Electrophysiology of Cranial Nerve Testing: Cranial Nerves IX and X.

The cranial nerves IX and X emerge from medulla oblongata and have motor, sensory, and parasympathetic functions. Some of these are amenable to neurophysiological assessment. It is often hard to separate the individual contribution of each nerve; in fact, some of the techniques are indeed a composite functional measure of both nerves. The main methods are the evaluation of the swallowing function (combined IX and X), laryngeal electromyogram (predominant motor vagal function), and heart rate variability (predominant parasympathetic vagal function). This review describes, therefore, the techniques that best evaluate the major symptoms presented in IX and X cranial nerve disturbance: dysphagia, dysphonia, and autonomic parasympathetic dysfunction.

Severe Lateral Thoracic Fracture-Dislocation without Neurological Deficit ­ Case Report

Introduction A case report of a thoracic fracture-dislocation (T11­T12) without neurological deficit is presented. Objective Report the diagnosis and treatment of a traumatic severe fracture with lateral dislocation at the thoracolumbar junction without neurological deficit. Background Fracture-dislocation of the thoracic spine without neurological deficit is a rare lesion. We retrieved only 15 cases reported in the literature. Surgical treatment with spinal decompression, fusion and realignment is the treatment of choice. Case A 40-year-old man suffered a bicycle accident and was admitted with severe back pain but neurologically intact. He was treated with a wide laminectomy and spinal cord decompression followed by correction of his deformity using pedicle screw instrumentation and rod maneuvers. Results After three days, the patient was able to walk, and after one month he had just mild back pain, but was neurologically intact, and was able to return to his usual daily activities. After six months, he was neurologically intact and performing routine physical activities. Conclusions Fracture-dislocation of the thoracic spine without neurological deficit is a rare injury. A good outcome can be obtained with modern spinal stabilization surgical techniques, avoiding late neurological deterioration.

Introdução Apresentamos um relato de caso de fratura-luxação torácica (T11­T12) com grande deslocamento lateral entre os corpos vertebrais, sem déficit neurológico. Objetivo Relatar o diagnóstico e tratamento de uma fratura-luxação grave na junção toracolombar com preservação da função neurológica. Dados Fratura-luxação da coluna torácica sem déficit neurológico é uma lesão rara. Apenas 15 casos relatados na literatura foram encontrados em nossa revisão. O tratamento de escolha se faz com descompressão medular, realinhamento e estabilização. Caso Um homem de 40 anos sofreu um acidente de bicicleta e foi admitido com dorsalgia severa, mas neurologicamente intacto. Ele foi tratado com ampla laminectomia e descompressão medular e, depois, correção da deformidade com parafusos pediculares lombares e manobras de realinhamento. Resultados Após três dias, o paciente estava apto a caminhar, e após um mês, tinha apenas leve dorsalgia e estava neurologicamente intacto, podendo retomar suas atividades de vida diária. Após seis meses da cirurgia, mantinha-se neurologicamente estável e realizando atividades físicas regularmente. Conclusão Fratura-luxação com deslocamento vertebral grave da coluna torácica sem déficit neurológico é uma lesão rara. Um bom desfecho pode ser obtido com técnicas modernas de estabilização da coluna e redução da lesão, evitando deterioração neurológica.

Laryngeal Electromyography: Are the Results Reproducible?

UNLABELLED: Laryngeal electromyography (LEMG) is an auxiliary diagnostic technique that is used to study neurologic diseases that affect the larynx. This study aimed to verify the reproducibility and accordance of LEMG findings obtained by different approaches applied to the same intrinsic laryngeal muscle in patients with neurologic disorders of the larynx. STUDY DESIGN: This study is prospective, blind, randomized, and controlled. METHODS: Forty subjects (20 males and 20 females) aged between 21 and 78 years underwent LEMG of the thyroarytenoid muscles by different techniques, with a total of 120 insertion sites for analysis. The electrophysiological findings were grouped as follows: (1) equal LEMG findings; (2) different LEMG findings but in agreement on the same electromyographic pattern; and (3) different LEMG findings and in discord on the same electromyographic pattern. RESULTS: We found 5% discordance in the LEMG findings between the sites analyzed. CONCLUSIONS: LEMG is an important and useful technique, but caution must be taken to avoid misinterpretation and the wrong muscle approach.

Laryngeal electromyography in movement disorders: preliminary data

Este estudo descreve dados preliminares de eletromiografia laríngea (LEMG) e tratamento com toxina botulínica em pacientes com disfonia associada a distúrbios do movimento. Foram estudados 25 pacientes, 19 com distonia laríngea ou disfonia espasmódica, 5 com tremor vocal e 1 com síndrome de Gilles de la Tourette. LEMG realizada com eletrodos monopolares, antes da administração de toxina botulínica, foi compatível com distonia em 14 pacientes (normal em 5), sugeriu tremor essencial em 3 e Parkinson em 2. Os diferentes padrões de LEMG e melhora considerável obtida com administração de toxina botulínica instituíram LEMG como rotina no ambulatório de distúrbios do movimento da UNICAMP.

Laryngeal electromyography in movement disorders: preliminary data.

This study describes preliminary laryngeal electromyography (LEMG) data and botulinum toxin treatment in patients with dysphonia due to movement disorders. Twenty-five patients who had been clinically selected for botulinum toxin administration were examined, 19 with suspected laryngeal dystonia or spasmodic dysphonia (SD), 5 with vocal tremor, and 1 with Gilles de la Tourette syndrome (GTS). LEMG evaluations were performed before botulinum toxin administration using monopolar electrodes. Electromyography was consistent with dystonia in 14 patients and normal in 5, and differences in frequency suggesting essential tremor in 3 and Parkinson tremors in 2. The different LEMG patterns and significant improvement in our patients from botulinum toxin therapy has led us to perform laryngeal electromyography as a routine in UNICAMP movement disorders ambulatory.