New determinants for casual peripheral mechanism of neurogenic lung edema in subarachnoid hemorrhage due to ischemic degeneration of vagal nerve, kidney and lung circuitry. Experimental study

Abstract Purpose: To evaluate whether there is a relationship between renal artery vasospasm related low glomerular density or degeneration and neurogenic lung edema (NLE) following subarachnoid hemorrhage. Methods: This study was conducted on 26 rabbits. A control group was formed of five animals, a SHAM group of 5 to which saline and a study group (n=16) injected with homologous blood into the sylvian cisterna. Numbers of degenerated axons of renal branches of vagal nerves, atrophic glomerulus numbers and NLE scores were recorded. Results: Important vagal degeneration, severe renal artery vasospasm, intrarenal hemorrhage and glomerular atrophy observed in high score NLE detected animals. The mean degenerated axon density of vagal nerves (n/mm2), atrophic glomerulus density (n/mm3) and NLE scores of control, SHAM and study groups were estimated as 2.40±1.82, 2.20±1.30, 1.80±1.10, 8.00±2.24, 8.80±2.39, 4.40±1.14 and 154.38±13.61, 34.69±2.68 and 12.19±1.97 consecutively. Degenerated vagal axon, atrophic glomerulus and NLE scores are higher in study group than other groups and the differences are statistically meaningful (p<0.001). Conclusion: Vagal complex degeneration based glomerular atrophy have important roles on NLE following SAH which has not been extensively mentioned in the literature.

Avaliação por imagem da paralisia de pregas vocais / Imaging evaluation of vocal cord paralysis

Paralisia das pregas vocais é causa frequente de rouquidão, podendo ser secundária a várias lesões ao longo do trajeto do X par craniano e seus ramos, particularmente os nervos laríngeos recorrentes. Apesar de grande parte dos casos ser idiopática, os métodos de imagem são muito importantes na pesquisa de fatores etiológicos, tais como lesões neoplásicas da tireoide e esôfago com invasão secundária dos nervos laríngeos recorrentes. Além destas, outras anormalidades como aneurismas do arco aórtico e da artéria subclávia direita podem ser encontradas. É fundamental que o radiologista conheça a anatomia pertinente a esta região e as principais afecções que podem ocorrer, para que o estudo seja corretamente planejado, auxiliando o diagnóstico e o planejamento terapêutico. Além disso, como até 35 por cento dos casos de paralisia da prega vocal são assintomáticos, o conhecimento dos sinais radiológicos que indicam esta condição é indispensável, cabendo ao radiologista alertar o médico assistente sobre os achados do exame. Neste trabalho realizamos uma revisão da anatomia e das principais doenças responsáveis pela paralisia de cordas vocais, demonstrando-as por meio de estudos de tomografia computadorizada e ressonância magnética de casos típicos. Mostramos, também, as alterações radiológicas próprias da laringe que indicam a presença de paralisia das pregas vocais.

Vocal cord paralysis is a common cause of hoarseness. It may be secondary to many types of lesions along the cranial nerve X pathway and its branches, particularly the laryngeal recurrent nerves. Despite the idiopathic nature of a great number of cases, imaging methods play a very significant role in the investigation of etiologic factors, such as thyroid and esophagus neoplasias with secondary invasion of the laryngeal recurrent nerves. Other conditions such as aortic and right subclavian artery aneurysms also may be found. The knowledge of local anatomy and related diseases is of great importance for the radiologist, so that he can tailor the examination properly to allow an appropriate diagnosis and therapy planning. Additionally, considering that up to 35 percent of patients with vocal cord paralysis are asymptomatic, the recognition of radiological findings indicative of this condition is essential for the radiologist who must warn the referring physician on the imaging findings. In the present study, the authors review the anatomy and main diseases related to vocal cord paralysis, demonstrating them through typical cases evaluated by computed tomography and magnetic resonance imaging, besides describing radiological findings of laryngeal abnormalities indicative of this condition.

