Background and Purpose—The authors present an overview of the current evidence and management recommendations for evaluation and treatment of adults with acute ischemic stroke. The intended audienc...

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Guidelines for the Early Management of Patients With Acute Ischemic Stroke A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Normal Normal facial function in all areas Mild dysfunction Gross: slight weakness noticeable on close inspection; may have very slight synkinesis At rest: normal symmetry and tone Motion Forehead: moderate to good function Eye: complete closure with minimum effort Mouth: slight asymmetry III Moderate dysfunction Gross: obvious but not disfiguring difference between two sides; noticeable but not severe synkinesis. contracture. and/or hemifacial spasm At rest: normal symmetry and tone Motion Forehead: slight to moderate movement Eye: complete closure with effort Mouth: slightly weak with maximum effort rv Moderately severe dysfunction Gross: obvious weakness and/or disfiguring asymmetry At rest: normal symmetry and tone Motion Forehead: none Eye: incomplete closure Mouth: asymmetric with maximum effort V Severe dysfunction Gross: only barely perceptible motion At rest: asymmetry Motion Forehead: none Eye: incomplete closure Mouth: slight movement VI Total paralysis No movement From the Otologic Medical Group. Supported by funds from the House Ear Institute, affiliated with the University of Southern California School of Medicine. Submitted for publication Dec. 7, 1984; accepted Jan. 29, 1985. Reprint requests: John W. House, MD, The Otologic Medical Group, 2122 W. Third St., Los Angeles, CA 90057. At the Annual Meeting of the Table 1. Facial nerve grading system American Academy of Otolaryngology-Head and Neck Surgery, the Facial Nerve Disorders Committee adopted a universal standard for grading facial nerve recovery. This standard is based on articles by US. •2 It is intended for use when a patient's facial nerve recovery is being assessed. The system involves a six-point scale with I being normal and VI total, flaccid paralysis (Table 1). Those who have their own method of assessing facial nerve recovery are encouraged to convert their results to this six-point scale, which will be required when results are reported in Otolaryngology-Head and Neck Surgery. To assist in placing patients in the proper group, an easy method of measuring facial movement has been developed by one of us (D.E.B.). This system involves

Facial nerve grading system

Byproducts of normal mitochondrial metabolism and homeostasis include the buildup of potentially damaging levels of reactive oxygen species (ROS), Ca2+, etc., which must be normalized. Evidence suggests that brief mitochondrial permeability transition pore (mPTP) openings play an important physiological role maintaining healthy mitochondria homeostasis. Adaptive and maladaptive responses to redox stress may involve mitochondrial channels such as mPTP and inner membrane anion channel (IMAC). Their activation causes intra- and intermitochondrial redox-environment changes leading to ROS release. This regenerative cycle of mitochondrial ROS formation and release was named ROS-induced ROS release (RIRR). Brief, reversible mPTP opening-associated ROS release apparently constitutes an adaptive housekeeping function by the timely release from mitochondria of accumulated potentially toxic levels of ROS (and Ca2+). At higher ROS levels, longer mPTP openings may release a ROS burst leading to destruction of mitochondria, and if propagated from mitochondrion to mitochondrion, of the cell itself. The destructive function of RIRR may serve a physiological role by removal of unwanted cells or damaged mitochondria, or cause the pathological elimination of vital and essential mitochondria and cells. The adaptive release of sufficient ROS into the vicinity of mitochondria may also activate local pools of redox-sensitive enzymes involved in protective signaling pathways that limit ischemic damage to mitochondria and cells in that area. Maladaptive mPTP- or IMAC-related RIRR may also be playing a role in aging. Because the mechanism of mitochondrial RIRR highlights the central role of mitochondria-formed ROS, we discuss all of the known ROS-producing sites (shown in vitro) and their relevance to the mitochondrial ROS production in vivo.

Mitochondrial Reactive Oxygen Species (ROS) and ROS-Induced ROS Release

In 1972 ~ and 19852 the Committee on Hearing and Equilibrium of the American Academy of Otolaryngolog3~-Head and Neck Surgery published recommended guidelines for reporting the results of treatment of Meniere's disease. These reports have proved very beneficial to efforts to understand this disorder and its treatment. With advancing knowledge it has become evident that the reporting guidelines could be refined further. In undertaking this review, the Committee established several guiding principles. We wished to establish a distinction between the recording of results and the analysis and interpretation of results. Insofar as is possible, we wanted to retain and integrate the methods recommended in the 1972 and 1985 reports. We wanted guidelines to be \"upwardly compatible\" in the sense of computer software, so that existing data could not only be conserved but analyzed in new ways. Reporting methods should be clearly stated, straightforward to apply, as simple as possible, and usable in a wide range of settings, from multicenter university studies to reviews of personal experience by individual private practitioners. Specialized test equipment should not be required. Methods should facilitate statistical evaluation and comparison of results among studies. The guidelines should encourage reports to reflect disease severity in a meaningful manner.

Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease*

Evoked potentials in clinical medicine , Evoked potentials in clinical medicine , کتابخانه مرکزی دانشگاه علوم پزشکی ایران

Evoked Potentials in Clinical Medicine

• Tumors that press on the auditory nerve can cause a latency increase that is detectable from the scalp by electric response audiometry (BERA). The response delay is best seen by comparing the Jewett wave V, or P5, latencies for the two ears. This interaural latency difference is normally less than 0.2 msec, but was 0.4 msec or greater for 35 acoustic tumor cases and for seven of ten other temporal bone tumors. Acoustic tumor size can be estimated from the amount of latency delay. (Arch Otolaryngol103:181-187, 1977)

Acoustic Tumor Detection With Brain Stem Electric Response Audiometry

Although single-channel electrode arrays implanted in the scala tympani of deaf patients are useful as an aid to lip reading and for distinguishing some environmental sounds, they do not transmit intelligible speech. However, multichannel electrode arrays, which take advantage of the cochlea's tonotopic organization, may be capable of generating the complex patterns of neural activity necessary for speech discrimination. In this study, multichannel electrodes were implanted in the cochleas of four volunteers, with access to the connecting wires made through the skin via a percutaneous connector. The major portion of the data presented is from two of these subjects: one has been bilaterally deaf since birth and the other has been unilaterally deaf for 15 years. Preliminary results of experiments with two more recently implanted subjects are described as well as experiments with a fifth volunteer who was implanted with five electrodes by House in 1969. Data on pitch and loudness discrimination as well as the effects of stimulation parameters on threshold, impedance, and electrode interaction are presented. Place pitch and periodicity pitch were observed in all five volunteers. The results of pitch-matching experiments with the unilaterally deaf volunteer were consistent with tonotopic maps of the cochlea, and experiments indicated that a pitch continuum may be achieved by combining place and periodicity pitch modulation. Preliminary experiments in tune recognition with one subject demonstrate his ability to recognize simple melodies based on periodicity pitch cues. These results, coupled with the finding that subjective sensations remain stable over the long-term, support the feasibility of providing artificial hearing with a multichannel cochlear stimulation system.

Auditory prostheses research with multiple channel intracochlear stimulation in man.

Background: Paragangliomas are rare and highly heritable tumours of neuroectodermal origin that often develop in the head and neck region. Germline mutations in the mitochondrial complex II genes, SDHB, SDHC , and SDHD , cause hereditary paraganglioma (PGL). Methods: We assessed the frequency of SDHB, SDHC , and SDHD gene mutations by PCR amplification and sequencing in a set of head and neck paraganglioma patients who were previously managed in two otolaryngology clinics in the USA. Results: Fifty-five subjects were grouped into 10 families and 37 non-familial cases. Five of the non-familial cases had multiple tumours. Germline SDHD mutations were identified in five of 10 (50%) familial and two of 37 (∼5%) non-familial cases. R38X, P81L, H102L, Q109X, and L128fsX134 mutations were identified in the familial cases and P81L was identified in the non-familial cases. Both non-familial cases had multiple tumours. P81L and R38X mutations have previously been reported in other PGL families and P81L was suggested as a founder mutation. Allelic analyses of different chromosomes carrying these mutations did not show common disease haplotypes, strongly suggesting that R38X and P81L are potentially recurrent mutations. Germline SDHB mutations were identified in two of 10 (20%) familial and one of 33 (∼3%) non-familial cases. P131R and M71fsX80 were identified in the familial cases and Q59X was identified in the one non-familial case. The non-familial case had a solitary tumour. No mutations could be identified in the SDHC gene in the remaining four families and 20 sporadic cases. Conclusions: Mutations in SDHD are the leading cause of head and neck paragangliomas in this clinic patient series. SDHD and SDHB mutations account for 70% of familial cases and ∼8% of non-familial cases. These results also suggest that the commonness of the SDHD P81L mutation in North America is the result of both a founder effect and recurrent mutations.

https://jmg.bmj.com/content/jmedgenet/39/3/178.full.pdf

Prevalence of SDHB, SDHC, and SDHD germline mutations in clinic patients with head and neck paragangliomas

IN a series of 1,354 cerebellopontine angle tumors treated at the Otologic Medical Group, approximately 10% were lesions other than acoustic neurinomas. Of the non-acoustic tumors, the majority were meningiomas, primary cholesteatomas, and neurinomas of other cranial nerves in the posterior fossa. Twenty-five other lesions were encountered; these rare tumors are the subject of this study. The benign tumors resemble acoustic neurinomas in appearance and in the method of treatment. Malignant tumors are characterized by rapid development of symptoms and are difficult to treat because of invasion of vital structures in the area.

Derald E. Brackmann

Papers

Facial nerve grading system

Acoustic Tumor Detection With Brain Stem Electric Response Audiometry

Auditory prostheses research with multiple channel intracochlear stimulation in man.

Prevalence of SDHB, SDHC, and SDHD germline mutations in clinic patients with head and neck paragangliomas

Rare Tumors of the Cerebellopontine Angle