Differential Recovery in Early- and Late-Onset Delayed Facial Palsy Following Vestibular Schwannoma Resection

2019 ◽  
Vol 18 (1) ◽  
pp. 34-40 ◽  
Author(s):  
Stephano Chang ◽  
Serge Makarenko ◽  
Ivan Despot ◽  
Charles Dong ◽  
Brian D Westerberg ◽  
...  
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Early Onset ◽  
Late Onset ◽  
Motor Evoked Potentials ◽  
Historical Analysis ◽  
Study Cohort ◽  
Postoperative Result ◽  
Nerve Recovery ◽  
Timing Of Onset

AbstractBACKGROUNDDelayed facial palsy (DFP) after resection of vestibular schwannomas (VS) is worsening of facial nerve function after an initially normal postoperative result.OBJECTIVETo characterize different types of DFP, compare recovery rates, and review of series of outcomes in patients following resection of VS.METHODSBetween 2001 and 2017, 434 patients (51% female) with VS underwent resection. We categorized the patients who developed facial palsy into groups based on timing of onset after surgery, immediate facial palsy (IFP), early-onset DFP (within 48 h), and late-onset DFP (after 48 h). Introduction of facial nerve motor-evoked potentials (fMEP) in 2002 and a change of practice utilizing perioperative minocycline in 2005 allowed for historical analysis of these interventions.RESULTSMean age of study cohort was 49.1 yr (range 13-81 yr), with 19.8% developing facial palsy. The late-onset DFP group demonstrated a significantly faster recovery than the early-onset DFP group (2.8 ± 0.5 vs 47 ± 8 wk, P < .0001), had prolonged latency to palsy onset after initiating perioperative minocycline (7.3 vs 12.5 d, P = .001), and had a nonsignificant trend towards faster recovery from facial palsy with use of minocycline (2.6 vs 3.4 wk, P = .11).CONCLUSIONGiven the timings, it is likely axonal degeneration is responsible for early-onset DFP, while demyelination and remyelination lead to faster facial nerve recovery in late-onset DFP. Reported anti-apoptotic properties of minocycline could account for the further delay in onset of DFP, and possibly reduce the rate and duration of DFP in the surgical cohort.

scholarly journals F.03 Timing of incidence and recovery of delayed facial palsy after vestibular schwannoma resection: insight into mechanisms

2016 ◽  
Vol 43 (S2) ◽  
pp. S19-S19
Author(s):  
S Cháng ◽  
I Despot ◽  
C Dong ◽  
B Westerberg ◽  
R Akagami
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Early Onset ◽  
Late Onset ◽  
Bimodal Distribution ◽  
Postoperative Result ◽  
Grade 3 ◽  
One Year ◽  
Timing Of Onset ◽  
Insight Into

Background: Delayed facial palsy (DFP) after resection of vestibular schwannomas (VS) is described as worsening of facial nerve function after a normal postoperative result. Several mechanisms have been postulated to explain this phenomenon, although none satisfactorily explain all of its features. Furthermore, systematic documentation of recovery rates is lacking. Methods: 403 consecutive cases of VS resection between 2001 and 2015 were reviewed. Patients with preoperative facial palsy were excluded. Patients developing significant facial palsy (HB grade ≥ 3) were categorized into groups based on timing of onset: immediate facial palsy (IFP), “early-onset” DFP (within 48 h), and “late-onset” DFP (after 48 h). IFP patients were subdivided into “minor” (HB grade 3) and “major” (HB grade≥4) groups. These groups were compared with respect to demographics, intraoperative data, and recovery. Results: The late-onset DFP group demonstrated the quickest recovery to HB≤2 (2.9 weeks), followed by the minor IFP group (8.5 weeks), then the early-onset DFP group (53 weeks). Major IFP group exhibited the poorest recovery with only 32% recovering to HB grade≤2 within one year. Conclusions: The bimodal distribution in recovery time in delayed facial palsy patients implies separate underlying phenomena. We propose that a delayed demyelination of the facial nerve occurs in late-onset DFP, and best explains the uniformly rapid recovery observed.

scholarly journals Bilateral facial palsy in an adult with chickenpox

2020 ◽  
Vol 6 (12) ◽  
pp. 2286
Author(s):  
Arthur Wong ◽  
Jeyanthi Kulasegarah
Keyword(s):  
Facial Nerve ◽  
Facial Palsy ◽  
Nerve Palsy ◽  
Facial Nerve Palsy ◽  
Clinical Signs ◽  
The Body ◽  
Varicella Zoster ◽  
Ramsay Hunt Syndrome ◽  
Hunt Syndrome ◽  
Nerve Recovery

