Hemidiaphragmatic paralysis: an unusual complication of cervical spondylosis.

Clinical investigations of a patient having shortness of breath and a paretic left hemidiaphragm revealed compromise of the left C3-4 neural foramen and signs of spondylitic spinal cord compression at that level. After laminectomy, the patient's symptoms and radiologic evidence of hemidiaphragmatic paralysis resolved. This case illustrates the importance of evaluating patients with hemidiaphragmatic paralysis for cervical spondylosis and of evaluating patients with cervical spondylosis for phrenic nerve compromise.

Endarterectomy of the vertebral artery from C2 to posterior inferior cerebellar artery intracranially.

A new technical approach to endarterectomy of the vertebral artery at the cranial cervical junction is discussed. A patient had symptoms of vertebrobasilar insufficiency on clinical examination. Angiography demonstrated a stenotic plaque in the vertebral artery at the level of C1, and an additional tandem lesion at the origin of the posterior inferior cerebellar artery. He underwent vertebral endarterectomy and was symptomatically improved postoperatively. The surgical approach used and possible alternatives will be discussed in detail.

Voice spectrography in the evaluation of myasthenia gravis of the larynx.

Myasthenia gravis is a neuromuscular disorder that affects striated muscles especially those innervated by the cranial nerves. The standard diagnostic regimen is to find a reversal of symptoms by acetylcholine esterase administration. The permanent and objective recording of this effect is the key to an accurate assessment of this test. The voice spectrograph is a noninvasive means of evaluating the voice. It has been used successfully to make a clear and specific diagnosis of myasthenia gravis as it affects the larynx. The test can be used to distinguish myasthenia gravis from other functional, anatomical and neuromuscular laryngeal disorders.