[Pediatric reversible acute velar palsy: A case report]. / Paralysie vélaire aiguë réversible de l'enfant : à propos d'un cas.

INTRODUCTION: Approximately 40 cases of acute idiopathic velopharyngeal reversible paralysis in the pediatric population have been reported in the literature. OBSERVATION: We present the case of a 12-year-old boy who had consulted in pediatric emergency departments for symptomatology including rhinolalia, nasal regurgitation, and deviation of the labial commissure. Paraclinical explorations helped diagnose rhombencephalitis with enterovirus. The introduction of oral corticosteroids was followed by rapid clinical improvement in 3 days. Monitoring 1 month later showed complete regression of symptoms. DISCUSSION: Similar cases in the literature describe the occurrence of nasal regurgitation and rhinolalia, sometimes associated with other cranial nerve impairment. The pathogenesis is rarely highlighted and the imaging results are always normal. Ad integrum recovery with or without corticosteroids is the rule. In light of this literature review, it is possible to conclude that the occurrence of such a suggestive clinical picture should limit the often costly and unnecessary additional tests.

Idiopathic cranial polyneuropathy with unilateral IX and X and contralateral XI nerve palsy in a 4-year-old boy.

A 4-year-old boy presented with a sudden onset of nasal escape of fluids, nasal speech, and difficulty placing his left arm through a sleeve. Neurologic examination indicated a unilateral cranial IX and X and contralateral XI nerve palsy that was considered idiopathic. Palsy of cranial nerves IX, X, and XI is rare in childhood, and few reports have described this condition. Our patient received prednisolone for 1 week and demonstrated complete recovery within several weeks. We suggest that aggressive therapy is unnecessary for patients with idiopathic cranial polyneuropathy. The pathogenesis of this condition may involve an immunologic mechanism.

Attention-deficit hyperactivity disorder and cardiac vagal control: a systematic review.

Attention-deficit hyperactivity disorder (ADHD) is characterized by behavioural disinhibition, deficient emotional self-regulation, inattention, and hyperactivity. The constellation of deficits found in children with ADHD implicates autonomic dysregulation characterized by deficient control of the heart by parasympathetic influences. While it is generally assumed that autonomic regulation of the heart is impaired during ADHD, the information pertaining to this dysregulation is limited. A systematic review of three databases was conducted between January and March 2012 for peer reviewed publications examining the relationship between cardiac vagal control (CVC) and ADHD without comorbid psychopathology. 19 articles were reviewed with only 6 meeting inclusion criteria. Findings were not unanimous but suggested that children with unmedicated ADHD experienced lower levels of CVC than did healthy controls. It was difficult to evaluate whether children with ADHD exhibited a different pattern of withdrawal and application of CVC than did normal controls. Findings suggested CVC reactivity depended on the task employed but children with ADHD experienced dampened CVC reactivity during tasks that involved self-regulation and emotion regulation. Finally, medication acted to correct the autonomic imbalance experienced by children with ADHD but did not bring this imbalance into normal levels. Given that so few studies were identified, no firm conclusions can be made, and there is a clear need for additional research in this area. Recommendations for future research are discussed.

Evidence for sensory neuropathy and pharmacologic management.

Recent literature points to postviral sensory neuropathy as a possible cause for refractory chronic cough. Vagal neuropathy may affect the sensory branches, inducing chronic cough or laryngospasm. Although the clinical presentation is fairly well described, there is little in the way of diagnostic criteria to establish this diagnosis. This article highlights the clinical picture of this disease and the efficacy, side-effect profiles of the currently used pharmacological interventions.

Combined cardiac sympathetic excitation and vagal impairment in patients with non-organic erectile dysfunction.