<p class="abstract">Chickenpox is a result of primary infection with varicella zoster virus. Isolated facial nerve palsy as a complication is rare, and here we report an extraordinary case of bilateral facial nerve palsy following chickenpox in an adult. A 55-year-old male presented to the emergency department with a day’s history of facial weakness. He had recently contracted chickenpox with an onset 16 days prior. Physical examination noted crusted vesicles all over the body and a bilateral facial palsy. There were no clinical signs of meningitis or cerebrovascular accident. He was managed with a short course of oral aciclovir and prednisolone and recovered fully after a month. Presentations of facial nerve palsy in chickenpox are rare and should be differentiated from Ramsay Hunt syndrome. Prognosis is relatively good with the majority of known cases seeing complete facial nerve recovery within 6 months.  </p>

scholarly journals Adverse childhood experiences and asthma: trajectories in a national cohort

Thorax ◽  
2021 ◽  
Vol 76 (6) ◽  
pp. 547-553
Author(s):  
Kathrine Pape ◽  
Whitney Cowell ◽  
Camilla Sandal Sejbaek ◽  
Niklas Worm Andersson ◽  
Cecilie Svanes ◽  
...  
Keyword(s):  
Childhood Asthma ◽  
Early Onset ◽  
Adverse Childhood Experiences ◽  
Early Life ◽  
Late Onset ◽  
Multinomial Logistic Regression ◽  
Study Cohort ◽  
Childhood Experiences ◽  
Asthma Phenotypes ◽  
Adverse Childhood

ObjectiveResearch has linked early adverse childhood experiences (ACEs) with asthma development; however, existing studies have generally relied on parent report of exposure and outcome. We aimed to examine the association of early life ACEs with empirically determined trajectories of childhood asthma risk, using independent register information on both exposures and outcome.MethodsBased on nationwide registries, we established a study cohort of 466 556 children born in Denmark (1997–2004). We obtained information on ACEs during the first 2 years of life (bereavement, parental chronic somatic and/or mental illness) and childhood asthma diagnosis or medication use from birth through age 10 years from the Danish National Patient and Prescription Registries, respectively. We identified asthma phenotypes using group-based trajectory modelling. We then used multinomial logistic regression to examine the association between early ACEs and asthma phenotypes.ResultsWe identified four asthma phenotypes: non-asthmatic, early-onset transient, early-onset persistent and late-onset asthma. Girls with early-onset transient asthma (OR 1.13, 95% CI 1.04 to 1.24), early-onset persistent asthma (1.27, 95% CI 1.08 to 1.48) or late-onset asthma (OR 1.28, 95% CI 1.11 to 1.48) vs no asthma were more likely to have early life ACE exposure compared with girls without ACE exposure. Results were similar for boys who also had experienced early life ACEs with ORs of 1.16 (95% CI 1.08 to 1.25), 1.34 (95% CI 1.20 to 1.51) and 1.11 (95% CI 0.98 to 1.25), respectively.ConclusionIn a nationwide-population study, we identified three childhood onset asthma phenotypes and found that ACEs early in life were associated with increased odds for each of these asthma phenotypes among both girls and boys.

Incidence, Timing of Onset and Severity of Post-Thrombotic Syndrome after Acute Symptomatic Deep Vein Thrombosis: Two-Year Results from a Canadian Multicenter Prospective Cohort Study (The VETO Study).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1636-1636
Author(s):  
Susan R. Kahn ◽  
Thierry Ducruet ◽  
Louise Arsenault ◽  
Marie Jose Miron ◽  
Andre Roussin ◽  
...  
Keyword(s):  
Longitudinal Data ◽  
Venous Thrombosis ◽  
Late Onset ◽  
Cumulative Probability ◽  
Study Cohort ◽  
Post Thrombotic Syndrome ◽  
Kaplan Meier ◽  
Timing Of Onset

