Cranial Nerve Disorders

Question 1

trigeminal neuralgia

Answer 1

results from degeneration or compression of artery/vein

Question 2

trigeminal neuralgia occurs in who

Answer 2

older population, mean 50

Question 3

characteristics of trigeminal neuralgia

Answer 3

brief paroxysms of severe neurogenic pain, stabbing/shooting, reoccurring frequently on the mandibular & maxillary distributions

unilateral
autonomic instability

Question 4

what can trigger symptoms of trigeminal neuralgia

Answer 4

stress, cold temp
relieved by relaxation

Question 5

how long do the attacks of trigeminal neuralgia last

Answer 5

several seconds to several minutes, followed by few minutes to hours of dull, achy pain

several attacks last days, weeks, months or longer

remission btw attacks can occur

Question 6

what is also seen with trigeminal neuralgia

Answer 6

depression
cluster headaches

Question 7

what is the major focus of examination with trigeminal neuralgia

Answer 7

pain - location, intensity
trigger points
triggering stimuli
motor function - control is normal

Question 8

management for trigeminal neuralgia?

Answer 8

meds
surgery
rehab - TENS

Question 9

prognosis of trigeminal neuralgia?

Answer 9

attacks become more frequent, easily triggered and more disabling

Question 10

bell’s palsy

Answer 10

idiopathic facial paralysis
facial nerve CNVII

Question 11

bell’s palsy is caused by what

Answer 11

acute inflammatory process of unknown - immune or viral - resulting in compression of the facial n within the temporal bone

Question 12

bell’s palsy mainly seen in who

Answer 12

age 20-40

Question 13

risk factors for bell’s palsy

Answer 13

pregnancy
preeclampsia
obesity
HTN
DM
respiratory illness

Question 14

characteristics of bell’s palsy

Answer 14

weak/paralyzed muscles of facial expression on involved side
loss of control of salivation/lacrimation
acute onset, severe in few hrs/days
preceded by pain behind ear

Question 15

how long does it take to recover from bell’s palsy

Answer 15

most fully recover in several weeks/months

Question 16

examination of bell’s palsy

Answer 16

drooping of corner of mouth, eyelids that dont close
function of muscles of facial expression
taste of anterior 2/3 tongue

Question 17

treatment for bell’s palsy?

Answer 17

meds - corticosteroids, analgesics

Question 18

how do we know the facial droop presented in bell’s palsy isn’t the first sign of a stroke?

Answer 18

full facial paralysis is bell’s palsy due to dual innervation

Question 19

rehab management for bell’s palsy

Answer 19

protect cornea - patching
estim to maintain tone
active facial exercise
may require sling
emotional support
eat foods that are easy to chew

Question 20

prognosis of bell’s palsy

Answer 20

very good
show improvements within 2 weeks
proper managment - some or all facial function within 6 months

Question 21

bulbar palsy

Answer 21

paresis or paralysis of the muscles innervated by the motor nuclei of the lower brainstem, affecting the muscles of the face, tongue, larynx, pharynx - CN IX, CN X, CN XII

Question 22

what is the etiology of bulbar palsy

Answer 22

results of tumor, vascular or degenerative disease, malignancy, inflammation, genetic disorders, impacting lower cranial nerve motor nuclei - can be progressive

Question 23

what does bulbar palsy look like

Answer 23

glossopharyngeal and vagal paralysis
change in voice quality - dysphonia
tongue atrophy, fasciculations

Question 24

what is a possible complication of bulbar palsy

Answer 24

aspiration pneumonia

Question 25

pseudobulbar palsy

Answer 25

bilateral dysfunction of corticobulbar innervation of brainstem nuclei
UMN lesion

Question 26

what is the major differences between pseudobulbar palsy and bulbar palsy

Answer 26

psudobulbar palsy has CN5/7 involvement
emotional incontinence
tongue spasticity
spastic dysarthria
hyperactive reflexes

Question 27

what is the jaw jerk reflex seen in pseudobulbar palsy

Answer 27

tap on jaw, contraction of masseter and temporalis muscles

Question 28

what is the snout reflex seen in pseudobulbar palsy

Answer 28

tap on lips produces pouting of lips