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Clin Med III Exam 3 (🐈, 👵🏼, 🌭) > Bell's Palsy And Trigeminal Neuralgia (Lauren🌭) > Flashcards

Bell's Palsy And Trigeminal Neuralgia (Lauren🌭) Flashcards

1
Q

What are some of the possible causes of facial palsy?

A

IDIOPATHIC**

Infections

Traumatic

Tumor

Stroke

Toxins

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2
Q

What are the functions of the facial nerve that may get messed up if you have Bell’s palsy

A

Facial expression😖

Staepedius muscle📢

Lacrimal and salivary glands😢

Taste to front 2/3 of tongue👅

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3
Q

What causes Bell’s palsy?

A

Unknown, but we think HSV might have something to do with it

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4
Q

What are 2 conditions that increase your risk of developing Bell’s Palsy?

A

Pregnancy, especially 3rd trimester or immediately post partum 🤰🏻

Diabetes 🧁

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5
Q

Bell’s palsy develops (Suddenly/gradual)

A

Suddenly.

Patients often wake up with it and notice it when they look in the mirror to brush their teeth

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6
Q

What will someone with Bell’s palsy look like?

🐝🐝🐝🐝🐝

A

Unable to CLOSE eye

Forehead does NOT wrinkle on that side

Facial drooping with flattening of nasolabial fold

Decreased tears

Hyperacusis (due to stapedius muscle)

+/- loss of taste to anterior 2/3 of tongue

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7
Q

What are 5 possible things that need to be on your differential when someone presents with Bell’s palsy symptoms?

A

Herpes zoster: Ramsay Hunt syndrome

Otitis Media

Lyme disease

Guillan-Barre

Tumor

Stroke (central lesion)

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8
Q

How would you know if it’s due to herpes zoster (Ramsay Hunt Syndrome)

A

Vesicles near external meatus

Preherpetic neuralgia (painful prodrome)

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9
Q

How would you know if someone’s facial drooping was due to Lyme disease?

A

It would probably be bilateral

They might have erythema/swelling prior to the palsy

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10
Q

How would you know if someone’s facial drooping was due to guillain-barre?

A

It would be bilateral and progressive

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11
Q

How would you know if someone’s facial drooping was due to a tumor?

A

It would have a gradual onset

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12
Q

How would you know if someone’s facial drooping was due to a central stroke?

A

They WILL be able to wrinkle their forehead!!****

(Of course you can’t completely rule out stroke if they can’t wrinkle forehead, but for the purposes of this exam you probably can)

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13
Q

Central or peripheral facial palsy:

UMN lesion affects contralateral portion of the lower face

A

Central

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14
Q

Central or peripheral facial palsy:

LMN lesions afffescts the ipsilateral side of the face

A

Peripheral

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15
Q

Central or peripheral facial palsy:

Forehead spared (can wrinkle forehead)

A

Central

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16
Q

Central or peripheral facial palsy:

Involves forehead (can’t wrinkle forehead)

A

Peripheral

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17
Q

Central or peripheral facial palsy:

Stroke

Tumor

MS

Trauma

A

Central

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18
Q

Central or peripheral facial palsy:

Bell’s palsy

Guillan barre

Otitis media

Lyme

Ramsay hunt syndrome

A

Peripheral

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19
Q

What is the name for herpes zoster that affects the facial nerve and causes facial drooping?

A

Ramsay hunt syndrome

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20
Q

True or false:

Bell’s palsy is a clinical diagnosis

A

True.

Based on:
1. Diffuse facial nerve involvement (forehead and eye affected)

  1. Acute onset in 1-2 days. Maximum severity within 3 weeks. Improvement or recovery in 6 months
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21
Q

If Bell’s palsy is not getting better in _________weeks, you need to start looking for some other cause

A

3

22
Q

When would you need to do diagnostic studies for someone with Bell’s palsy?

A

Getting worse after 3 weeks

No significant improvement in 4 months

Atypical symptoms

23
Q

What kinds of diagnostic studies can you do to work up weird Bell’s palsy?

A

Serologic testing for Lyme and HSV

Fasting blood glucose

EMG/NCS

CT/MRI

24
Q

If you suspect Bell’s palsy and your patient tests positive for HSV, that will (support/hurt) the diagnosis of Bell’s palsy

A

Support

25
Q

What is the pharmacological management of Bells Palsy?

