MyMedR

Hypokalaemic periodic paralysis secondary to subclinical hyperthyroidism: an uncommon cause of acute muscle paralysis

Payus AO, Liew SL, Tiong N, Mustafa N

BMJ Case Rep, 2021 Jun 24;14(6).

PMID: 34167974 DOI: 10.1136/bcr-2020-240666

Hypokalaemic periodic paralysis secondary to subclinical hyperthyroidism is an uncommon clinical phenomenon characterised by lower limb paralysis secondary to hypokalaemia in the background of subclinical hyperthyroidism. In this article, we report a patient who presented with progressive lower limb muscle weakness secondary to hypokalaemia that was refractory to potassium replacement therapy. He has no diarrhoea, no reduced appetite and was not taking any medication that can cause potassium wasting. Although he was clinically euthyroid, his thyroid function test revealed subclinical hyperthyroidism. His 24-hour urine potassium level was normal, which makes a rapid transcellular shift of potassium secondary to subclinical hyperthyroidism as the possible cause. He was successfully treated with potassium supplements, non-selective beta-blockers and anti-thyroid medication. This case report aimed to share an uncommon case of hypokalaemic periodic paralysis secondary to subclinical hyperthyroidism, which to our knowledge, only a few has been reported in the literature.

Matched MeSH terms: Paralysis/etiology

Wernicke Encephalopathy as the First Presentation of Neuromyelitis Optica Spectrum Disorder With Horizontal Nerve Palsy

Supahiah P, Thomas BHI, Zhen PC, Aris AM, Abdul-Jalil F, Din NM

J Neuroophthalmol, 2023 Dec 01;43(4):e293-e295.

PMID: 34924530 DOI: 10.1097/WNO.0000000000001444

Matched MeSH terms: Paralysis

Fulltext Ultrasonic scissors-assisted 'open-book' thyroidectomy in massive goiter compressing airway and causing unilateral vocal cord paralysis

Irfan M, Yaroko AA, Soleh MN, Periasamy C

Med J Malaysia, 2013 Apr;68(2):183-5.

PMID: 23629575

A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62- year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.

Matched MeSH terms: Vocal Cord Paralysis*

A Rare Case of Posterior Interosseous Nerve Palsy Post-venepuncture

Yeak RDK, Yap YY, Nasir NM

J Coll Physicians Surg Pak, 2021 Nov;31(11):1357-1358.

PMID: 34689498 DOI: 10.29271/jcpsp.2021.11.1357

Wrist drop post-venepuncture is uncommon. There has been reported cases of direct injury to the radial nerve during venepuncture but to our knowledge, there has never been a case of posterior interosseous nerve (PIN) injury. A 34-year female, right hand dominant homemaker, with a newly diagnosed diabetes mellitus, was admitted for diabetic ketoacidosis. There was difficult access with multiple attempts in her blood taking over the antebrachial fossa and forearm. Thereafter, she was unable to fully extend her wrist, fingers and thumb with an intact sensation. The electrophysiological study was suggestive of demyelinating right radial neuropathy at the elbow. Despite the transient blood taking session, patient developed neuropraxia, which only resolved after four months. We wish to report this case of unusual presentation of a PIN palsy post- routine venepuncture, which can result in high morbidity to a patient. Key Words: Posterior interosseous nerve syndrome, venepuncture, neuropraxia, wrist drop.

Matched MeSH terms: Paralysis/etiology

Fulltext Experiences with teflon injections in unilateral adductor vocal cord paralysis

Lee SS

Med J Malaysia, 1990 Sep;45(3):239-43.

PMID: 2152086

Six of 16 patients presenting to the University Hospital Kuala Lumpur with unilateral recurrent laryngeal nerve paralysis were treated with teflon injection of the paralysed vocal cord. The results are presented and the role of surgical therapy, in particular teflon injection is reviewed.

Matched MeSH terms: Vocal Cord Paralysis/pathology; Vocal Cord Paralysis/therapy*

Vocal Fold Injury Following Intubation

Mohd Umbaik NA, Mohamad I, Nik Hassan NFH

J Craniofac Surg, 2020 10;31(7):2064-2065.

