Aetiology of Nerve palsies Flashcards

Question

what is a opthalmoplegic migraine

Answer 1

Rare condition – sometimes called intracranial neuralgia Unilateral headache Followed by 3rd nerve palsy - partial or complete, pupil often affected 6th nerve may be affected and a suggested cause of recurrent 6th nerve palsy in children - in absence of any pathology

Answer 2

4th nerve particularly susceptible to closed head trauma 6th nerve may be affected if downward displacement of brain stem 3rd nerve least frequently affected by trauma, frontal blow to accelerating head Shaken baby syndrome – isolated or bilateral palsies may occur

Answer 3

Occurs rarely in children In adults higher incidence in females and in the obese Main signs and symptoms include: Headache Nausea and vomiting Papilloedema (swelling of optic disc) Pulsatile tinnitus 6th nerve palsy commonest – 3rd & 4th also reported Unilateral or bilateral (NB Also concomitant strabismus or decompensation has been reported) Can respond to Diamox or gain relief following lumbar puncture

Answer 4

Following dural puncture (e.g diagnostic lumbar puncture; accidentally during epidual anaesthesia) Headache (and nausea), worse when upright, may occur after puncture Extraocular muscle palsy is a rare complication 6th nerve palsy commonest – 3rd & 4th also reported Unilateral or bilateral Onset 1 – 3 days after puncture (Nishio et al, 2004)

Answer 5

3rd nerve or 6th nerve most frequently affected Pupil generally spared ?CauseInterruption of blood supplyInflammation of nerveFocal demyelination

Answer 6

Rule: when aneurysm compresses 3rd nerve, the iris sphincter will be impaired Do not apply rule where palsy is incomplete Great caution in the under 50 year age group unless glaring vasculopathic risk factors

Answer 7

Features occur six weeks or more after onset. Include (alone or in combination): Retraction of upper lid on down gaze Elevation of upper lid on adduction Constriction of the pupil on elevation, depression or adduction Adduction on attempted elevation (and occasionally on depression) Tends to occur where trauma or space occupying lesion is cause

Answer 8

Virus affects dorsal root ganglia - trigemminal ganglia affected - unilateral painful rash Muscle palsies may be ipsilateral, contralateral or bilateral, and may affect one or more nerves Can affect any age, but more common in elderly or immuno-compromised Treated with anti-viral therapy (e.g acyclovir)

Answer 9

Multiple SclerosisDemyelination of nerve sheathSuspected in young adults with isolated nerve palsy(most common age for presentation 20 – 40 years; but can be younger or older) May have other symptoms or history of previous episode

Answer 10

Meningitis Encephalitis Poliomyelitis Tertiary syphilis (late stage) Tolosa-Hunt syndrome

Answer 11

Non-specific granulomatous inflammation in anterior part cavernous sinus / SOF area Possible involvement 3rd, 4th, 6th nerves with severe constant pain Visual loss if ON involved Proptosis Sluggish Pupil Diagnosis: CT scan, ESR may be raised Treatment: Systemic steroids (e.g prednisolone)

Answer 12

Systemic lupus erythematosus (SLE) Immunological disorder affecting connective tissue and nervous system Nerve palsy may be due to vaso-occlusion of small vessels No cure, pain relief used, if severe immunosuppressives Sarcoidosis Granulomatous disease Isolated or multiple nerve palsies reported, may be accompanied by pain No cure, but treated with steroids

Answer 13

Acute inflammatory demyelinating polyradiculoneuropathy – Aetiology not fully understood. May occur after viral infection. Slightly more common in males than females, can affect any age but most common 20-50 yrs age Sudden, acute motor paresis peaking within 4 weaks Ocular involvement to varying extent: ophthlmoplegia, fixed dilated pupils, optic neuritis, facial nerve palsy Treatment: Intravenous immunoglobulin treatment, steroids, plasma exchange (treatment removes antibodies from blood)

Answer 14

Possibly a variant of Guillan-Barre May occur after upper respiratory tract infection Ophthalmoplegia – usually symmetrical (divergence paralysis, impaired smooth pursuit have also been reported) Ataxia Hyporeflexia or areflexia Diagnosis: Increased protein in CSF from lumbar puncture. Management: As for Guillan-Barre. Good prognosis.

Answer 15

Gradenigo’s Syndrome Infection of middle ear leading to petrositis and affecting 6th nerve as it crosses petrous part of temporal bone Ipsilateral pain of trigeminal nerve distribution Constant ottorhea

Answer 16

Complications may involve cranial nerves: Infections Parasitic e.g toxoplasmosis Fungal e.g cryptococcosis Neoplasms Vascular (high risk of infarct or haemorrhage)

Answer 17

Neoplasms TraumaLess common: Cavernous Sinus Lesions, Aneurysms, Herpes Zoster, Meningitis, Encephalitis, Tolosa-Hunt, Miller Fisher.

Answer 18

Congenital conditions Hydrocephalus Cerebral palsy Inherited SO palsy Intoxications from mother Lead poisoning, drugs, alcohol Birth trauma