Vocal cord paralysis is a comlex disorder which may result from numerous causes. It is often associated with trauma, disease in adjacent tissue, or a generalized neuroligical disorder. Laryngeal EMG is a useful technique for vocal cord paralysis. However it has not been used due to the uncertainties of normal human vocal cord physiology and the technical difficulties in performing these studies. We investigated the pathophysiology of vocal cord paralysis with laryngeal electromyography(LEMG). We studied 20 patients with idiopathic vocal cord paralysis. 6 patients were denervated in the cricothyroid(CT) and 6 patients in the thyroarytenoid(TA), and 3 patients in both CT and TA muscles. These indicated superior laryngeal neuropathy, recurrent laryngeal neuropathy, and proximal laryngeal or vagus neuropathy, respectively. LEMG proved to be a safe and effective procedure in the diagnosis of laryngeal neuropathy, and make it possible to use electromyography as a routine procedure in diagnosis laryngeal paralysis.
Diagnosis ; Electromyography* ; Humans ; Muscles ; Physiology ; Vagus Nerve Diseases ; Vocal Cord Paralysis* ; Vocal Cords*

Varicella zoster virus may cause a single presence or a combination of various types of cranial nerve palsy depending on the invasion site of head and neck region. Herpes zoster laryngitis has an extremely low incidence particularly in the head and neck region when compared to varicella zoster oticus. Moreover, it has also been reported to occur rarely from a worldwide perspective. The current case is a 63-year old man who visited us with a chief complaint of laryngopharyngeal pain. Flexible fiberoptic laryngoscopy revealed complete right vocal cord palsy fixed at the intermediate position. We experienced a case of Herpes Zoster Laryngitis which was accompanied by a single presence of vagal nerve paralysis. Here, we report our case with a review of literature.
Chickenpox ; Cranial Nerve Diseases ; Head ; Herpes Zoster ; Herpesvirus 3, Human ; Incidence ; Laryngitis ; Laryngoscopy ; Neck ; Paralysis ; Vagus Nerve ; Vocal Cord Paralysis

The authors report a case of glossopharyngeal neuralgia which was successfully treated with intracranial section of the glossopharyngeal and upper two rootlets of the vagus nerves. Despite of the complete section of these nerves, corresponding sensory or motor deficit was not developed. And the histories of this surgery were reviewed.
Glossopharyngeal Nerve Diseases ; Neuralgia* ; Vagus Nerve

Schwannomas are benign nerve sheath tumors that originate from any anatomical site. Most schwannomas occur in the head, neck or limbs, but rarely occur in the retroperitoneal space. Furthermore, the schwannoma originating from the vagus nerve of retroperitoneal space is much rare. We experienced a case of retroperitoneal schwannoma of the vagus nerve. A 34-year-old male was refered to our hospital for the evaluation of abdominal mass on ultrasonography. Endoscopic examination revealed submucosal tumor-like lesion on high body of the stomach. Computed tomography (CT) revealed that the stomach was compressed by a solid tumor in the retroperitoneum. On exploratory laparotomy, this mass turned out to be a baseball sized mass in the retroperitoneal space. The mass was excised in an encapsulated state. Histological examination with immunohistochemical stains revealed a schwannoma of the vagus nerve.
Adult ; Cranial Nerve Neoplasms/*diagnosis ; English Abstract ; Humans ; Male ; Neurilemmoma/*diagnosis ; Retroperitoneal Space ; *Vagus Nerve ; Vagus Nerve Diseases/*diagnosis

It is well known that M. leprae involves peripheral nerves, but it is a few known that M. leprae involves craninal nerves. I experienced one case of relapsed leprosy accompanied by multiple cranial nerve palsies. Revealed symptoms are to involve trigeminal nerve (V). facial nerve (VII), vestibular nerve (VIII), glossopharyngeal nerve (IX), vagus nerve (X). It is not effect to treat with corticosteroid, but is good effect to treat with MDT(multiple drug therapy)
Cranial Nerve Diseases* ; Cranial Nerves* ; Dystroglycans ; Facial Nerve ; Glossopharyngeal Nerve ; Leprosy* ; Peripheral Nerves ; Trigeminal Nerve ; Vagus Nerve ; Vestibular Nerve