Thoracic Vagal Ganglion and Referred Craniofacial Pain: a Case Report and Review / Ganglio Torácico Vagal y Dolor Craneofacial Referido: Reporte de Caso y Revisión

The presence of a ganglion-like tumefaction is reported in the mediastinal course of the right vagus nerve at Tl level in a cadaver in the Universidad Industrial de Santander's morphology laboratory. The vagal ganglion was located next to hyperplasic lymphoid nodes in para-tracheal and tracheal-bronchial levels, agglomerating in a large lymphoid mass in the carina and the pulmonary hilum. Anatomical-pathological study revealed a marked, diffusely distributed, predominantly histo-lymphocyte mixed inflammation, separating the epineurium, producing lysis of the vagus nerve fibers. This finding showed the degeneration of this cranial par by mediastinal pathology. This provided a possible explanation for the physiopathology of pain referring to the head and neck in inflammatory or neoplastic pathology involving compression and degeneration by inflammatory infiltration of the vagus nerve. Pons-medullar trigeminal afferent tracts and connectivity, supra-spinal pathways for processing somatic-visceral pain, possible somatic-vegetative responses and the integration of the trigeminal system in the physiology of pain concerning the vagus nerve are all discussed.

Se reporta la presencia de una tumefacción a manera de "ganglio" en el trayecto mediastínico del nervio vago derecho, a nivel de TI, en un cadáver en el Laboratorio de Morfología de la Universidad Industrial de Santander, Colombia. El "ganglio" vagal se encuentra adyacente a nodos linfoides hiperplásicos, en niveles para-traqueales y tráqueo-bronquiales que se aglomeran en una gran masa linfoide a la altura de la carina e hilio pulmonar. En el estudio anatomopatológico, se encontró marcado proceso inflamatorio mixto de predominio histo-linfocitario el cual se distribuye de manera difusa separando el epineuro y produciendo lisis de las fibras del nervio vago. Este hallazgo muestra la degeneración de este par craneal por patologías a nivel mediastínico. Esto brinda una posible explicación de la fisiopatología del dolor referido a cabeza y cuello, en patologías inflamatorias o neoplásicas que involucran la compresión y degeneración por infiltración inflamatoria del nervio vago. Se discute los tractos y la conectividad de las aferencias vagales a nivel ponto-medular, las vías supraespinales para el procesamiento del dolor sómato-visceral, las posibles respuestas sómato-vegetativas y la integración del sistema trigeminal en la fisiología del dolor en el nervio vago.

Vagus Nerve Stimulation in Intractable Childhood Epilepsy: a Korean Multicenter Experience

We evaluated the long-term outcome of vagus nerve stimulation (VNS) in 28 children with refractory epilepsy. Of these 28 children, 15 (53.6%) showed a >50% reduction in seizure frequency and 9 (32.1%) had a >75% reduction. When we compared seizure reduction rates according to seizure types (generalized vs. partial) and etiologies (symptomatic vs. cryptogenic), we found no significant differences. In addition, there was no correlation between the length of the stimulation period and treatment effect. The seizure reduction rate, however, tended to be inversely related to the seizure duration before VNS implantation and age at the time of VNS therapy. VNS also improved quality of life in this group of patients, including improved memory in 9 (32.1%), improved mood in 12 (42.9%), improved behavior in 11 (39.3%), improved altertness in 12 (42.9%), improved achievement in 6 (21.4%), and improved verbal skills in 8 (28.6%). Adverse events included hoarseness in 7 patients, dyspnea at sleep in 2 patients, and wound infection in 1 patient, but all were transient and successfully managed by careful follow-up and adjustment of parameters. These results indicate that VNS is a safe and effective alternative therapy for pediatric refractory epilepsy, without significant adverse events.

Neurilemmoma of the cervical vagus nerve

A patient with neurilemmoma arising from the crevical vagus nerve is described and management discussed, as tumors originating from this site are seen very infrequently. The recommended treatment for this tumor is complete surgical excision while preserving the nerve and nerve grafting whenever necessary

Huge neurofibroma of intrathoracic vagus

A case of neurofibroma of the left vagus nerve associated with a Recklinghausen's disease is reported. The review of the literature shows how rare is this type of localisation, only 62 cases are reported since 1926. The authors remind us the absence of specific signs of vagal involvement and mildness of postoperative course of surgical excision

Inervaçäo do coraçäo a partir de um plexo abdominal no homem / Innervation of the heart from an abdominal plexus in men

E feito, em 43 peças de necropsia de indivíduos adultos, por meio de dissecçäo e de métodos histológicos usuais de coloraçäo e de impregnaçäo argêntica, estudo do conjunto formado pelo ligamento venoso, veia cava inferior e átrio direito. Os resultados indicam a presença de conexäo nervosa direta entre o plexo hepático e o átrio direito, feita por via que corre pelos ramos esquerdos da a. hepática e v. porta, ligamento venoso, ramo esquerdo da v. hepática e v. cava inferior atravessando o diafragma pelo forame da v. cava. Esta conexäo se processa por ramos nervosos muito finos da parte superior do ligamento venoso, visíveis apenas em nível microscópico