CN VII and Headache (F)

Question 1

What is the presentation of Tolosa-Hunt Syndrome? 1. Where is the lesion? 2

Answer 1

1. Periorbital pain or unilateral headache with
   ipsilateral ophthalmoplegia
2. cavernous sinus or superior orbital fissure

Question 2

What are some ophthalmic causes of headache and pain around the eye?

Answer 2

 Angle closure glaucoma
 Refractive error
 Heterophoria/tropia
 Herpes zoster ophthalmicus
 Other corneal disease
 Scleritis/iritis/uveitis
 Optic neuritis

Question 3

What are the motor functions of CN VII that need to be examined?

Answer 3

1. Note facial asymmetry, blink pattern, forehead wrinkling, lagophthalmos, and facial emotional response and response to command
2. Assess orbicularis strength: patient forces eyes closed while examiner attempts opening
3. Marginal reflex distance

Question 4

What is the criteria to be considered a cluster headache?

Answer 4

A. At least 5 attacks fulfilling criteria B-D
B. severe unilateral orbital, supraorbital, and/or temporal pain lasting 15 to 180 min untreated
C. HA associated with at least one of the following signs present on painful side: conjunctival injection and/or lacrimation, nasal congestion an/or rhinorrhea, eyelid edema, forehead and facial sweating, miosis and/or ptosis, a sense of restlessness or agitation
D. one to eight attacks per day
E. not attributed to any other disorder

Question 5

What is the chief differential for cluster HA from a painful Horner syndrome?

Answer 5

carotid dissection

Question 6

What are the signs of a sinus headache?

Answer 6

Dull, aching, constant, tenderness over sinus

Question 7

Where is the lesion most likely located with CN V, VI or VIII affected with CN VII?

Answer 7

brain stem lesion (pons)

Question 8

What do supranuclear VII palsies usually present with?

Answer 8

1. dissociation between spontaneous and voluntary facial movement
2. preservation of forehead wrinkles and brow elevation

Question 9

Where is the lesion most likely located with signs of increased intracranial pressure, with CN VI and VII dysfunction?

Answer 9

space occupying lesion

Question 10

What is the extracranial course of CN VII?

Answer 10

 Motor branches of the facial nerve exit the skull base via the stylomastoid foramen.
 The facial nerve then bends again to proceed forward to penetrate the posterior aspect of the parotid gland.
 Within the substance of the parotid gland, the facial nerve divides into upper and lower divisions.
 These divisions may be further subdivided from top to bottom into temporal, zygomatic, buccal, mandibular, and cervical branches

Question 11

Where is the lesion most likely located with CN VII and VIII dysfunction?

Answer 11

lesion in area of internal acoustic meatus

Question 12

When is automated threshold VF testing warranted in cases of headaches?

Answer 12

1. decreased vision
2. RAPD
3. EOM abnormality