel secure regarding the safety of this product, and will it be enough to alleviate our concern? We present a case of an infant with an infected umbilical stump, which required a surgical wound debridement. This infant developed a sudden progressive flaccid paralysis a few days after the application of topical medical grade honey for wound care. Even though suspicion of wound botulism is high, confirmation of the diagnosis, detection of neurotoxin, and isolating the organism remains a challenge.

Matched MeSH terms: Paralysis/etiology
Fulltext The association between myopia and gender in Indian schoolchildren in Kuala Lumpur

Norhani Mohidin, Saadah Mohd Akhir, Bariah Mohd Ali, Zainora Mohammed, Sharanjeet, K., Chung, K.M.

Jurnal Sains Kesihatan Malaysia, 2005;3(2):49-54.
MyJurnal

A vision screening study was carried out among Indian schoolchildren around Kuala Lumpur to determine whether the prevalence of myopia was higher in boys or girls. Altogether 749 students (49.7% boys and 50.3% girls) aged 7-18 years were screened and their refractive error examined using retinoscopy without cycloplegia. For the right eye 15.1% of the girls' eyes were found to be myopic as compared to 16.9% of the boys, of which chi-square showed no significant difference (p = 0.44). For the left eye 18.8% of the girls' eyes were myopic as compared to 16.4% of the boys. Chi square also showed no significant difference (p = 0.26). When high myopia (> -6.00D) was considered, there was no difference found between boys and girls. The number of students with high myopia greater than -6.00D was also very small (0.3%-0.5%). In conclusion, it was found that there was no significant difference in myopia between girls and boys among Indian schoolchildren.

Matched MeSH terms: Paralysis
Tembusu-like flavivirus (Perak virus) as the cause of neurological disease outbreaks in young Pekin ducks

Homonnay ZG, Kovács EW, Bányai K, Albert M, Fehér E, Mató T, et al.

Avian Pathol, 2014;43(6):552-60.
PMID: 25299764 DOI: 10.1080/03079457.2014.973832

A neurological disease of young Pekin ducks characterized by ataxia, lameness, and paralysis was observed at several duck farms in Malaysia in 2012. Gross pathological lesions were absent or inconsistent in most of the cases, but severe and consistent microscopic lesions were found in the brain and spinal cord, characterized by non-purulent panencephalomyelitis. Several virus isolates were obtained in embryonated duck eggs and in cell cultures (Vero and DF-1) inoculated with the brain homogenates of affected ducks. After exclusion of other viruses, the isolates were identified as a flavivirus by flavivirus-specific reverse transcription-polymerase chain reaction (RT-PCR) assays. Inoculation of 2-week-old Pekin ducks with a flavivirus isolate by the subcutaneous or intramuscular route resulted in typical clinical signs and histological lesions in the brain and spinal cord. The inoculated virus was detected by RT-PCR from organ samples of ducks with clinical signs and histological lesions. With a few days delay, the disease was also observed among co-mingled contact control birds. Phylogenetic analysis of NS5 and E gene sequences proved that the isolates were representatives of a novel phylogenetic group within clade XI (Ntaya virus group) of the Flavivirus genus. This Malaysian Duck Tembusu Virus (DTMUV), named Perak virus, has moderate genomic RNA sequence similarity to a related DTMUV identified in China. In our experiment the Malaysian strain of DTMUV could be transmitted in the absence of mosquito vectors. These findings may have implications for the control and prevention of this emerging group of flaviviruses.

Matched MeSH terms: Paralysis/veterinary
Surgical outcomes of transmastoid facial nerve decompression: Preliminary data from a Malaysian tertiary hospital from 2013-2018

