Cranial Nerve Issues Flashcards
Bell’s palsy Bulbar palsy Horner’s syndrome
What is Bell’s Palsy?
A sudden, unilateral, idiopathic lower motor neuron facial nerve palsy.
True/False: Bell’s Palsy affects both the upper and lower parts of the face.
true
Bell’s Palsy primarily affects cranial nerve number ____.
Seven (VII)
Which age groups are most commonly affected by Bell’s Palsy?
It can affect any age group but is most common between 15–45 years.
True/False: Bell’s Palsy has no gender predilection.
true
What is the presumed cause of Bell’s Palsy?
Reactivation of latent herpes simplex virus (HSV-1) or varicella-zoster virus (VZV).
Bell’s Palsy results in inflammation and swelling of the ______ nerve within the facial canal.
Facial
What are the key symptoms of Bell’s Palsy?
Sudden onset of facial weakness, inability to close the eye, drooping of the mouth, loss of forehead wrinkling, and impaired taste on the anterior two-thirds of the tongue.
True/False: Bell’s Palsy can present with pain around the ear.
true
Patients with Bell’s Palsy may have ______, or an increased sensitivity to sound on the affected side.
Hyperacusis.
How is Bell’s Palsy diagnosed?
Clinically, based on unilateral lower motor neuron facial palsy and exclusion of other causes.
True/False: Imaging is typically required to diagnose Bell’s Palsy.
False. Imaging is reserved for atypical cases.
Upper motor neuron lesions spare the ______, unlike Bell’s Palsy.
Forehead.
Name two differential diagnoses for Bell’s Palsy.
Stroke and Ramsay Hunt Syndrome.
True/False: Lyme disease can mimic Bell’s Palsy.
True.
Ramsay Hunt Syndrome involves facial paralysis and ______ due to VZV reactivation.
Vesicular rash in the ear.
What is the first-line treatment for Bell’s Palsy?
Prednisolone within 72 hours of symptom onset.
True/False: Antiviral therapy is routinely recommended for Bell’s Palsy.
False. Antivirals are only considered in severe cases or suspected viral reactivation.
Eye care, including ______ and artificial tears, is crucial in Bell’s Palsy to prevent corneal damage.
Eye patching.
What percentage of Bell’s Palsy cases recover fully without treatment?
Around 70–80%.
True/False: Residual weakness after Bell’s Palsy is uncommon.
True, but it occurs in some cases.
Prognosis is poorer in older individuals and those with complete ______ paralysis at onset. (For Bell’s palsy)
Facial.
What is bulbar palsy?
A lower motor neuron lesion affecting the cranial nerves IX, X, XI, and XII, which control muscles involved in speech, swallowing, and other bulbar functions.
True/False: Bulbar palsy exclusively affects upper motor neurons.
False. It affects lower motor neurons.
Bulbar palsy results from damage to the ______ in the brainstem or their nuclei.
Cranial nerve motor nuclei.
Name three potential causes of bulbar palsy.
Motor neuron disease (ALS), brainstem stroke, and Guillain-Barré Syndrome.
True/False: Myasthenia gravis can cause bulbar palsy.
True
Peripheral neuropathies, such as ______, can contribute to bulbar palsy.
Guillain-Barré Syndrome.
What are the primary symptoms of bulbar palsy?
Dysarthria, dysphagia, nasal regurgitation, and weak or absent gag reflex.
True/False: Patients with bulbar palsy may have a nasal, “breathy” voice.
True
Atrophy and ______ of the tongue are characteristic findings in bulbar palsy.
Fasciculations.
What is a key differential diagnosis of bulbar palsy?
Pseudobulbar palsy.
True/False: Pseudobulbar palsy is caused by bilateral upper motor neuron lesions.
True
Unlike bulbar palsy, pseudobulbar palsy presents with ______ reflexes such as an exaggerated gag reflex.
Hyperactive
What investigations are commonly performed for suspected bulbar palsy?