Abstract Background and Objectives: The post thrombotic syndrome (PTS) is a chronic complication of deep venous thrombosis (DVT). It is difficult to provide DVT patients with long-term prognostic information as there is little longitudinal data on the occurrence of PTS after DVT. We performed a prospective multicenter study of long-term outcomes after DVT (the Venous Thrombosis Outcomes [VETO] Study) to determine the incidence, timing of onset and severity of PTS. Methods: Consecutive patients with objectively diagnosed acute DVT were recruited at 7 participating hospital centres from April 2001-July 2002. Patients attended study visits at Baseline, 4, 8, 12 and 24 months. Clinical data were recorded and standardized assessments for PTS (using Villalta scale) were performed by trained study personnel at each follow-up visit. Patients were classified as having developed PTS if the ipsilateral Villalta score was ≥ 5 on at least 2 visits or at the final follow-up visit, and having severe PTS if a score of &gt;14 or a venous ulcer was documented on any one occasion. The Kaplan-Meier survival method was used to estimate the cumulative probability of PTS and of severe PTS over time. Results: The study cohort consisted of 359 patients. The mean age was 56 years, 50% were male, 2/3 were outpatients, 55% had proximal DVT and 20% had previous DVT. The Kaplan-Meier estimates of cumulative risk of PTS were 29% at 4 months, 33% at 8 months, 35% at 12 months and 37% at 24 months. Corresponding risks of severe PTS were 6.6%, 6.9%, 6.9% and 6.9%, respectively. When the analysis was stratified according to history of DVT, the cumulative incidence of PTS in patients without previous DVT was 25%, 28%, 30% and 31% at 4, 8, 12 and 24 months. Corresponding rates of PTS in patients with previous DVT were 45%, 51%, 53% and 57%. Conclusions: More than one third of patients in our cohort developed PTS within 2 years of DVT, and of these, 1 in 6 was classified as severe. Most cases of PTS and of severe PTS were apparent by 4 months after DVT. Patients with previous DVT had a higher frequency of PTS and of late onset PTS. Our study provides longitudinal data on prognosis that is relevant both to patients with DVT and their treating physicians.

Early-onset sepsis: can we screen fewer babies safely?

2019 ◽  
Vol 106 (1) ◽  
pp. 86-88 ◽  
Author(s):  
Julian Eason ◽  
Hope Ward ◽  
Olha Danko ◽  
Kerrie Richardson ◽  
Rima Vaitkute ◽  
...  
Keyword(s):  
Risk Factors ◽  
Early Onset ◽  
Late Onset ◽  
Adverse Outcomes ◽  
Study Cohort ◽  
Term Infants ◽  
Usual Practice ◽  
Suspected Infection ◽  
Early Onset Sepsis ◽  
Group B

BackgroundOver the past 2–3 years at the Southwest Peninsula tertiary neonatal unit in Plymouth, the authors have observed an increase in the number of clinically well term infants being screened and treated with antibiotics for infection in accordance with NICE guidance. The aim of our study was to assess the safety of implementing the Kaiser Permanente Early Onset Sepsis (KPEOS) calculator to minimise antibiotic usage in term infants in line with antimicrobial stewardship, reducing separation from mother at birth and facilitating earlier discharge.MethodsA 2-year retrospective review of medical records from 2014 to 2015 inclusive revealed 9217 deliveries, with 1550 infants (16.8%) having risk factors, 945 (10.2%) being term infants. Of those, 507 (53.6%) had a clinical reason to screen and 438 (46.4%) had risk factors alone treated with antibiotics for variable periods of time. This enabled us to review our usual practice and compare it with our KPEOS implementation.InterventionNational Health Service England permission was obtained to implement the KPEOS for a 6-month period. We collected data on all 175 term infants with risk factors to compare with our previous practice when The National Institute for Health and Care Excellence and Royal College of Obstetrics and Gynaecology maternal guidance was being followed.ResultsThe percentage of infants screened with a suspected infection previously receiving 5 days of antibiotics reduced from 31% (136/438) to 5% (9/157, p<0.0001) using the KPEOS calculator. Clinically well infants with risk factors alone previously receiving 36 hours of antibiotics, reduced from 63% (275/438) to 3% (5/157, p<0.0001) of infants treated. There was no late-onset sepsis in this study cohort or any observed adverse outcomes.ConclusionThese results demonstrated a potentially safe and effective quality improvement (QI) in our hospital with fewer babies treated and a reduced length of stay for this cohort. Considering individual hospitals rates for term Group B Streptococcal sepsis, this QI may be a safe and economical alternative to current practices for screening well term infants.

Prognostic factors for the incidence and recovery of delayed facial nerve palsy after vestibular schwannoma resection

2011 ◽  
Vol 114 (2) ◽  
pp. 375-380 ◽  
Author(s):  
Ryan P. Morton ◽  
Paul D. Ackerman ◽  
Marc T. Pisansky ◽  
Monika Krezalek ◽  
John P. Leonetti ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Facial Nerve ◽  
Vestibular Schwannoma ◽  
Facial Palsy ◽  
Late Onset ◽  
Postoperative Recovery ◽  
Nerve Monitoring ◽  
Facial Nerve Monitoring ◽  
Patient Groups