Siang PG, Ying XT, Dayang Suhana AM, Ing PT

Med J Malaysia, 2020 05;75(3):281-285.
PMID: 32467545

INTRODUCTIONS: Facial nerve palsy (FNP) occurs in 7-10% of temporal bone fractures. The aim of this study was to review the surgical outcome of nine patients with severe to complete traumatic facial nerve (FN) injury.
METHODS: The patients were evaluated clinically and FNP was graded using the House Brackmann (HB) scale. High resolution computerized tomography (HRCT) of the temporal bone was used to evaluate temporal bone fractures. Transmastoid facial nerve decompression was performed and the facial nerve function was re-evaluated in subsequent follow ups.
RESULTS: There were five cases with immediate onset and four with delayed onset of FNP. Only three cases had pure temporal bone fractures, the others were associated with other life threatening injuries. The sensitivity and specificity of HRCT temporal bone to detect the obvious facial canal fracture line were 50% and 40% respectively. 75% of patients with immediate onset of HB grade VI FN palsy who were operated within a month recovered completely. Surgeries for the delayed onset FNP were performed at a mean of 70 days (range 51-94). All recovered to HB grade II-III from severe FNP.
CONCLUSIONS: Our study demonstrated that transmastoid FN decompression surgery was beneficial to traumatic nerve injury. Early intervention resulted in better outcomes. However, FN function could still be salvaged even in delayed FN decompression.

Matched MeSH terms: Facial Paralysis/surgery*
Fulltext Surgical intervention in traumatic facial nerve paralysis

Yeoh TL, Mahmud R, Saim L

Med J Malaysia, 2003 Aug;58(3):432-6.
PMID: 14750385

A four years review from June 1998 to June 2002 of traumatic facial nerve paralysis from temporal bone fractures that required surgical intervention is presented. The aim of this clinical presentation was to determine the current pattern of cases with traumatic facial paralysis which required surgical intervention at our center. There were six cases, of which four (66%) were longitudinal fractures, one each (17%) had transverse fracture and fracture over the lateral wall of mastoid. Hearing loss (83%) was the commonest associated clinical symptom. All cases underwent decompression via the transmastoid surgical approach. Intraoperative findings revealed oedema of facial nerve involving vertical segment and horizontal segment in three cases each respectively. Two cases had concomitant bony impingement. The facial nerve functions in four cases (66%) and one case recovered to House Brackmann grade 2 and 4, 12 months and 3 months respectively postsurgery. The case with transverse fracture remained as House Brackmann grade 5 after two years.

Matched MeSH terms: Facial Paralysis/etiology*; Facial Paralysis/surgery*
Fulltext Severe neurotoxic envenoming by the Malayan krait Bungarus candidus (Linnaeus): response to antivenom and anticholinesterase

Warrell DA, Looareesuwan S, White NJ, Theakston RD, Warrell MJ, Kosakarn W, et al.

Br Med J (Clin Res Ed), 1983 Feb 26;286(6366):678-80.
PMID: 6402200

Five patients were bitten by the Malayan krait Bungarus candidus (Linnaeus) in eastern Thailand or north western Malaya. Two patients were not envenomed but the other three developed generalised paralysis which progressed to respiratory paralysis in two cases, one of which ended fatally. One patient showed parasympathetic abnormalities. Anticholinesterase produced a dramatic improvement in one patient. Another patient probably benefited from paraspecific antivenom. The efficacy of antivenoms and adjuvants such as anticholinesterases in patients with neurotoxic envenoming requires further study.

Matched MeSH terms: Paralysis/etiology
Selective Laryngeal Examination: Sensitivity of Endocrine Surgeons in Screening Voice Abnormality

Al-Yahya SN, Muhammad R, Suhaimi SNA, Azman M, Mohamed AS, Baki MM

J Voice, 2020 Sep;34(5):811.e13-811.e20.
PMID: 30612893 DOI: 10.1016/j.jvoice.2018.12.003

