Laryngeal function in postpolio patients.

Of the 250,000 survivors of the polio epidemics, approximately 25% experience progressive muscle weakness known as postpolio syndrome (PPS). Laryngeal function in postpolio patients previously has not been studied. This paper presents data detailing laryngeal function in a group of postpolio patients who had been evaluated for swallowing complaints. Nine patients underwent comprehensive history and physical exam, acoustical voice analysis, and laryngeal videostroboscopic endoscopy. Three patients underwent laryngeal electromyography (EMG) evaluation. Results indicated some degree of phonatory or laryngeal deficit in all subjects. Subjects with dysphagia also demonstrated vocal fold paralysis. EMG revealed decreased recruitment and increased amplitude, findings consistent with EMG studies in skeletal muscle in postpolio patients. Results suggest that postpolio patients who complain of swallowing difficulties are at risk for laryngeal pathology.

The fate of medialized cartilage in thyroplasty type I.

Thyroplasty type I is rapidly emerging as the preferred means of medializing a paralyzed vocal fold. We discuss our experience with the fate of a medialized cartilage window 9 months after an otherwise successful operation. Cartilage resorption over time resulted in degeneration of voice and in progressive aspiration. We recommend removing the cartilage window rather than medializing it, in the interest of stabilizing the degree of long-term vocal fold medialization.

Severe disturbances in speech, swallowing, and gait following stereotactic infrathalamic lesions in Gilles de la Tourette's syndrome.

A 40-year-old man with severe Gilles de la Tourette's syndrome characterized by forceful self-injurious motor tics, coprolalia, and obsessive-compulsive disorder had bilateral anterior cingulotomies and bilateral infrathalamic lesions placed stereotactically during two neurosurgical procedures. During the second procedure, the patient acutely developed a marked dysarthria. Postoperatively, he manifested a severe gait disturbance with postural instability, bradykinesia, axial rigidity, micrographia, and a profound swallowing disorder. MRI showed asymmetric (left > right) low-density areas in an infrathalamic region as well as low-density areas bilaterally in the anterior cingulate gyri. Although the patient's tic and obsessive-compulsive symptoms improved, the self-injurious motor tics along with other motor and phonic tics have recurred. The patient's speech remains largely unintelligible 8 months following the last surgical procedure, and the other neurologic deficits remain unchanged.

Subcortical projections to the centromedian and parafascicular thalamic nuclei in the cat.

The primary objective of this study is to identify the totality of input to the centromedian and parafascicular (CM-Pf) thalamic nuclear complex. The subcortical projections upon the CM-Pf complex were studied in the cat with three different retrograde tracers. The tracers used were unconjugated horseradish peroxidase (HRP), horseradish peroxidase conjugated to wheat germ agglutinin (WGA-HRP), and rhodamine-labeled fluorescent latex microspheres (RFM). Numerous subcortical structures or substructures contained labeled neurons with all three tracing techniques. These labeled structures included the central nucleus of the amygdala; the entopeduncular nucleus; the globus pallidus; the reticular and ventral lateral geniculate nuclei of the thalamus; parts of the hypothalamus including the dorsal, lateral, and posterior hypothalamic areas and the ventromedial and parvicellular nuclei; the zona incerta and fields of Forel; parts of the substantia nigra including the pars reticularis and pars lateralis, and the retrorubral area; the pretectum; the intermediate and deep layers of the superior colliculus; the periaqueductal gray; the dorsal nucleus of the raphe; portions of the reticular formation, including the mesencephalic, pontis oralis, pontis caudalis, gigantocellularis, ventralis, and lateralis reticular nuclei; the nucleus cuneiformis; the marginal nucleus of the brachium conjunctivum; the locus coeruleus; portions of the trigeminal complex, including the principal sensory and spinal nuclei; portions of the vestibular complex, including the lateral division of the superior nucleus and the medial nucleus; deep cerebellar nuclei, including the medial and lateral cerebellar nuclei; and lamina VII of the cervical spinal cord. Moreover, the WGA-HRP and rhodamine methods (known to be more sensitive than the HRP method) revealed several afferent sources not shown by HRP: the anterior hypothalamic area, ventral tegmental area, lateral division of the superior vestibular nucleus, nucleus interpositus, and the nucleus praepositus hypoglossi. Also, the rhodamine method revealed labeled neurons in laminae V and VI of the cervical spinal cord.

Thalamocortical connections of the rostral intralaminar nuclei: an autoradiographic analysis in the cat.

In this study the pattern of projections from the rostral intralaminar thalamic nuclei to the cerebral cortex was examined in the cat by autoradiography. Injections of tritiated proline and leucine were placed into the central lateral, paracentral, central medial, and para-stria medullaris nuclei. After injections into the central lateral nucleus, label is present on the lateral side within the presylvian sulcus, in most of the suprasylvian gyrus, including the adjacent lateral and suprasylvian sulci, and in the posterior corner of the ectosylvian gyrus. On the medial side, label is present in the orbitofrontal (Of), precentral agranular (Prag), anterior limbic (La), retrosplenial (Rs), and postsubicular (Ps) areas, as defined by Rose and Woolsey ('48a). The cingulate gyrus also contains label throughout (part of which was defined as the "cingular area," Cg, by Rose and Woolsey, '48a). Label is also found on both banks of the splenial and cruciate sulci. In addition, label is present within the lateral gyrus, on both its lateral and medial sides. The paracentral projections are similar to the central lateral input. On the lateral side, label is found within the presylvian sulcus, suprasylvian gyrus and adjacent lateral and suprasylvian sulci, and posterior ectosylvian gyrus. Medially, label is present in the Of, Prag, La, Cg, Rs, and Ps areas, and within the cruciate and splenial sulci, and in portions of the lateral gyrus. Following injections of the central medial nucleus, label is present in the presylvian sulcus; but in contrast to the central lateral and paracentral projections, the suprasylvian gyrus is labeled only in its posterior part. The central medial nucleus also projects to the posterior lateral gyrus, both laterally and medially. Also, the central medial nucleus projects heavily to rostral cortical zones, which include the Of, Prag and La areas, cruciate sulcus, and the rostral cingulate gyrus. The para-stria medullaris nucleus projects only to the presylvian sulcus and orbitofrontal cortex laterally, but, medially, has an extensive input similar to the central lateral and paracentral projections in that label is present in the Of, Prag, La, Cg, Rs, and Ps areas, in the cruciate and splenial sulci, and in the posterior lateral gyrus. The laminar distribution of label is as follows: the central lateral, paracentral and para-stria medullaris nuclei project primarily to layers I and III, whereas the central medial nucleus projects to layers I and VI. In addition, the central lateral projection has a patchy appearance in the retrosplenial and postsubicular cortices.