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  Indian J Med Microbiol
 

Figure 4: (a) VVR of 1.2 - severe stress, (b) VR of same patient at follow up is normal (1.5) i.e., no stress. This suggests gross parasympathetic paralysis. In 2nd patient the preoperative VR is 2.0 (c) which is normal, (d) Post-operative VR has decreased but still lies in normal range. This suggests no parasympathetic involvement. VR - Valsalva ratio

Figure 4: (a) VVR of 1.2 - severe stress, (b) VR of same patient at follow up is normal (1.5) i.e., no stress. This suggests gross parasympathetic paralysis. In 2<sup>nd</sup> patient the preoperative VR is 2.0 (c) which is normal, (d) Post-operative VR has decreased but still lies in normal range. This suggests no parasympathetic involvement. VR - Valsalva ratio