Object Preservation of facial nerve function in vestibular schwannoma (VS) resections remains a significant operative challenge. Delayed facial palsy (DFP) is one specific challenge yet to be fully elucidated. The aim of this study was to evaluate DFP among VS resection cases to identify significant prognostic factors associated with its incidence and clinical recovery. Methods This investigation involves a retrospective review of 104 cases of VS resection that occurred between December 2005 and May 2007. Patients who developed DFP were compared with patients exhibiting no facial palsy postoperatively with regard to surgical approach, severity and day of palsy onset, tumor size, intraoperative facial nerve monitoring, and postoperative recovery and treatment. Patients who demonstrated immediate facial palsy (IFP) following VS resection were also analyzed. Furthermore, specific analyses were performed in 2 distinct DFP patient groups: those who developed DFP after postoperative Day 3 (“late onset DFP”), and those whose palsy worsened after initial DFP identification (“deteriorators”). Results Of the 104 patients who underwent VS resection, 25.0% developed DFP and 8.6% demonstrated IFP postoperatively. The DFP group did not differ significantly in any measure when compared with patients with no postoperative facial palsy. However, patients with DFP presented with significantly smaller tumor sizes than patients with IFP. This IFP group averaged significantly smaller intraoperative facial nerve responses than patients without facial palsy, and larger tumor sizes than both the DFP and no facial palsy groups. Within the DFP group, patients with late onset DFP showed diminished intraoperative facial nerve responses when compared with the total DFP patient population. In total, 25 (96.2%) of 26 patients with DFP and 7 (77.8%) of 9 patients with IFP recovered to normal or near-normal facial function (House-Brackmann Grade I or II) at longest clinical follow-up. Conclusions Although patients with DFP did not exhibit any distinguishable characteristics when compared with patients without postoperative facial palsy, our analysis identified significant differences in patients with palsy presenting immediately postoperatively. Further study of patients with DFP should be undertaken to predict its incidence following VS resection.

NEONATAL SEPSIS AND IDENTIFICATION OF RISK FACTORS: STUDY IN AVBRH HOSPITAL SAWANGI

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Pramod P. Singhavi
Keyword(s):  
Risk Factors ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Late Onset ◽  
Signs And Symptoms ◽  
Premature Rupture ◽  
Maternal Risk ◽  
Late Onset Sepsis ◽  
Early Onset Sepsis ◽  
Meconium Stained Amniotic Fluid

Introduction: India has the highest incidence of clinical sepsis i.e.17,000/ 1,00,000 live births. In Neonatal sepsis septicaemia, pneumonia, meningitis, osteomyelitis, arthritis and urinary tract infections can be included. Mortality in the neonatal period each year account for 41% (3.6 million) of all deaths in children under 5 years and most of these deaths occur in low income countries and about one million of these deaths are due to infectious causes including neonatal sepsis, meningitis, and pneumonia. In early onset neonatal sepsis (EOS) Clinical features are non-specific and are inefficient for identifying neonates with early-onset sepsis. Culture results take up to 48 hours and may give false-positive or low-yield results because of the antenatal antibiotic exposure. Reviews of risk factors has been used globally to guide the development of management guidelines for neonatal sepsis, and it is similarly recommended that such evidence be used to inform guideline development for management of neonatal sepsis. Material and Methods: This study was carried out using institution based cross section study . The total number neonates admitted in the hospital in given study period was 644, of which 234 were diagnosed for neonatal sepsis by the treating pediatrician based on the signs and symptoms during admission. The data was collected: Sociodemographic characteristics; maternal information; and neonatal information for neonatal sepsis like neonatal age on admission, sex, gestational age, birth weight, crying immediately at birth, and resuscitation at birth. Results: Out of 644 neonates admitted 234 (36.34%) were diagnosed for neonatal sepsis by the paediatrician based on the signs and symptoms during admission. Of the 234 neonates, 189 (80.77%) infants were in the age range of 0 to 7 days (Early onset sepsis) while 45 (19.23%) were aged between 8 and 28 days (Late onset sepsis). Male to female ratio in our study was 53.8% and 46% respectively. Out of total 126 male neonates 91(72.2%) were having early onset sepsis while 35 (27.8%) were late onset type. Out of total 108 female neonates 89(82.4%) were having early onset sepsis while 19 (17.6%) were late onset type. Maternal risk factors were identified in 103(57.2%) of early onset sepsis cases while in late onset sepsis cases were 11(20.4%). Foul smelling liquor in early onset sepsis and in late onset sepsis was 10(5.56%) and 2 (3.70%) respectively. In early onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 21(11.67%), 19 (10.56%), 20(11.11%) and 33 (18.33%) cases respectively. In late onset sepsis cases maternal UTI, Meconium stained amniotic fluid, Multipara and Premature rupture of membrane was seen in 2 (3.70%), 1(1.85%), 3 (5.56%) and 3 (5.56%) cases respectively. Conclusion: Maternal risk identification may help in the early identification and empirical antibiotic treatment in neonatal sepsis and thus mortality and morbidity can be reduced.

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