OBJECTIVE: To explore the clinical anatomy and the methods to protect or reconstruct the continuity and function of vagus nerve during the operation of cervical vagal paraganglioma. METHOD: Six cases of vagal paraganglioma were reviewed. All tumors were identified to wrap the cervical vagus nerve stem and excised during surgery. The operative modality was to trace the vagus nerve stem inside the tumor as far as possible, to reconstruct the continuity by way of vagus nerve anastomosis (3/6) or alternatively, other motor nerve transplantation (3/6). Postoperative treatment included steroid, neurotrophic medication and voice and swallowing rehabilitation. RESULT: Two cases of the recurrent paraganglioma experienced aspiration during swallowing preoperatively and no aspiration after surgery. Choking was gradually reduced in four recurrent cases half to one year postoperatively. Hoarseness was improved in five cases (5/6) half to one year postoperatively, while one case remained prolonged obvious hoarseness. Three months postoperatively, the vocal cord fibrillation at the tumor-related side was observed during pronunciation in the end-to-end anastomosis cases (3/6), sublingual nerve-transplanted case (1/6) and deep cervical nerve-transplanted cases (1/6) under fiberoptic laryngoscope, and the mobility was even more obvious at the time of half an year postoperatively. While in another deep cervical nerve-transplanted case (1/6), the vocal cord demonstrated no obvious fibrillation. CONCLUSION To carefully identify and preserve the vagus nerve fibers as much as possible during the operation of cervical vagal paraganglioma could significantly eliminate postoperative hoarseness and aspiration. End-to-end anastomosis, deep cervical nerve or sublingual nerve transplantation to resume the continuity of vagus nerve may improve the mobility of vocal cord thus the quality of voice and swallowing.
Adult ; Cranial Nerve Neoplasms ; surgery ; Female ; Humans ; Male ; Middle Aged ; Neurosurgical Procedures ; Paraganglioma ; surgery ; Reconstructive Surgical Procedures ; methods ; Vagus Nerve ; surgery ; Vagus Nerve Diseases ; surgery

Swallowing is a rare cause of syncope. In swallowing syncope, loss of consciousness occurs during or immediately after a swallow. It is mediated via an esophagocardiac vagal reflex arc. The efferent impulse originates in the esophageal sensory endings of the vagus nerve and from the dorsal vagal nucleus an efferent vagus nerve to the heart cause bradycardia or varying degrees of heart block. Bradycardia or heart block in response to swallowing produces decreased cardiac output and results in cerebral hypoperfusion and loss of consciousness. It is occasionally associated with the esophageal or heart disease. The esophageal or heart disease may exaggerate the reflex. We report a patient who had loss of consciousness during swallowig and had a esoophageal submucosal tumor. In EKG monitoring a swallowing induced sinoatrial black was found.
Bradycardia ; Cardiac Output ; Deglutition* ; Electrocardiography ; Heart ; Heart Block ; Heart Diseases ; Humans ; Reflex ; Syncope* ; Unconsciousness ; Vagus Nerve

OBJECTIVETo determine if pathologic examination can be useful in both diagnosing cervical paraganglioma and deducing its vagal origin.

METHODSFour cases of vagal paraganglioma were studied by light microscopy and immunohistochemistry, with clinical and radiologic (computerized tomography and/or magnetic resonance imaging) correlation.

RESULTSAll patients were females and complained of upper neck mass with symptoms and signs of vagus nerve involvement, such as hoarseness of voice, ipsilateral vocal cord dysfunction and cough induced by drinking or local pressure. Radiological examination showed a tumor mass over the common carotid artery bifurcation, lying between the internal carotid artery and internal jugular vein. On gross inspection, the stump of the resected vagus nerve could be identified, with nerve bundles splaying over the tumor surface. Microscopically, the tumors showed a relatively uniform nesting arrangement (Zellballen pattern) of cells and were associated with rich sinusoidal vessels and fibrous stroma. Multiple myelinated nerve fibers were present in stroma and fibrous capsule of the tumor. Sometimes, invasion of nerve trunk by tumor cells was seen. Immunohistochemically, the tumor cells showed diffuse positivity for chromogranin A, neuron-specific enolase and synaptophysin. There was no expression of cytokeratin. The sustentacular cells and nerve bundles were highlighted by S-100 protein.