A

Prednisone 60-80mg x 7 days (or some crazy tapering dosage)

+/- Valacyclovir 1g TID x 7 days

Best results if tx initiated within 3 days of onset

26
Q

You should start prednisone and valacyclovir within _____ days of symptom onset for Bell’s palsy

A

3

27
Q

Do you need to do anything else for Bell’s palsy patients other than prednisone and valacyclovir

A

EYE CARE
🌵👁

(They cant close one eye)

28
Q

How do you keep someone’s eye from drying out if they have Bell’s palsy?

A

Artificial tears every hour during the day

Eye ointments at night +/- patch

Sunglasses 😎

29
Q

How long will it take for someone with Bell’s palsy to return to normal function?

A

3-6 months

30
Q

What is the fancy name for trigeminal neuralgia?

A

Tic doulaureux

31
Q

Trigeminal neuralgia pain is described as:

A

attacks of electrical shock-like pain that lasts a few seconds and can occur repetitively

Episodes happen daily or several times a month

Episodes of remission last for 6+ months

32
Q

What age is typically diagnosed with trigeminal neuralgia?

A

> 50

33
Q

Overall, what causes Trigeminal neuralgia?

A

Compression of trigeminal nerve that causes demyelination

34
Q

What are the 2 classifications of trigeminal neuralgia?

A

Classic- idiopathic or vascular compression

Secondary/painful trigeminal neuropathy- compression is caused by other reasons (Multiple sclerosis, herpes zoster, vestibular Schwannoma, meningioma, cyst)

35
Q

Trigeminal neuralgia is usually (unilateral/bilateral)

A

Unilateral

36
Q

Which branches of CNV are usually affected by trigeminal neuralgia?

A

V2 and V3

37
Q

If V1 is affected by trigeminal neuralgia, what other symptoms would you expect to see?

A

Autonomic symptoms (which would make it look like a cluster headache)

38
Q

What can trigger an attack of trigeminal neuralgia?

A

Light touch

Chewing

Talking

Shaving

Brushing teeth

Cold air

39
Q

What is pretrigeminal neuralgia?

A

Prodrome of an achey jaw prior to an attack of trigeminal neuralgia

(People often go to the dentist)

40
Q

What kind of imaging do you NEED to do when someone shows up with symptoms of trigeminal neuralgia?

A

MRI brain with and without contrast

Maybe an MRA to look for vascular compression if they have the classic presentation

41
Q

What is the pharmacologic treatment for trigeminal neuralgia?

A

Carbamazepine 100-200mg BID

Increase gradually to 600-800mg total daily

42
Q

What are the side effects of carbamazepine?

A

Drowsiness

Dizziness

N/V

Leukopenia

Aplastic anemia

43
Q

What lab test do you need to monitor when someone is on carbamazepine?

A

CBC (due to the risk of leukopenia and aplastic anemia)

44
Q

What genetic test do you need to do before you start someone on carbamazepine, especially Asian patients?

A

HLA-B 1502 due to the risk of Stevens Johnson Syndrome

45
Q

What treatments other than carbamazepine may be helpful for trigeminal neuralgia?

A

Other anticonvulsants (oxcarbazepine, gabapentin, phenytoin, Lamotrigine)

Baclofen can be used alone OR in combo with carbamazepine

Topical lidocaine

Opioids (require high dose, just dont do this ok?)

46
Q

What two titers should be drawn when a patient presents with Bells Pasly?

A

Herpes simplex

Lyme

47
Q

What 2 clinical conditions increase the risk for Bell’s palsy

A

Pregnancy

Diabetes

48
Q

A patient has a flat nasolabial fold, cant close his right eye, and cant wrinkle the right side of his forehead. On exam you note vesicles in the right ear canal. What is the diagnosis =

A

Ramsay Hunt Syndrome

49
Q

A patient presents with jaw pain, no trauma, ROM is diminished with attempts to open the mouth. What is the diagnosis?

A

TMJ dysfucntion

50
Q

What neurological condition os most commonly seen with trigeminal neuralgia:

A. Myasthenia gravis

B. Guillan barre

C. Parkinson’s

D. Multiple Sclerosis

A

D. Multiple Sclerosis

51
Q

What rheumatic condition may be associated with giant cell arteritis?

A

Polymyalgia rheumatica

52
Q

What is the treatment of choice for Giant Cell arteritis?

A

High dose oral steroids

Clin Med III Exam 3 (🐈, 👵🏼, 🌭) (3 decks)

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