PMID: 32890162 DOI: 10.1097/SCS.0000000000006839

Matched MeSH terms: Vocal Cord Paralysis*

Case report of renal tubular acidosis presenting with periodic paralysis

Devadason I

Med J Malaysia, 1976 Sep;31(1):75-6.

PMID: 1023019

Matched MeSH terms: Paralysis/etiology*

Congenital bilateral facial nerve hypoplasia with sensorineural hearing loss: a case report

Hamizan AW, Yean KT, Abdullah A

Int J Pediatr Otorhinolaryngol, 2012 Mar;76(3):455-9.

PMID: 22281372 DOI: 10.1016/j.ijporl.2012.01.002

A 3-year-old child presented with congenital bilateral facial nerve palsy with bilateral profound sensorineural hearing loss. High Resolution Computed Tomogram (HRCT) of the temporal bones found bilateral atresia of cochlear nerve canals, incomplete partition of the cochleae and narrow facial nerve canals. Magnetic resonance imaging (MRI) revealed bilateral hypoplasia of facial nerves and aplasia of both vestibulocochlear nerves. There have been no other reported cases with this presentation. The possible aetiology and treatment options for the patient are discussed. We highlighted the review of aplasia/hypoplasia of the facial nerve and hypoplasia of cochlear nerve canal.

Matched MeSH terms: Facial Paralysis/complications*; Facial Paralysis/congenital*; Facial Paralysis/diagnosis

Fulltext Congenital bilateral vocal cord paralysis

Hasniah AL, Asiah K, Mariana D, Anida AR, Norzila MZ, Sahrir S

Med J Malaysia, 2006 Dec;61(5):626-9.

PMID: 17623966 MyJurnal

Congenital upper airway obstruction is a relatively rare but important cause of major respiratory problems in the neonatal period. Vocal cord paralysis is the second most common cause of congenital airway obstruction presenting with neonatal stridor. It is often the reason for the failure of neonates to wean from the respiratory support. A retrospective analysis of medical record review was conducted. There were seven paediatric patients diagnosed with bilateral vocal fold paralysis in the past three years, of which five were recently diagnosed. All patients underwent flexible with/without rigid bronchoscopes to confirm the diagnosis. This case series highlight our experience in managing the problem of bilateral vocal cord paralysis in the paediatric population, with particular emphasis on their clinical presentations, associated complications and both upper and lower airway abnormalities. The management options and outcome of these patients will also be discussed.

Matched MeSH terms: Vocal Cord Paralysis/congenital; Vocal Cord Paralysis/diagnosis*; Vocal Cord Paralysis/surgery

Fulltext Iatrogenic facial nerve palsy: lessons to learn

Asma A, Marina MB, Mazita A, Fadzilah I, Mazlina S, Saim L

Singapore Med J, 2009 Dec;50(12):1154-7.

PMID: 20087551

This study aims to review the management and discuss the outcome of patients with iatrogenic facial nerve palsy.

Matched MeSH terms: Facial Paralysis/etiology*; Facial Paralysis/radiography; Facial Paralysis/therapy*

Total paralysis regime in severe tetanus

Alhady SMA, Bowler DP, Reid HA, Scott LT

Br Med J, 1960;1:540-545.

Tetanus may be mild, moderate, severe, or inevitably fatal. Our clinical experience suggests it may be classified as severe (or, maybe, inevitably fatal) when a tetanic spasm stops respiration. Ten patients with severe tetanus were treated by the total paralysis regime (T.P.R.), consisting of tracheostomy, curarization, and intermittent positiveor positive/negative-pressure respiration. Two of the patients were saved by T.P.R. and therefore only limited effectiveness can be claimed for the regime. In inevitably fatal cases survival can be prolonged by T.P.R. so that further effects of tetanus toxin emerge. Of these, the most important appears to be direct damage to the myocardium.

Matched MeSH terms: Paralysis

Fulltext Common peroneal nerve palsy due to posterolateral displacement of fractured lateral tibial plateau

Myint K, Iqbal QM, Kanagasuntheram R

Med J Malaysia, 1980 Sep;35(1):61-3.