MRI of the brainstem, EMG/NCS, and blood tests for autoimmune and infectious causes.
True/False: EMG can confirm lower motor neuron involvement in bulbar palsy.
True
MRI is used to exclude structural lesions such as ______ or brainstem tumors.
Strokes
What is the primary approach to managing bulbar palsy?
Treat the underlying cause, supportive care for speech and swallowing, and nutritional support.
True/False: Patients with bulbar palsy may require PEG feeding due to severe dysphagia.
True
______ therapy can help manage dysarthria in bulbar palsy.
Speech
What are two major complications of bulbar palsy?
Aspiration pneumonia and malnutrition.
True/False: Respiratory failure is a potential complication of severe bulbar palsy.
True
Early identification of ______ is crucial to prevent aspiration-related complications in bulbar palsy.
Dysphagia.
What factors affect the prognosis of bulbar palsy?
The underlying cause, severity of symptoms, and response to treatment.
True/False: Prognosis is generally poor in progressive conditions like ALS.
True
Non-progressive causes of bulbar palsy, such as Guillain-Barré Syndrome, may have a ______ prognosis.
Better
What is Horner’s Syndrome?
A neurological syndrome caused by disruption of the sympathetic nerves supplying the eye and face.
True/False: Horner’s Syndrome is always bilateral.
false
Horner’s Syndrome is characterized by ______ ptosis, miosis, and anhidrosis.
Partial
What are the three neuronal levels of the sympathetic pathway involved in Horner’s Syndrome?
First-order (hypothalamus to spinal cord), second-order (spinal cord to sympathetic chain), and third-order (sympathetic chain to the face and eyes).
True/False: A lesion at the level of the carotid artery can cause Horner’s Syndrome.
true
Third-order neuron damage in Horner’s Syndrome often involves the ______ ganglion.
Superior cervical.
What are the hallmark features of Horner’s Syndrome?
Ptosis, miosis, anhidrosis, and enophthalmos (less prominent).
True/False: Ptosis in Horner’s Syndrome is due to levator palpebrae superioris weakness.
False. It is due to dysfunction of Müller’s muscle.
The absence of sweating in Horner’s Syndrome occurs on the ______ side of the face.
Affected
List three possible causes of Horner’s Syndrome.
Stroke, carotid artery dissection, and Pancoast tumor.
True/False: Horner’s Syndrome can result from a traumatic spinal cord injury.
true
A ______ tumor affecting the apex of the lung can compress the sympathetic chain, leading to Horner’s Syndrome.
Pancoast
What pharmacological test can be used to confirm Horner’s Syndrome?
Cocaine or apraclonidine eye drop test.
True/False: MRI is the gold standard imaging to investigate the cause of Horner’s Syndrome.
False. Both MRI and CT can be used depending on the suspected etiology.
Imaging of the ______ artery is recommended in suspected carotid artery dissection.
Internal carotid.
How do central and peripheral causes of Horner’s Syndrome differ in presentation?
Central lesions often affect both sweating and eye symptoms, while peripheral lesions may only involve the eye.
True/False: A central cause of Horner’s Syndrome typically spares facial sweating.
False. It often affects sweating.
Peripheral causes of Horner’s Syndrome commonly involve damage to the ______ sympathetic chain.
Cervical
What is the primary focus of treatment for Horner’s Syndrome?
Treating the underlying cause.
True/False: Horner’s Syndrome itself requires specific pharmacological treatment.
False. Management targets the underlying pathology.
Urgent investigation is required for Horner’s Syndrome caused by suspected ______ artery dissection.
Carotid
What is a potential life-threatening cause of Horner’s Syndrome that must not be missed?
Carotid artery dissection leading to stroke.
True/False: Pancoast tumors causing Horner’s Syndrome may indicate advanced malignancy.
true
Horner’s Syndrome associated with neck pain may suggest ______ as a cause.
Carotid dissection
