Epiphora and Hyperlacrimation as Paradoxical Manifestations of Facial Nerve Injury: Mechanistic Insights.

The incidence of facial nerve paralysis is approximately 30 per 100,000 persons annually. Although it is often idiopathic, as in Bell's palsy, it can also result from infections, trauma, or neoplasms. Facial nerve paralysis may present with partial or total facial paresis, lagophthalmos, denervation of the lacrimal gland, and other ocular abnormalities. While dry eye is a commonly expected outcome of facial nerve injury, some patients may paradoxically experience epiphora and hyperlacrimation. In this review, we examine this phenomenon and its mechanisms in facial nerve injury. Several mechanisms have been proposed for epiphora and hyperlacrimation, including aberrant axonal regeneration, which is known to cause crocodile tears syndrome; ocular irritation due to dry eye, resulting in increased reflex lacrimation due to disruption of the tear film; and impaired drainage of tears caused by paralysis of the orbicularis oculi muscle and malposition of the eyelids. Understanding the pathophysiology of these symptoms is crucial in guiding the management of patients with facial nerve injury. Further experimental and clinical studies focusing on the quantification of tear production and localization of nerve damage will help improve our understanding of the neuroanatomical correlates of this paradoxical manifestation.

Stroke, music, and creative output: Alfred Schnittke and other composers.

Alfred Schnittke (1934-1998), a celebrated Russian composer of the twentieth century, suffered from several strokes which affected his left cerebral hemisphere. The disease, however, did not diminish his musical talent. Moreover, he stated that his illness in a way facilitated his work. The composer showed amazingly high productivity after his first and second injuries of the central nervous system. The main topic of this chapter is the effect of strokes on Schnittke's output, creativity, and style of music. A brief biography of the composer with the chronology of his brain hemorrhages is included. In addition, the influence of cerebrovascular lesions on creative potential of other prominent composers such as Benjamin Britten, Jean Langlais, Vissarion Shebalin, Igor Stravinsky, and Ira Randall Thompson is discussed.

Meningitis, a whirlpool of death: literary reflections and Russian cultural beliefs.

Meningitis is an inflammation of the meninges, the membranes that cover the central nervous system. The most frequent causes of the disease are viruses and bacteria. In the past, the disease was commonly referred to as "brain fever" or "brain inflammation," and extreme temperatures, sun, rain, mental distress, and other factors were believed to be its potent triggers. By the beginning of the twentieth century, these beliefs faded away in the United States and most western European countries. In contrast, some of these archaic notions persist in Russia, where cold air, draft, wet hair, and failure to cover one's head with a hat during winter are perceived as serious risks for contracting meningitis. These sentiments are reflected in the prose of Solzhenitsyn and other contemporary Russian authors. However, in the fictional literature of the nineteenth century, emotional or intellectual disturbances rather than the wrath of winter were portrayed worldwide as the most frequent cause of brain inflammation. Both physicians and laity blamed nervous breakdown or mental distress for the development of meningitis and the tragic deaths of the eminent Russian writer Gogol, talented poet Nadson, and heir to the Imperial throne Grand Duke Nicholas Romanov. Even in the twentieth century, esteemed Russian artists, including Pasternak, Paustovsky, and Roerich, highlighted this belief. Following the discovery of the infectious nature of meningitis, fictional depictions of the illness changed. While literary accounts of brain inflammation by the realists (e.g., Dostoevsky and Flaubert) were rather imprecise, the descriptions of the course and symptoms of meningitis by the modernists (e.g., Balmont, Hesse, and Huxley) became detailed and recognizable. Typically, the victim of the disease is a boy, and his imminent agony is preceded by immense suffering that devastates his parents. The dreadful experience of seeing children in the merciless clutches of meningitis had a profound personal effect on Maugham, Twain, and Russian philosopher Tikhomirov, changing their spiritual convictions. However, several authors, among them Avseenko, Davydov, Gazdanov, and Shmelyov, created uplifting stories of survival of the affliction. In this chapter, references to meningitis in the medical and fictional literature are explored through a cultural and historical prism, which may help readers to understand how and why this disease has held a special significance in the Russian psyche.

Age-related impairment in choroidal blood flow compensation for arterial blood pressure fluctuation in pigeons.

PURPOSE: Choroidal vessels compensate for changes in systemic blood pressure (BP) so that choroidal blood flow (ChBF) remains stable over a BP range of approximately 40 mm Hg above and below basal. Because of the presumed importance of ChBF regulation for maintenance of retinal health, we investigated if ChBF compensation for BP fluctuation in pigeons fails with age. METHODS: Transcleral laser Doppler flowmetry was used to measure ChBF during spontaneous BP fluctuation in anesthetized pigeons ranging in age from 0.5 to 17 years (pigeons can live approximately 20 years in captivity). RESULTS: ChBF in <8-year-old pigeons remained near 100% of basal ChBF at BPs ranging 40 mm Hg above and below basal BP (95 mm Hg). Baroregulation failed below approximately 50 mm Hg BP. In ≥8-year-old pigeons, ChBF compensation was absent at >90 mm Hg BP, with ChBF linearly following BP. Over the 60 to 90 mm Hg range, ChBF in ≥8-year-old pigeons was maintained at 60-70% of young basal ChBF. Below approximately 55 mm Hg, baroregulation again followed BP linearly. CONCLUSIONS: Age-related ChBF baroregulatory impairment occurs in pigeons, with ChBF linear with above-basal BP, and ChBF failing to adequately maintain ChBF during below-basal BP. Defective autonomic sympathetic and parasympathetic neurogenic control, or defective myogenic control, may cause these baroregulatory defects. In either case, overperfusion during high BP may cause oxidative injury to the outer retina, whereas underperfusion during low BP may result in deficient nutrient supply and waste removal, with both abnormalities contributing to age-related retinal pathology and vision loss.

Rare infections are just an airplane trip away: Salmonella typhi meningitis in a recent immigrant to the United States.

We report a case of a 24-year-old immigrant from Bangladesh with Salmonella typhi meningitis, a rare disease in the United States, especially among adults. The common manifestations of meningitis such as neck rigidity and changes in mental status did not develop and Kernig sign was absent. The patient was successfully treated with intravenous ceftriaxone. This case demonstrates the importance of considering endemic infections in the country of origin when recent immigrants and returnees to the United States present with febrile illness.