PMID: 7254001

Numerous aetiopathologic factors have been enumerated as the possible causes of injuries to the common peroneal nerve at knee. This report presents a case of postero-lateral displacement of the upper end of fibula consequent to the displacement of fractured lateral tibial plateau leading to common peroneal nerve palsy which has not been reported before.

Matched MeSH terms: Paralysis/etiology*

Red tide and outbreak of paralytic shellfish poisoning in Sabah

Roy RN

Med J Malaysia, 1977 Mar;31(3):247-51.

PMID: 904522

Matched MeSH terms: Paralysis/epidemiology

Herpes zoster with severe neurological complication. A report of two cases

Ghee LT

Med J Malaya, 1972 Mar;26(3):201-4.

PMID: 5031016

Matched MeSH terms: Paralysis/etiology

Case Report: Unilateral Hemispheric Hemorrhage with Bilateral Ptosis and Upgaze Palsy

Wong KH, Yong MH, Mohd Khialdin S, Wan Abdul Halim WH

Optom Vis Sci, 2023 Dec 01;100(12):895-899.

PMID: 38019959 DOI: 10.1097/OPX.0000000000002089

SIGNIFICANCE: Determining the anatomic location of insult in cases of concurrent bilateral upgaze palsy with bilateral ptosis can be challenging because of the various overlapping pathways and shared functions. It is more commonly related to bilateral oculomotor nerve palsies and myasthenia gravis. However, the possibility of unilateral cerebrovascular events may be overlooked because of the lack of laterality of disease manifestations.

PURPOSE: This report documents the uncommon presentation of bilateral ptosis and upgaze palsy in unilateral hemispheric hemorrhage with the corresponding clinical and anatomical review.

CASE REPORT: A 46-year-old gentleman presented to the emergency department with left-sided hemiplegia, concurrent bilateral ptosis, and upgaze palsy. He was found to have acute hemorrhagic stroke secondary to significantly elevated blood pressure. Computed tomography of the brain revealed acute extensive intraparenchymal hemorrhage involving the right basal ganglia, frontal lobe, and temporal lobe. There was an extension of hemorrhage into the third ventricle and subarachnoid extension to the Sylvian fissure with obstructive hydrocephalus. An emergency right craniotomy was performed to evacuate the blood clot, and the hydrocephalus subsequently resolved. Post-operatively, bilateral ptosis and upgaze palsy improved and then resolved.

CONCLUSIONS: Acute bilateral ptosis and upgaze palsy suggest the possibility of unilateral hemispheric hemorrhage, even though there is no direct involvement of the brainstem and its nuclei.

Matched MeSH terms: Paralysis/complications

Thyrotoxicosis presenting as hypokalaemic paralysis and hyperlactataemia in an oriental man

Al-Jubouri MA, Inkster GD, Nee PA, Andrews FJ

Ann. Clin. Biochem., 2006 Jul;43(Pt 4):323-5.

PMID: 16824287 DOI: 10.1258/000456306777695681

A 35-year-old Malaysian man presented with rapid onset of flaccid quadriparesis associated with nausea and vomiting. General blood tests revealed severe hypokalaemia (serum potassium 1.5 mmol/L) and hypophosphataemia (serum phosphate 0.29 mmol/L) as a potential cause of the flaccid paralysis. Arterial blood gases showed mixed acid base disturbance of respiratory alkalosis and metabolic acidosis with hyperlactataemia. Thyrotoxic periodic paralysis (TPP) was suspected as the underlying cause of this presentation and thyroid function tests showed severe hyperthyroid results (free T4 > 77.2 pmol/L, free T3 19.3 pmol/L, thyroid-stimulating hormone [TSH] < 0.05 mIU/L). Treatment with intravenous potassium and phosphate infusion and oral propranolol resulted in rapid resolution of his symptoms. A discussion of the clinical and pathophysiological features and treatment of TPP (a very rare encounter in UK clinical practice) is presented, and to our knowledge associated hyperlactataemia has not been previously described.

Matched MeSH terms: Hypokalemic Periodic Paralysis/complications; Hypokalemic Periodic Paralysis/diagnosis*; Hypokalemic Periodic Paralysis/ethnology

Delayed facial palsy in Miller Fisher syndrome

Tan CY, Yuki N, Shahrizaila N

J Neurol Sci, 2015 Nov 15;358(1-2):409-12.

