Laryngeal electromyography.

Laryngeal electromyography (LEMG) evaluates the integrity of the neuromuscular system in the larynx by recording action potentials generated in the laryngeal muscles during voluntary and involuntary contraction. LEMG is particularly useful for helping to differentiate between disorders involving upper motor neurons, lower motor neurons, peripheral nerves, the neuromuscular junction, muscle fibers, and the laryngeal cartilages and joints. LEMG should be considered to be an extension of the physical examination, not an isolated laboratory procedure.

Thoracic paraparesis following an embolic vascular event during lumbar spinal surgery.

Objective: A case report illustrating the rare occurrence of thoracic paraparesis following the presumed occurrence of an embolic vascular event during lumbar spinal surgery is presented. The goal is to investigate the potential causes of acute postoperative paraparesis following lumbar spine surgery. A discussion of the symptoms, diagnosis, differential diagnosis, and management of spinal cord ischemia and postembolic infarction is presented.

Diagnostic algorithms for neuromuscular diseases.

Neuromuscular disorders can impose significant disability in patients by virtue of weakness, pain, and sensory and autonomic symptoms and deficits. For all of these disorders, supportive measures, appropriate physical therapy, and respiratory support are beneficial. Pain management can be accomplished by the use of antiepileptic medications, such as carbamazepine, phenytoin, valproic, and gabapentin.

Urologic manifestation of spinal cord sarcoidosis.

We present the first report of neurogenic lower urinary tract dysfunction associated with neurosarcoidosis. Urodynamic findings of detrusor hyperreflexia with detrusor-sphincter dyssynergia correlate with this patient's magnetic resonance imaging (MRI) examination which found intramedullary involvement at the mid-thoracic level.

Vagus nerve stimulation for treatment of partial seizures: 1. A controlled study of effect on seizures. First International Vagus Nerve Stimulation Study Group.

Vagus nerve stimulation (VNS) was shown to reduce seizure frequency in refractory epilepsy patients in two pilot studies. Based on these results, a multicenter, prospectively randomized, parallel, double-blind study of patients with refractory partial seizures was initiated. After a 12-week baseline period, identical vagus nerve stimulators were implanted and patients randomized to either a high or low 14-week VNS treatment paradigm.

Antiepileptic drug intoxication: factors and their significance.

A retrospective chart review (1979-1985) was performed to identify probable causes of intoxication with antiepileptic drugs (AEDs). We identified 141 patients meeting clinical and laboratory criteria for intoxication and 17 with clinical signs but with serum concentrations within the therapeutic range. The majority were epileptic patients; almost half were treated with monotherapy, most with phenytoin (PHT).

Visualization of isolated trigeminal nerve invasion by lymphoma using gadolinium-enhanced magnetic resonance imaging.

A 50-year-old man with active histiocytic lymphoma for 12 years developed an isolated right trigeminal neuropathy. Initial evaluation with head computed tomography, X-rays of the skull base, bone scan, and cerebrospinal fluid analysis including cytology were normal. Gadolinium-enhanced magnetic resonance imaging (MRI) showed enlargement of the proximal third of the right trigeminal nerve.

Phenytoin-induced seizures: a paradoxical effect at toxic concentrations in epileptic patients.

We examined the incompletely defined convulsant action of phenytoin (PHT) at toxic concentrations in humans. A retrospective chart review (1979-1985) yielded 96 cases (90 patients), meeting both clinical and laboratory criteria for PHT intoxication. Seven patients, all with epilepsy, had one or more seizures while toxic.

Dissociated weakness of sternocleidomastoid and trapezius muscles with lesions in the CNS.

We describe three patients with lesions in the CNS that produced dissociated weakness of trapezius (TM) and sternocleidomastoid muscles (SCM). One patient with a right cerebral hemisphere lesion had left TM weakness and right SCM weakness. A second, with a brainstem lesion, and a third, with a high cervical cord lesion, had TM weakness with preserved SCM strength.

Familial 'sleep apnea plus' syndrome: report of a family.

We describe a familial disorder consisting of sleep apnea, anosmia, colorblindness, partial complex seizures, and cognitive dysfunction. The phenotypic expression of the syndrome suggests an autosomal dominant inheritance with incomplete penetrance.