20 cards Flashcards
Differentiating feature between an UMN and LMN lesion affecting the facial nerve
UMN - sparing of the forehead. contralateral symptoms
Cause of Bell’s palsy
Facial nerve inflmmation and edema induced by reactivation of herpes simplex or VZV
Clin F of Bell’s palsy
Unilateral face weakness
Dry eyes and mouth
Taste disturbance
Hyperacusis
RF for Bell’s palsy
Pregnancy
Severe pre-eclampsia
Obesity
HTN
Diabetes
URTI
Differentials for facial weakness
Neurological
Stroke (upper motor neuron palsy)
Guillain–Barré syndrome
Multiple sclerosis
Otologic
Acute or chronic otitis media
Malignant/necrotising otitis externa
Cholesteatoma
Schwannoma
Infectious
Herpes zoster virus
Mumps
Rubella
Epstein–Barr virus
Inflammatory
Sarcoidosis
Neoplastic
Cerebral tumour
Cutaneous cancer of the face and neck
Parotid tumour
Metastatic tumour
Lymphoma
Idiopathic
Bell’s palsy
Trauma
Temporal bone fracture
Surgical intervention with subsequent damage to the facial nerve
Examination to do when facial weakness
Inspection of ear canal and tympanic membrane > Herpes zoster infection
Head and neck > cutaneous cancers and palpation for masses
CN examination
House- Brackmann grading scale for dynamic facial nerve funciton
Management of Bell’s palsy
PO Corticosteroids for 10 days - high dose for 5 days and tapering the remaining 5 days
Antivirals do not have strong evidence after 72hours of symptom onset
If incomplete eye closure, need to offer eye protection: sunglasses, lubricating eye drops and tape eyelid when sleeping
Recommended anticoagulant in patients with HITTS
Fondaparinux or danaparoid
What is warfarin’s use in relation to VTEs
NOT for ppx
Treatment of already established DVTS/PES
What is rivaroxaban’s use in relation to VTES
Treatment of established DVTs/PEs
VTE ppx for patients post hip or total knee replacement
Mng of essential tremor
Non selective beta blockers like propanolol or anticonvulsants like primidone
Clin F of essential tremor
Bilateral postural tremor affecting the hands, worsens with voluntary movement, improves with rest
Management of carotid artery stenosis
Asymptomatic - medical therapy: potent antihypertensives, antiplatelets, antihypertensives, lifestyle mods
Symptomatic: carotid endarterectomy/ carotid angiplasty with stenting within 14 days for 50-99% stenosis
When is carotid artery stenosis considered symptomatic
Ipsilateral amurosis fugax, contralateral limb weakness, speech disturbances
What is post traumatic amnesia
State of confusion and disorientation that occurs following TBI
Duration of post traumatic amnesia is one of the most reliable predictors of funcitonal outcome following TBI - accurate for prognostics and rehab planning
most appropriate frequency for ongoing post-traumatic amnesia testing?
Daily until three consecutive perfect scores
What scale do you use for post traumatic amnesia
Westmead PTA scale
What is Todd’s paralysis
After focal seizures and is the postictal weakness of paralysis of the involved limb or facial muscles . Can last for minutes or up to 36 hours
What score can be used to risk stratify TIA pts
ABCD2 score