PMID: 26277343 DOI: 10.1016/j.jns.2015.08.009

Miller Fisher syndrome is characterised by the triad of ophthalmoplegia, ataxia and areflexia. However, facial palsy can occur during the course of the illness although development of facial palsy when other cardinal signs of Miller Fisher syndrome have reached nadir or improving, is unusual. This delayed appearance of facial palsy can be easily overlooked by the treating clinician. Here, we report four patients with Miller Fisher syndrome and delayed-onset facial palsy. We discuss the possible underlying reasons behind the delay in facial palsy.

Matched MeSH terms: Facial Paralysis

Fulltext Facial nerve palsy in otitis externa: A red flag?

Badaruddin A, Choo MM

Malays Fam Physician, 2021 Mar 25;16(1):117-120.

PMID: 33948150 DOI: 10.51866/cr1108

Otitis externa is an infection of the external auditory canal. It rarely results in facial palsy except in severe cases such as necrotizing otitis externa, which is a life-threatening invasive infection of the external auditory canal. Early recognition with prompt and appropriate treatment of necrotizing otitis externa is crucial to prevent more sinister complications. Here we report a case of an elderly gentleman who presented with otitis externa and developed facial palsy a month later. We identified possible problems that may have led to the complication so that such an occurrence can be prevented in the future.

Matched MeSH terms: Facial Paralysis

Fulltext The association between myopia and gender in Indian schoolchildren in Kuala Lumpur

Norhani Mohidin, Saadah Mohd Akhir, Bariah Mohd Ali, Zainora Mohammed, Sharanjeet, K., Chung, K.M.

Jurnal Sains Kesihatan Malaysia, 2005;3(2):49-54.

MyJurnal

A vision screening study was carried out among Indian schoolchildren around Kuala Lumpur to determine whether the prevalence of myopia was higher in boys or girls. Altogether 749 students (49.7% boys and 50.3% girls) aged 7-18 years were screened and their refractive error examined using retinoscopy without cycloplegia. For the right eye 15.1% of the girls' eyes were found to be myopic as compared to 16.9% of the boys, of which chi-square showed no significant difference (p = 0.44). For the left eye 18.8% of the girls' eyes were myopic as compared to 16.4% of the boys. Chi square also showed no significant difference (p = 0.26). When high myopia (> -6.00D) was considered, there was no difference found between boys and girls. The number of students with high myopia greater than -6.00D was also very small (0.3%-0.5%). In conclusion, it was found that there was no significant difference in myopia between girls and boys among Indian schoolchildren.

Matched MeSH terms: Paralysis

Fulltext Hyperkalaemic periodic paralysis in pregnancy

Yong SL, Sin TH, Tang EB, Chai MC

BMJ Case Rep, 2018 Jun 04;2018.

PMID: 29866669 DOI: 10.1136/bcr-2017-223588

Hyperkalaemic periodic paralysis is a rare skeletal muscle disorder which is characterised by episodic muscle paralysis associated with hyperkalaemia. Although it is an autosomal-dominant disease, cases of de novo mutations have been reported. We report the case of a 30-year-old woman, gravida 5 para 3+1, who was planned for an elective repeated caesarean section at 38 weeks and 3 days of pregnancy. She developed recurrent episodes of hyperkalaemic periodic paralysis after receiving corticosteroids. Intravenous calcium gluconate was administered to normalise potassium levels (from 6.3 mmol/L to 4.1 mmol/L). Extra anaesthetic precautions were taken during the caesarean delivery. Postoperatively, she was well and discharged from the ward. She encountered similar symptoms in her third pregnancy, and there was no family history of muscle weakness which suggested a de novo mutation. Pregnancy seemed to result in vulnerability to hyperkalaemic attacks as she was never symptomatic outside pregnancy.

Matched MeSH terms: Paralysis, Hyperkalemic Periodic/diagnosis*; Paralysis, Hyperkalemic Periodic/drug therapy; Paralysis, Hyperkalemic Periodic/metabolism

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