B7-024 Facial Weakness

Question 1

for the lower face, the wiring UMN control is analogous to […]

Answer 1

corticospinal tract

(crosses)

Question 2

for the upper face, the wiring UMN control is […]

Answer 2

bilateral

(makes it difficult to move one eyebrow)

Question 3

if the […] is spared, it is an UMN (central) lesion

Answer 3

forehead

Question 4

if both the upper face and lower face are involved, it is a […] lesion

Answer 4

peripheral (LMN or facial nerve)

Question 5

hallmark of brainstem lesion

Answer 5

alternating hemiplegia

(affects ipsilateral cranial nerve and contralateral long tract)

Question 6

pattern:
entire face
contralateral leg (UMN)

[where is the lesion?]

Answer 6

brain stem
alternating hemiplegia

Question 7

entire face affected
no alternating hemiplegia

Answer 7

extra axial 7th

Question 8

functions of the facial nerve at the facial motor nucleus [3]

Answer 8

face muscles
stapedius (dampens sound)
digastric

Question 9

functions of the facial nerve at the gustatory nucleus

Answer 9

taste to anterior 2/3s of tongue

Question 10

functions of the facial nerve at the main sensory nucleus

Answer 10

ear region sensation

Question 11

functions of the facial nerve at the superior salivatory nucleus [3]

Answer 11

lacrimal glands
submandibular glands
sublingual glands

Question 12

dry eyes
hyperacusis
decreased taste
facial weakness

[indicate lesion affecting]

Answer 12

facial nerve

Question 13

idiopathic
peripheral CN VII palsy

Answer 13

Bell’s palsy

(thought to be caused by inflammation, but unknown etiology)

Question 14

Bell’s palsy caused by inflammation from reactivation of VZV

vesicles in the ear

Answer 14

Ramsay Hunt syndrome

Question 15

Bell’s palsy secondary to Lyme disease

Answer 15

peripheral 7th from neuroborrelosis

Question 16

should KC patients with Bell’s palsy be tested for Lyme?

Answer 16

no, often false positive. It’s not an endemic area

Question 17

reactivation of HSV1 within the […] can cause Bell’s palsy

Answer 17

geniculate ganglion

Question 18

secondary defect from Bell’s palsy due
to afferent reinnervation

Answer 18

synkinesis

(can cause gustatory tears and facial spasm as well)

Question 19

grading scale for recovery from Bell’s palsy

Answer 19

House and Brackmann grading scale

(1 is normal, 6 is total paralysis)

Question 20

[…] of patients will Bell’s palsy will have normal recovery

Answer 20

70%

(usually takes about 3-8 weeks)

Question 21

poor prognostic factors for Bell’s palsy

Answer 21

older age
non-ear region pain
complete palsy
gradual onset (longer than 3 days)
vertigo
diabetes
hypertension

Question 22

prevention of exposure keratitis [2]

Answer 22

eye lubrication
eye patching

Question 23

treatment for Bell’s palsy [2]

Answer 23

steroids (high evidence)
acyclovir (low evidence, unless VZV)

Question 24

the facial motor nuclei supplying the lower motor neurons going to the lower face receive input from the […] cerebral hemisphere

Answer 24

contralateral

Question 25

the facial nerve originates in the

Answer 25

pons

Question 26

the facial nerve enters the temporal bone through the

Answer 26

internal auditory canal

Question 27

the facial nerve exits the temporal bone through the

Answer 27

stylomastoid foramen

Question 28

cause of Bell's palsy

Answer 28

inflammation of the facial nerve within the temporal bone causes ischemia, demyelination, and axon loss

Question 29

acute facial weakness along with ipsilateral limb weakness may indicate

Answer 29

stroke (treat with thrombolytic)

Question 30

pain [...] the ear is a poor prognostic indicator for functional outcome

Answer 30

outside the region of the ear (non-ear pain) (not ear pain itself)

Question 31

most common peripheral facial palsy

Answer 31

Bell palsy

Question 32

Bell palsy usually develops after [...] reactivation

Answer 32

HSV

Question 33

most patients with Bell palsy gradually recover, but [...] can occur

Answer 33

aberrant regeneration

Question 34

other causes of facial palsy [5]

Answer 34

Lyme disease VZV (ramsay Hunt) sarcoidosis tumors (in parotid) diabetes mellitus

Question 35

[UMN or LMN lesion of Facial] lesion is in the motor cortex

Answer 35

UMN

Question 36

[UMN or LMN lesion of Facial] affects the contralateral side

Answer 36

UMN

Question 37

[UMN or LMN lesion of Facial] only affects lower muscles of facial expression

Answer 37

UMN

Question 38

[UMN or LMN lesion of Facial] forehead is spared

Answer 38

UMN (due to bilateral innervation)

Question 39

[UMN or LMN lesion of Facial] lesion at the facial nucleus

Answer 39

LMN

Question 40

[UMN or LMN lesion of Facial] lesion is in the connection from the motor cortex to the facial nucleus

Answer 40

UMN

Question 41

[UMN or LMN lesion of Facial] lesion anywhere along CN VII

Answer 41

LMN

Question 42

[UMN or LMN lesion of Facial] ipsilateral side is affected

Answer 42

LMN

Question 43

[UMN or LMN lesion of Facial] affects the upper and lower muscles of facial expression

Answer 43

LMN

Question 44

[UMN or LMN lesion of Facial] can be associated with incomplete eye closure, hyperacusis, loss of taste to anterior tongue

Answer 44

LMN