Cranial nerve disorders Flashcards

1
Q

nerves in relation to eyes?

A

3,4,6,

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2
Q

SO muscle of the eye, innervated by what nerve?

A

CNIV - trochlear

in an ddownward movement

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3
Q

LR muscle of the eye, innervated by what nerve?

A

CNVI - abducens

lateral movement

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4
Q

double vision looking down indicates what?

A

CNIV - trochlear

4th nerve palsy following head injury

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5
Q

causes IVth nerve palsy?

A

congenital

idiopathic

severe head trauma

microvascular disease (HT, DM, atherosclerosis)

tumour

aneurysm

MS

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6
Q

MS?

A

CNS, white matter demyelination disorder

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7
Q

4th nerve ipsilateral of contralateral?

A

condralateral

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8
Q

ptosis?

A

drooping eyelid

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9
Q

dilated pupil/occulomotor abnormalities, what nerve is affected?

A

3rd nerve palsy

eye down and out, complete ptsosis and dilated pupil

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10
Q

causes of 3rd nerve palsy?

A

microvascular, infact of teh centre of the 3rd nerve
- can be pupil sparing

posterior aneurysm
- pupil involving, pt about to rupture an aneurysm

cavernous sinus
- tumour
- sinus thrombosis

meningeal
- aneurysm (posterior commuivcatung artery aneurysm)
- infective or malignant meningitus/inflammation

neuromuscular junction - myasthenia

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11
Q

what nerve innervates the levator palpabre superioris?

A

occulomotor CN3

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12
Q

syndrome associated with CN3 palsy?

A

horner’s syndrome

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13
Q

symtoms of horner’s syndrome?

A

constricted pupil

small ptsosis, couple milimetreds drop in eyelid. droopy eyelid

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14
Q

fatuigable CN3 palsy?

A

myasthenia gravis

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15
Q

sympatheuc muller’s muscle? (CNIII)

A

muscle helps rasie the upper eyelid

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16
Q

myasthenia gravis? (CNIII)

A

Myasthenia gravis is a rare long-term condition that causes muscle weakness.

autoimmune disorder, antibodies against acetyl nicotinic acetylcholione receptor

It most commonly affects the muscles that control the eyes and eyelids, facial expressions, chewing, swallowing and speaking. But it can affect most parts of the body.

It can affect people of any age, typically starting in women under 40 and men over 60

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17
Q

causes of horners syndrome? (CNIII)

A

Injury
- Damage to the carotid artery, the main artery to the brain
Injury to the brachial plexus, the nerves at the base of the neck
Birth trauma, such as during a difficult birth
Accidental injury

Tumors
- Tumors at the top of the lung
Tumors between the lungs and neck
Neuroblastoma, a childhood cancer of the nerve tissues

Other conditions

Migraine or cluster headaches
Stroke
Spinal cord injury
Infection in the top of the lung, between the lungs, and neck
Surgical complications 

Congenital or hereditary

Horner syndrome can be present at birth, or it can be inherited 

Idiopathic

Sometimes no cause can be found. This is called idiopathic Horner syndrome.
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18
Q

types of MG?

A

pure ocular MG

gernalised mg
- Extra-ocular
- bulborespiratory muscles
- limbs

19
Q

what is associated with MG?

A

thymoma and thymic hyperplasia

20
Q

tx for MG?

A

acetylcholineesterase inhibitirs (used to wake up form GA)

immunosuppression
- steroids
- IV immunoglobulin, plasma exchange
- Azathioprine, cyclosporin, cyclophosphamide, methotrexate

21
Q

examples of acetylychonesterase inhibitirs?

A

pyridostigimine, neostigmine

22
Q

casues of worsening MG?

A
  • Infection
    – Drugs, aminoglycosides, quinolones, quinine
23
Q
  • 32 year-old 2/7 pain behind ear
  • Awoke right facial paralysis –near complete
  • Noises sound louder on RHS

what is the problem?

A

bells pasly

24
Q

who is most at risk of bells palsy?

A

More common age 30-45
– 5-fold in diabetes
– 3-fold in pregnancy esp. 3rd trimester

25
Q

prognosis of bells pasly?

