Tapia's Syndrome after Posterior Cervical Spine Surgery under General Anesthesia

We present a case report to remind surgeons of this unusual complication that can occur in any surgery, even posterior cervical spine surgery under general anesthesia and discuss its causes, treatment methods, and the follow-up results in the literature. The peripheral Tapia''s syndrome is a rare complication of anesthetic airway management. Main symptoms are hoarseness of voice and difficulty of tongue movement. Tapia''s syndrome after endotracheal general anesthesia is believed to be due to pressure neuropathy of the vagus nerve and the hypoglossal nerve caused by the endotracheal tube. To our knowledge, no report has been published or given an explanation for Tapia''s syndrome after posterior cervical spine surgery. Two patients who underwent posterior cervical surgery complained hoarseness and tongue palsy postoperatively. There is no direct anatomical relation between the operation, the vagus nerves and the hypoglossal nerves, and there is no record of displacement or malposition of the endotracheal tube. After several months, all symptoms are resolved. To avoid this problem in posterior cervical spine surgery, we suggest paying special attention to the position of the endotracheal tube to avoid excessive neck flexion before and during the positioning of the patient.     

Assessing speech dysfunction using BOLD and acoustic analysis in parkinsonism

IntroductionSpeech dysfunction is often associated with parkinsonism (Parkinson's disease (PD), Multiple System Atrophy (MSA), and Progressive Supranuclear Palsy (PSP)), along with characteristic motor features. Any or all of the following i.e. respiratory, phonatory, resonatory, or articulatory components of speech production may be affected. Articulatory imprecision, repetition of syllables (tachyphrenia), and tremor of oropharyngeal structures add to speech unintelligibility. We studied acoustics using spectrogram and its correlation with BOLD activation during voice/speech production across these subjects.MethodsBOLD studies were conducted on 108 subjects (29 PD, 20 MSA and 19 PSP and 40 controls) on 1.5 T MR scanner using 130 dynamics. Active phase involved acquisition (10 volumes each) of audible reading of visually presented bi-syllabic meaningful Hindi simple words (5 types of non-nasal stop consonant categories, i.e. namely velars, palatals, retroflexes, dentals, bilabials and one nasal stop consonant) with interleaved silence during baseline. The subjects' voice samples were analyzed for acoustic parameters, namely formant frequencies of the adjoining vowels, voice onset time (VOT), and intensities using spectrogram. Correlation of BOLD activation in different brain areas with acoustic parameters was evaluated.ResultsVoice intensity was significantly lowered, while VOTs were delayed in these patients as compared to healthy controls. All acoustic parameters were significantly affected for nasal consonants. BOLD activation correlated positively in primary motor cortex to VOTs, while F₂ formants to activation of supplementary motor area.ConclusionThe differences in the acoustic quality of various stop consonants in patients may be helpful in differentiating these three parkinsonian disorders.     

Role of Bowel Ultrasound in the Diagnosis and Follow-up of Patients with Crohn's Disease

Crohn's disease (CD) is an inflammatory chronic bowel disorder; it can involve the whole gastrointestinal tract, but its localization in the ileum or colon is most common. The reference standard for the diagnosis of CD is ileocolonoscopy with histologic assessment. The reference standard for the detection of any complications is surgery. However, imaging techniques have an important role both in the detection/localization of CD and in the follow-up of CD patients. In the last few years, the technical development of ultrasound equipment, the advent of new technologies such as elastography and mostly the increased expertise of sonographers have boosted the role of bowel ultrasound in assessment of the gastrointestinal tract. In fact, bowel ultrasound is particularly attractive thanks to its widespread availability, non-invasiveness, low cost and good reproducibility, as it can be easily repeated during follow-up. The aim of this article is to provide an extensive overview of the actual role of bowel ultrasound in the detection and follow-up of patients with CD.     

Empathic and aversive responses to others among 16‐month‐olds: associations with maternal depressive and relational variables

Mothers' depressive symptomatology and quality of relationships with other adults was related to the empathic behaviour of their 16‐month‐olds. Fifty‐four 16‐month‐olds (23 girls, 31 boys) watched videotapes of young children of the same gender and minority status expressing sad, happy, and neutral affect. Mothers completed self‐report measures of depressive symptomatology (Beck Depression Inventory) and quality of relationships with other adults. Infants of mothers who rated themselves as lower on comfort with closeness to other adults (one of the three quality of relationship subscales) were more likely to respond to the videotapes in a manner suggesting that they did not apprehend and/or take part in the actors' expressions of emotion. Infants of mothers who rated themselves higher on depressive symptoms displayed more aversive behaviours in response to sad stimuli. The findings are congruent with the assertion that infants' ability to understand and share the emotional experiences of others is influenced by their mothers' mental health and relationships with other adults.     

The relevance of migraine in patients with Ménière's disease

Conclusion. Coexistent migraine affects relevant clinical features of patients with Ménière's disease (MD). Objective. Epidemiological studies have shown an association between migraine and MD. We sought to determine whether the coexistence of migraine affects any clinical features in patients with MD. Patients and methods. In this retrospective case-control study of University Neurotology Clinic patients, 50 patients meeting 1995 AAO-HNS criteria for definite MD were compared to 18 patients meeting the same criteria in addition to the 2004 IHS criteria for migraine (MMD). All had typical low frequency sensorineural hearing loss and episodes of rotational vertigo. Outcome measures included: sex, age of onset of episodic vertigo or fluctuating hearing loss, laterality of hearing loss, aural symptoms, caloric responses, severity of hearing loss, and family history of migraine, episodic vertigo or hearing loss. Results. Age of onset of episodic vertigo or fluctuating hearing loss was significantly lower in patients with MMD (mean±1.96*SE=37.2±6.3 years) than in those with MD (mean±1.96*SE=49.3±4.4 years). Concurrent bilateral aural symptoms and hearing loss were seen in 56% of MMD and 4% of MD patients. A family history of episodic vertigo was seen in 39% of MMD and 2% of MD patients.