OBJECTIVE: Patients with non-organic erectile dysfunction (ED) frequently present with syndromes involving systemic sympathovagal dysfunction. The linkage of ED to cardiac autonomic regulation is not well understood. METHODS: Forty-four men with non-organic ED and 38 healthy age-matched control subjects with ages ranging from 40 years to 69 years were recruited. These two groups were divided into three distinct age categories at 10-year intervals. Patients were divided into three different severity categories, among whom 35 patients received a two-month oral treatment of trazodone. Power spectral analysis of successive R-R intervals (RR) was performed to evaluate the variance (variance of RR-interval values), the high-frequency power (HF), and the ratio of low-frequency power to HF (LF/HF) of their heart rate variability (HRV). RESULTS: Patients exhibited a significantly lower variance and HF, but a higher LF/HF compared to the control group across all age categories. The changes in variance and HF were severity dependent. In addition, all the HRV parameters of the patients with a satisfactory response after treatment have significantly improved. CONCLUSION: The results indicate that patients with non-organic ED had significant cardiac sympathetic hyperactivity and severity-dependent cardiac vagal impairment. SIGNIFICANCE: Non-organic ED may be accompanied by an abnormality in cardiac autonomic regulation.

[Autonomic cardiovascular regulation in patients with tics and Tourette syndrome].

Autonomic cardiovascular regulation has been assessed in patients aged 4-15 years with Tourette syndrome (n = 22) and other tic disorders (n = 48). Symptom significance was estimated by a number of hyperkinetic episodes per 20 minutes, tic scale and variants of the disease course. The functional condition of autonomic nervous system was studied clinically and using spectral analysis of heart rate variability in both upright and supine positions. Negative correlation between the ratio of sympathetic and vagus influences and severity of the disease was found: the severer were tic symptoms, the stronger was a trend to vagotonia (beta = -0.36; p < 0.0025; F > 4.0). In orthostatic test, patients with Tourette syndrome demonstrated an unfavorable hypersympathicotonic type of cardiovascular system reaction. Patients were treated during 4 weeks with glycinum (0.2 +/- 0.1 mg/day), phenibutum (0.5 +/- 0.25 mg/day), clonazepam (1.5 +/- 0.5 mg/day), tiapride (200 +/- 100 mg/day), haloperidol (1-1.5 mg/day), rispolept (2 mg/day). There was no negative effect of the drugs on heart rate variability. On the contrary, the therapy reduced hyperkinetic symptoms and corrected autonomic influences on the sinus rhythm. It is suggested that changes in autonomic cardiovascular regulation might be of secondary character and do not need any special correction.

Isolated vagus nerve palsy probably associated with herpes simplex virus infection.

Vagus nerve palsy caused by herpes simplex virus (HSV) infection is rare. Here, we present a 29-year-old man with acute onset of right side otalgia and sore throat, followed by dysphonia, dysphagia and some vesicles seen on the deep soft palate. Laryngoscopy revealed right vocal cord palsy. Neck to chest CT did not reveal local lesion. Three months later, his serum HSV IgG antibody titer was eight times elevation and a throat swab culture for virus isolation yielded HSV type I. T2-weighted images of neck MRI showed abnormally high signal intensity on the right sub-glottis region with Gadolinium enhancement that was compatible with local infection. Thereafter, one course of acyclovir; was given. Three months after finishing the acyclovir, his symptoms were almost gone and neck MRI did not show the aforementioned lesions. HSV infection should be considered as a differential diagnosis for patients with idiopathic dysphonia and dysphagia.

Malignant neurocardiogenic vasovagal syncope associated with chronic exaggerated vagal tone.

A head-up tilt test was performed in a 23-year-old woman with a history of two syncopal episodes. The patient developed abrupt syncope with 48 seconds of sinus arrest. Analysis of the high frequency (HF) power of heart rate variability over 24 hours before and after metoprolol therapy showed a significantly elevated HF power in this patient compared to age- and sex-matched healthy subjects. It is suggested that an exaggerated resting vagal tone might be associated with the pathogenesis of prolonged asystole in our patient.