OBJECTIVES: Selective laryngeal examination for patients undergoing thyroidectomy is recommended for patients with voice alterations, history of prior cervical or chest surgery, and patients with proven or suspected thyroid malignancy. The study objective is to measure the sensitivity of surgeons in detecting voice abnormalities in patients undergoing thyroidectomy, parathyroidectomy complicated with laryngeal nerve paralysis, or patients with known vocal cords palsy (VCP) due to other neck surgeries.
DESIGN AND SETTING: Descriptive cross-sectional study in a tertiary center.
PARTICIPANTS AND METHODS: The subjects are 274 audio files of voices of patients undergoing thyroid, parathyroid surgeries, and known VCP due to other neck surgeries. Voice assessments were done by three endocrine surgeons (A, B, and C) with 20, 12, and 4 years of surgical experience.
MAIN OUTCOME MEASURES: Sensitivity and specificity of surgeon documented voice assessment in patients with underlying VCP. Subjects' acoustic analysis and Voice Handicap Index (VHI-10) were analyzed.
RESULTS: Raters A, B, and C have sensitivity of 63.6%, 78.8%, and 66.7%, respectively. Inter-rater reliability shows substantial agreement (ƙ = 0.67). VHI-10 has sensitivity of 75.8% and strong correlation of 0.707 (p value <0.001) to VCP. Subjects with VCP have notably higher jitter, shimmer, and noise-to-harmonic ratio compared to normal subjects with sensitivity of 74.2%, 71.2%, and 72.7%, respectively.
CONCLUSIONS: The results for surgeons documented voice assessment did not reach the desired sensitivity for a screening tool for patients with underlying VCP. Other tools such as VHI-10 and acoustic analysis may not be used as standalone tools in screening patients with underlying VCP. Routine preoperative laryngeal examination may be recommended for all patients undergoing thyroid, parathyroid, or other surgeries that places the laryngeal nerves at risk.

Matched MeSH terms: Vocal Cord Paralysis
Fulltext Retrospective review of facial nerve schwannomas: the universiti kebangsaan malaysia medical centre experience

Mazita, A., Zahirrudin, Z., Saim, L., Asma, A.

Medicine & Health, 2010;5(2):86-92.
MyJurnal

Facial nerve schwannoma is a rare slow growing benign tumour which arises from the Schwann cell of the neurilemma. A retrospective review of 6 patients who had been diagnosed with facial nerve schwannoma between 1998 and 2008 was conducted. There was equal distribution of male and female patients. The mean age was 42 years (range 19 to 66 years). The tumour originated in the internal auditory canal (2 patients), intra-temporal (3 patients) and intraparotid (1 patient) segments of the facial nerve. All tumours were successfully removed and facial nerve continuity was pre-served in 2 cases. The presenting symptoms of facial nerve schwannoma are non specific and dependent on the site of tumour origin. It is a great mimicker of other lesions that can present at the same location. The surgeon should have a high index of suspicion when patients present with progressive facial nerve palsy. Patients should always be counselled regarding risk of facial paralysis because the diagnosis of facial nerve schwannoma is often confirmed intra-operatively.

Matched MeSH terms: Facial Paralysis
Fulltext Reoperative thyroid surgery in hospital universiti sains malaysia

Tun M, Salekan K, Sain AH

Malays J Med Sci, 2003 Jan;10(1):86-9.
PMID: 23365506 MyJurnal

From 1996 to 2001, 393 thyroidectomies were performed and 25 (6.4%) patients underwent reoperative thyroid surgery at Hospital Universiti Sains Malaysia. All reoperated patients had undergone one prior thyroid operation. All were females with an average age of 39.1 years (18-61 years). The most frequent indication for reoperation was cancer in resected specimen of an originally misdiagnosed carcinoma treated by partial thyroid resection. Final histological diagnosis of 25 reoperations showed thyroid carcinoma in 22 (88%) cases and multinodular goiter in 3 cases. The overall interval between the initial and the reoperative procedures ranged from 3 weeks to 15 years. There was no post-operative mortality after reoperation. Post-operative complications were discovered in 5 patients, as 3 (12%) of whom had transient hypocalcaemia, one (4%) had wound breakdown and one (4%) had permanent recurrent laryngeal nerve palsy. Reoperative thyroid surgery is an uncommon operation with high complication rate.

Matched MeSH terms: Vocal Cord Paralysis
Relapse of B-cell acute lymphoblastic leukaemia presenting as right aural polyp with facial and mandibular nerves palsy

Shiun Chuen C, Md Daud MK, Che Jalil NA, Hazmi H

Med J Malaysia, 2017 10;72(5):318-320.
PMID: 29197892 MyJurnal

A patient presenting with an ear polyp is a common finding in otorhinolaryngology practice. The common causes include chronic otitis media and cholesteatoma. We report an adult female patient with a history of acute leukaemia presenting with chronic otitis media symptoms and right ear polyp. She was subsequently diagnosed as relapse of B-cell acute lymphoblastic leukaemia based on histopathological examination. The presentation may be similar to an inflammatory pathology of the middle ear, making it misleading.

Matched MeSH terms: Facial Paralysis/physiopathology*

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