CONCLUSIONIn addition to the microscopic accurate diagnosis of paraganglioma, histopathologists can be of help in deducing the vagal origin of this tumor.

Cranial Nerve Neoplasms ; pathology ; Female ; Humans ; Immunohistochemistry ; Magnetic Resonance Imaging ; Paraganglioma ; pathology ; Tomography, X-Ray Computed ; Vagus Nerve Diseases ; pathology

Epilepsy is one of the most common and disabling neurologic disorders in childhood. The primary goal of epilepsy treatment is to choose the treatment modality that provides the best chance of improving the patient's quality of life. In addition to classic antiepileptic drugs, newly developed antiepileptic drugs ketogenic diet, epilepsy surgery, and vagal nerve stimulation have improved the ability to treat seizure disorders during the past decades. The mainstay of treatment remains pharmacotherapy. The factors that affect decision of whether to treat seizures with medications and which antiepileptic drugs to use include the likelihood of seizure recurrence, type and severity of seizures, available antiepileptic drug efficacies and toxicities, need for hematologic monitoring, ease to dosing, underlying illness, pharmacologic interaction, and school and other social issues. In this article, we will describe the principle of drug selection for seizure disorder in pediatric patients and the efficacies and adverse effects of the typical and new antiepileptics. Information about the available antiepileptic drugs will help the pediatrician to select the best drug for children with epilepsy.
Anticonvulsants ; Child ; Drug Therapy* ; Epilepsy* ; Humans ; Ketogenic Diet ; Nervous System Diseases ; Quality of Life ; Recurrence ; Seizures ; Vagus Nerve Stimulation

BACKGROUND: Although herpes zoster primarily affects afferent sensory neurons, it may complicated by motor nerve involvement in 0.5% to 5% of cases. However herpes zoster-induced muscle paresis is still under-recognized by dermatologists, and there has been insufficient clinical investigation of these conditions. OBJECTIVE: This study was conducted to investigate the clinical aspects of motor nerve involvement of herpes zoster. METHODS: We retrospectively reviewed the data of 711 patients with herpes zoster who had been admitted to our hospital in the departments of dermatology, ophthalmology, otorhinolaryngology, neurology, neurosurgery and rehabilitation medicine between 2005 and 2010. RESULTS: Among the 711 patients with herpes zoster, 15 patients had motor paresis (2.1%). 11 patients (73.3%) had facial nerve palsy including one patient who had accompanying vagus nerve palsy. Besides, one case of trochlear nerve palsy, one case of hypoglossal nerve palsy, one case of upper limb paresis and one case of lower limb paresis were noted. Associated underlying diseases were observed in nine patients (60.0%). Duration of motor weakness ranged from 1 month to 4 years. Twelve patients (80.0%) achieved complete recovery. CONCLUSION: In our patient population, the incidence of motor involvement of herpes zoster was higher in cranial nerves, especially the facial nerve, than in spinal nerves. Although motor nerves are usually involved in relation to dermatome, cranial nerve palsy may occur regardless of its dermatome because of complicated anatomical association. The majority of cases recovered completely without any complications. Further prospective investigation with a large group of patients is necessary to better understand the epidemiology of motor nerve involvement of herpes zoster.
Cranial Nerve Diseases ; Cranial Nerves ; Dermatology ; Facial Nerve ; Herpes Zoster ; Humans ; Hypoglossal Nerve Diseases ; Incidence ; Lower Extremity ; Neurology ; Neurosurgery ; Ophthalmology ; Otolaryngology ; Paralysis ; Paresis ; Retrospective Studies ; Sensory Receptor Cells ; Spinal Nerves ; Trochlear Nerve Diseases ; Upper Extremity ; Vagus Nerve