Cases reported "Gagging"

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1/4. Hyperactive rhizopathy of the vagus nerve and microvascular decompression. Case report.

    A 37-year-old woman underwent microvascular decompression of the superior vestibular nerve for disabling positional vertigo. Immediately following the operation, she noted severe and spontaneous gagging and dysphagia. Multiple magnetic resonance images were obtained but failed to demonstrate a brainstem lesion and attempts at medical management failed. Two years later she underwent exploration of the posterior fossa. At the second operation, the vertebral artery as well as the posterior inferior cerebellar artery were noted to be compressing the vagus nerve. The vessels were mobilized and held away from the nerve with Teflon felt. The patient's symptoms resolved immediately after the second operation and she has remained symptom free. The authors hypothesize that at least one artery was shifted at the time of her first operation, or immediately thereafter, which resulted in vascular compression of the vagus nerve. To the authors' knowledge, this is the first reported case of a hyperactive gagging response treated with microvascular decompression. The case also illustrates the occurrence of a possibly iatrogenic neurovascular compression syndrome.
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2/4. glossopharyngeal nerve injury complicating carotid endarterectomy.

    Injury can occur to several of the cranial nerves during carotid endarterectomy. Among these, glossopharyngeal nerve injury is an uncommon complication because it is remote from the field of dissection in most carotid procedures. From more than 2000 carotid operations four cases of symptomatic ninth cranial nerve injury were identified. Analysis revealed that dissection cephalad to the level of the hypoglossal nerve was a common feature of each and severe functional disability can result from glossopharyngeal nerve paresis. When mobilization of this nerve and division of the posterior belly of the digastric muscle and styloid process become necessary for additional exposure, the risk of glossopharyngeal nerve injury increases. Specific recommendations are made regarding management and maneuvers to help reduce the incidence of this uncommon, yet potentially serious, complication.
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3/4. Trigeminal-palatal synkinesis.

    A patient developed synkinetic movements of facial musculature and "crocodile tears" following the removal of a large acoustic neurinoma. A reflex palatal movement resulted from tactile stimulation of the lower part of the face as well. Analysis of the palatal movement suggested action of the tensor veli palatini muscle, acting in isolation. We believe the palatal contraction represents a synkinetic phenomenon involving both sensory and motor nerve fibers within the motor root of the trigeminal nerve.
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4/4. Vascular compression, hemifacial spasm, and multiple cranial neuropathy.

    hemifacial spasm is usually an isolated symptom resulting from facial nerve root compression. Three patients had, in addition, tinnitus, hearing loss, facial sensory loss, diminished gag reflex, dysphagia, and dysarthria. Acoustic reflexes were abnormal, and facial nerve conduction studies showed evidence of ephaptic transmission and ectopic excitation. brain CT and metrizamide cisternography were normal. Surgical exploration showed compression of cranial nerve roots by posterior inferior cerebellar artery branches. After decompression, symptoms abated, and electrical signs of hemifacial spasm disappeared. Vascular compression of nerve roots in the cerebellopontine recess may cause multiple cranial neuropathy.
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