Thixotropy of levator palpebrae as the cause of lagophthalmos after peripheral facial nerve palsy.
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Patients with facial nerve palsy are at risk of developing corneal ulceration because of lagophthalmos (incomplete closure of the affected eyelid). Lagophthalmos could result from thixotropy of the levator palpebrae muscle--that is, the formation of tight crossbridges between the actin and myosin filaments of the muscle fibres causing stiffness of the muscle--rather than from paralysis of the orbicularis occuli muscle as previously supposed. This possibility was investigated in 13 patients with a peripheral facial nerve palsy in a prospective open study. The levator muscle of the affected eyelid was stretched by manipulation and downward movement of the passively closed upper eyelid for approximately 15 seconds. The amount of lagophthalmos was measured before and immediately after this manoeuvre. In all patients except one there was a clear reduction in lagophthalmos (mean reduction 72%; range 60-100%). Thus in this setting the lagophthalmos appears to be caused by thixotropy of the levator palpebrae muscle, which has implications for treatment. (+info)
Bilateral peripheral facial palsy secondary to lymphoma in a patient with HIV/AIDS: a case report and literature review.
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Neurological complications represent one of the most important causes of morbidity and mortality in patients with HIV/AIDS. However, peripheral neuropathy comprises only 5% to 20% of the total neurological complications and facial nerve palsy, especially when it is bilateral, is a less common manifestation. Peripheral facial palsy has been considered as a possible neurological complication of the early stage of HIV infection but the number of reported cases in the literature is limited. Histological findings of nervous tissue in peripheral facial palsy at an early stage of HIV infection include a degenerative and not suppurative inflammatory process, but its etiology remains obscure. Peripheral facial palsy in the late stage of HIV infection is characterized by an advanced immunological deficit and generally it is secondary to an opportunistic infection of the CNS, such as neurotoxoplasmosis and lymphoma. However, this peripheral attack of the facial nerve is not very common at this late stage of HIV infection. Bilateral peripheral facial palsy as a complication of non-Hodgkin s lymphoma is considered an extremely rare entity. There are no published reports of bilateral peripheral facial palsy secondary to lymphomas or other neoplasms of the CNS in immunosuppressed patients. Non-Hodgkin s lymphoma (NHL) has been considered a late and relatively common manifestation of HIV infection, but an exact cause for the higher incidence of this malignant neoplasm in HIV/AIDS patients is still uncertain. (+info)
Blink reflex in the prediction of outcome of idiopathic peripheral partial facioparesis: follow-up study.
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AIM: To determine the value of the blink reflex as a predictor of outcome of idiopathic peripheral partial facial paresis. METHOD: The study included 30 patients suffering from acute idiopathic peripheral facioparesis and 30 age- and sex-matched healthy controls. Patients with symptomatic disease were excluded on the basis of neuroradiologic and laboratory findings. We stimulated the supraorbital foramen and recorded the evoked response from both orbiculares oculi muscles. We measured the ipsilateral early phasic component (R1) and bilateral late tonic component (ipsilateral R2 and contralateral R2) immediately, and a week and 6 months after the first test. RESULTS: In the acute phase of idiopathic peripheral partial facioparesis, the blink reflex showed slightly prolonged latencies and greatly reduced amplitudes of both R1 and R2 and the normal latencies and amplitudes of R2. All subjects showed clinical symptoms and typical electromyographic (EMG) changes, whereas 24 had blink reflex abnormalities. One week after the onset, all patients were still symptomatic and showed EMG changes, but blink reflex abnormalities remained in only 11 patients. Six months after the onset, 21 patients became asymptomatic and showed no EMG changes, 7 had no clinical symptoms but showed chronic neurogenic EMG changes, whereas 2 showed both clinical symptoms and EMG changes. Blink reflex abnormalities were observed in 6 patients. The amplitudes of R1 immediately and one week after the onset were the best predictors of residual motor deficit. CONCLUSION: Blink reflex is a useful tool for follow-up and recovery prognosis in patients with partial idiopathic facioparesis, especially in the early recovery phase. (+info)
The effect of apomorphine on blink kinematics in subhuman primates with and without facial nerve palsy.