A

90% had complete recovery
– 60% with complete paralysis had complete recovery
– 85% begin to recover by 3 weeks
– 15% permanently diminished weakness or synkinesis
– 8-10% have recurrence- ipsi or contralateral

26
Q

causes of bells pasly?

A

lime disease
viral infection
meningitus …

27
Q

symptoms of bells palsy?

A

Drooping of the eyelid and corner of the mouth
Difficulty closing one eye
Difficulty eating and drinking
Drooling
Facial pain
Dry mouth
Changes in taste
Eye pain
Excessive tearing (crocodile tears)

28
Q

Differential diagnosis of unilateral facial pasly?

A
  • Idiopathic (Bell’s palsy)
  • Pontine tumour (e.g. acoustic neuroma), demyelination, stroke
  • Infective
    – Varicella zoster
    – Ramsay Hunt syndrome
    – Lyme disease
    – Middle ear infections
  • Ischaemia
    – Vasculitis
  • Inflammation
    – Sarcoid
    – Sjogren’s syndrome
    – Behcet’s
  • Temporal bone fracture or tumour
  • Parotid gland tumours/infections
  • Facial trauma
  • Upper motor neuron facial weakness
29
Q

UMN lesion causes?

A

stroke or tumour

lower half of face completely paralysed, can wrinkle forehead

30
Q

LMN lesion causes?

A

bells palsy, lyne, sarcoid

opposute side completely paralysed

31
Q

tx for bells pasly?

A

steroid for 10 days
- within 3 days of onset
- prednisolone 50 mg daily

eye protection
- artifiial tears
- cover eye at night

32
Q

triggers of trigeminal neuralgia?

A

brushing teeth, eating, wind of face, talking

33
Q

common cause of trigeminal neuralgia?

A

commonly root entry zone irrtation by artery

other causes: tumour, MS

34
Q

tx for trigeminal neuralgia?

A
  • good response to Carbamazepine, gabapentin, amitryptylline
  • Surgery – decompress artery, foramen ovale injections
35
Q

symptoms of trigeminal neuralgia?

A
  • Sudden, sharp, stabbing pain in the face
  • Pain that lasts from seconds to minutes
  • Pain that usually affects one side of the face
  • Aching, burning, or throbbing sensation between attacks
  • Pain that can be triggered by touch, sounds, or vibrations
36
Q

CNXII palsy?

A
  • Exits hypoglossal canal
  • Close proximity to accessory+vagus N. and internal
    carotid artery
  • Tongue deviates to side of lesion
    + fasciculations + wasting
37
Q

causes of CNXII palsy?

A

– Trauma (12%)
– Stroke (6%)
– Multiple Sclerosis (6%)
– Surgery (5%)
– Guillain Barre Syndrome (4%)

38
Q

nerves that control speech, chewing and swallowing?

A

CN V (motor)
* CN VII, IX, X, XI, XII

39
Q

cerebeller speech?

A

– staccato speech +nystagmus +balance impairment +incoordination

40
Q

bulbar palsy (LMN)?

A

– flaccid nasal dysarthria
– nasal regurgitation

41
Q

pseudobulbar palsy (bilateral UMN)

A

– spastic dysarthria
– emotional lability
– droolin

42
Q

Causes of speech and swallowing disorders?

A
  • Cerebellar disorders
    – Stroke
    – multiple sclerosis
    – hereditary ataxia
    – drugs (e.g. carbemazepine)
  • tumour
  • Bulbar palsy
    – Neuropathy
    – Myasthenia
    – Myopathy
    – Motor neuron disease
  • Pseudobulbar palsy (R+L corticobulbar UMN lesions)
    – MS
    – MND
    – Bilateral strokes
43
Q

Guillain-Barré syndrome (GBS) ?

A

Guillain-Barré syndrome (GBS) is a rare neurological disorder that occurs when the body’s immune system attacks the peripheral nervous system. This damage can cause muscle weakness and sometimes paralysis.

Symptoms
- Weakness or tingling in the legs, arms, face, or upper body
- Difficulty swallowing or breathing
- Loss of sensation in the arms or legs
- Fatigue
- Anxiety and depression

Causes
- Infection with a virus or bacteria, such as campylobacter, influenza, or COVID-19
- Surgery or trauma