Cranial nerve disorders Flashcards
nerves in relation to eyes?
3,4,6,
SO muscle of the eye, innervated by what nerve?
CNIV - trochlear
in an ddownward movement
LR muscle of the eye, innervated by what nerve?
CNVI - abducens
lateral movement
double vision looking down indicates what?
CNIV - trochlear
4th nerve palsy following head injury
causes IVth nerve palsy?
congenital
idiopathic
severe head trauma
microvascular disease (HT, DM, atherosclerosis)
tumour
aneurysm
MS
MS?
CNS, white matter demyelination disorder
4th nerve ipsilateral of contralateral?
condralateral
ptosis?
drooping eyelid
dilated pupil/occulomotor abnormalities, what nerve is affected?
3rd nerve palsy
eye down and out, complete ptsosis and dilated pupil
causes of 3rd nerve palsy?
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
what nerve innervates the levator palpabre superioris?
occulomotor CN3
syndrome associated with CN3 palsy?
horner’s syndrome
symtoms of horner’s syndrome?
constricted pupil
small ptsosis, couple milimetreds drop in eyelid. droopy eyelid
fatuigable CN3 palsy?
myasthenia gravis
sympatheuc muller’s muscle? (CNIII)
muscle helps rasie the upper eyelid
myasthenia gravis? (CNIII)
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
causes of horners syndrome? (CNIII)
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.
types of MG?
pure ocular MG
gernalised mg
- Extra-ocular
- bulborespiratory muscles
- limbs
what is associated with MG?
thymoma and thymic hyperplasia
tx for MG?
acetylcholineesterase inhibitirs (used to wake up form GA)
immunosuppression
- steroids
- IV immunoglobulin, plasma exchange
- Azathioprine, cyclosporin, cyclophosphamide, methotrexate
examples of acetylychonesterase inhibitirs?
pyridostigimine, neostigmine
casues of worsening MG?
- Infection
– Drugs, aminoglycosides, quinolones, quinine
- 32 year-old 2/7 pain behind ear
- Awoke right facial paralysis –near complete
- Noises sound louder on RHS
what is the problem?
bells pasly
who is most at risk of bells palsy?
More common age 30-45
– 5-fold in diabetes
– 3-fold in pregnancy esp. 3rd trimester
prognosis of bells pasly?
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
causes of bells pasly?
lime disease
viral infection
meningitus …
symptoms of bells palsy?
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)
Differential diagnosis of unilateral facial pasly?
- 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
UMN lesion causes?
stroke or tumour
lower half of face completely paralysed, can wrinkle forehead
LMN lesion causes?
bells palsy, lyne, sarcoid
opposute side completely paralysed
tx for bells pasly?
steroid for 10 days
- within 3 days of onset
- prednisolone 50 mg daily
eye protection
- artifiial tears
- cover eye at night
triggers of trigeminal neuralgia?
brushing teeth, eating, wind of face, talking
common cause of trigeminal neuralgia?
commonly root entry zone irrtation by artery
other causes: tumour, MS
tx for trigeminal neuralgia?
- good response to Carbamazepine, gabapentin, amitryptylline
- Surgery – decompress artery, foramen ovale injections
symptoms of trigeminal neuralgia?
- 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
CNXII palsy?
- Exits hypoglossal canal
- Close proximity to accessory+vagus N. and internal
carotid artery - Tongue deviates to side of lesion
+ fasciculations + wasting
causes of CNXII palsy?
– Trauma (12%)
– Stroke (6%)
– Multiple Sclerosis (6%)
– Surgery (5%)
– Guillain Barre Syndrome (4%)
nerves that control speech, chewing and swallowing?
CN V (motor)
* CN VII, IX, X, XI, XII
cerebeller speech?
– staccato speech +nystagmus +balance impairment +incoordination
bulbar palsy (LMN)?
– flaccid nasal dysarthria
– nasal regurgitation
pseudobulbar palsy (bilateral UMN)
– spastic dysarthria
– emotional lability
– droolin
Causes of speech and swallowing disorders?
- 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
Guillain-Barré syndrome (GBS) ?
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