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PURPOSE: The purpose of this study was to document the effect of acutely delivered apomorphine, a dopamine receptor agonist with both D1 and D2 properties, on blink rate and the amplitude-velocity characteristics of eyelid kinematics in a group of nonhuman primates. METHODS: Three cynomolgus and two rhesus macaques underwent baseline recordings for eyelid kinematics, using the Robinson search coil technique. Next, each animal received a 0.15-mg/kg subcutaneous injection of apomorphine. Recordings were taken at 45 and 90 minutes, respectively, after injection. Blink rates per minute were obtained, and main sequence relationships were calculated for every animal. The data were pooled for each eyelid, excluding one monkey who was affected by facial nerve palsy and was analyzed separately. RESULTS: Monkeys with normal facial musculature and normal baseline blink rates showed consistently longer, faster blinks after apomorphine. The main sequence relationship, although tending to be lower, was not statistically different from baseline. One monkey, with prior facial nerve palsy and a very steep amplitude versus peak velocity relationship, showed normalization of the main sequence slope after apomorphine at both 45 and 90 minutes after injection. CONCLUSIONS: Apomorphine consistently lowers blink rate and changed blink metrics in normal monkeys and, more dramatically, in a monkey with facial nerve palsy. These findings add credence to models in which dopamine deficiency plays a role in the modulation of blink kinematics. (+info)
Emotional facial paresis in temporal lobe epilepsy: its prevalence and lateralizing value.
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The selection of patients with medically refractory temporal lobe epilepsy (TLE) for surgery depends on the concordance of data from clinical, imaging and electroencephalographic evaluation. Though clinical examination is often normal, emotional facial paresis has been described in patients with TLE. Utilizing a well-characterized group of mesial TLE (MTLE) patients, who have achieved excellent seizure outcome following anterior temporal lobectomy with amygdalohippocampectomy (ATL), we investigated the prevalence, predictive value and associations of emotional facial paresis. When compared to 8 out of 50 control subjects (16%), 36 out of 50 MTLE patients (72%) exhibited unilateral emotional facial paresis; the difference was highly significant (P<0.0001). The presence of contralateral emotional facial paresis correctly predicted the side of ATL in 86.1% patients. The occurrence of emotional facial paresis was significantly associated with longer duration of epilepsy prior to ATL and left ATL. Our observations confirm that emotional facial parersis contralateral to the side of mesial temporal sclerosis (MTS) is a valuable localizing sign in correctly predicting the epileptogenic temporal lobe. We hypothesize that the presence of an intact right hemisphere and pathological changes more extensive than MTS may be required for emotional facial paresis to readily manifest. (+info)
Facial nerve palsy after intracisternal papaverine application during aneurysm surgery--case report.
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A 61-year-old woman suffered transient mydriasis and prolonged facial nerve palsy after intracisternal papaverine application subsequent to elective clipping of an unruptured middle cerebral artery aneurysm. The mydriasis resolved within 90 minutes, but the facial nerve dysfunction persisted for 2 months before complete recovery. Prolonged irrigation of the cisterns may have washed the papaverine into contact with the facial nerve. This case supports previously reported evidence of a possible effect of topical intracisternal papaverine hydrochloride application on the facial nerve. (+info)
Pathological laughter in a patient with trigeminal neurinoma.
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We present a 47-year-old woman with a long history of anxiety and a more recent history of shock-like facial pain and episodes of laughter without any motivation. She could not explain the laughing bursts and did not have a sense of mirth preceding it. On neurological examination she presented a VI nerve palsy and trigeminal hypoesthesia (V2 and V3) on the right side. Magnetic resonance imaging exhibited a large cystic lesion on the right middle fossa causing significant compression on the brain stem. A frontoorbitozygomatic and pretemporal combined approach was performed. During intra and extradural exploration a large tumor was found on the trigeminal nerve. The whole lesion was resected, revealing to be a neurinoma on pathological exhamination. She maintained a VI nerve palsy but had complete remission of the unmotivated laughing episodes during the one year follow up. (+info)
Preoperative facial muscle imaging predicts final facial function after facial nerve grafting.
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BACKGROUND AND PURPOSE: Our goal was to determine whether preoperative MR imaging of facial muscles predicts facial function after facial nerve grafting. METHODS: A retrospective review of all patients undergoing facial nerve grafting between 1997 and 2001 revealed 26 patients. Twelve of the patients had adequate preoperative MR images available for review and had undergone clinical follow-up for at least 12 months. Eight had malignant parotid tumors, and four had benign skull base or parotid tumors. Preoperative facial muscle MR imaging appearance was categorized as symmetrical or asymmetrical. The asymmetrical images were further classified into mild or pronounced asymmetry. Preoperative facial function was classified by using the House-Brackmann scale. Postoperative function was graded with the May scale. RESULTS: Four patients had symmetrical facial muscles shown by preoperative MR imaging, three had mild asymmetry, and five had pronounced asymmetry. No or mild asymmetry had an 86% positive predictive value for good to excellent functional outcome. Eighty percent of patients with pronounced asymmetry experienced poor functional outcomes. Six of eight patients with malignant and perineural tumors at surgery had asymmetrical facial muscles revealed by preoperative MR imaging studies. CONCLUSION: Symmetrical or mildly asymmetrical facial muscles are predictive of good facial function after nerve grafting. Pronounced asymmetry of facial muscles on MR images is predictive of poor facial function after grafting. Asymmetric facial muscles on preoperative MR images are associated with perineural tumor spread in patients with malignant disease. (+info)