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Neurology > Cranial Nerve Palsies > Flashcards

Cranial Nerve Palsies Flashcards

1
Q

What can cause a cranial nerve palsy?

A

Tumours

Trauma

Ischaemia

Infections

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2
Q

Clinical features of olfactory nerve palsy

A

Ansomia

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3
Q

Test for olfactory nerve palsy

A

Identification of certain smells e.g. peppermint, coffee

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4
Q

Aetiology of olfactory nerve palsy

A

Trauma to lateral and occipital regions

SOLs

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5
Q

Aetiology of optic nerve palsy

A

Ischaemic optic neuropathy

Inflammation: MS, sarcoidosis, viral infections

Trauma

Tumours (e.g. optic nerve glioma, pituitary adenoma)

Raised ICP (e.g. hydrocephalus)

B12 deficiency

Drugs: sildenafil, amiodarone, ethambutol

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6
Q

Clinical features of optic nerve palsy

A

Impaired vision

Complete transection → ipsilateral blindness and loss of direct pupillary reflex

Papilloedema (raised ICP)

Compression (e.g. tumour) → optic atrophy

Pituitary oedema → compression of optic chiasm → bitemporal hemianopia

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7
Q

Test for optic nerve palsy

A

Visual field test

Visual acuity test

Fundoscopy (e.g. papillitis)

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8
Q

Aetiology of oculomotor nerve palsy

A

Ischaemic stroke

MS

Aneurysm of posterior communicating

Transtentorial herniation

Cavernous sinus thrombosis

Diabetic cranial mononeuropathy

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9
Q

Clinical features of oculomotor nerve palsy

motor portion

A

Paralytic squint

Adduction weakness

Down-and-out gaze (exotropia + hypotropia)

Ptosis

Horizontal diplopia (worsens when head turned away from side of the lesion)

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10
Q

Clinical features of oculomotor nerve palsy

sensory portion

A

Absence of pupillary reaction

Prominent motor dysfunction and sparing of pupil in ischaemic lesions due to vascular disease

Severely impaired pupillary reaction with relatively spared motor function in compression lesions

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11
Q

Aetiology of trochlear nerve palsy

A

Microvascular damage (diabetes, hypertension, arteriosclerosis)

Cavernous sinus thrombosis

Trauma

Congenital fourth nerve palsy

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12
Q

Clinical features of trochlear nerve palsy

A

Extorsion of the eye (inability to depress and abduct the eyeball simultaneously)

Diplopia

Mild hypertropia and excyclotorsion

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13
Q

Aetiology of trigeminal nerve palsy

A

Tumour

Vascular compression

Oral surgery

Inflammation of the nerve

Cavernous sinus thrombosis

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14
Q

Clinical features of trigeminal nerve palsy

A

Ophthalmic nerve (CNV1): absent corneal reflex, loss of sensation in ipsilateral forehead

Maxillary nerve (CNV2): loss of sensation in ipsilateral midface

Mandibular nerve (CNV3): anaesthesia of ipsilateral lower third of face and anterior 2/3s of tongue, paresis of muscles of mastication

Tenso tympani branch: hearing impairment

Trigeminal nerve nuclei: ipsilateral weakness of muscles of mastication and/or ipsilateral loss of sensation

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15
Q

Aetiology of abducens nerve palsy

A

Trauma

Pseudomotor cerebri

Cavernous sinus thrombosis

Space-occupying lesion causing downward pressure (e.g. tumour)

Diabetic neuropathy

Congenital: Duane syndrome

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16
Q

Clinical features of abducens nerve palsy

A

Horizontal diplopia worsens when looking at distant objects

Esotropia: medial deviation of affected eye at primary gaze

Inability to abduct eye (will rotate head to look at the side)

17
Q

What is the most common ocular cranial nerve palsy?

A

Vestibulocochlear nerve palsy

18
Q

Aetiology of vestibulocochlear nerve palsy

A

Bacterial meningitis (most common cranial nerve palsy)

Lyme disease

Tumour (e.g. acoustic neuroma, neurofibromatosis type 2)

Basilar skull fracture

19
Q

Clinical features of vestibulocochlear nerve palsy

A

Sensorineural hearing loss

Vertigo

Horizontal nystgamus

Motion sickness

20
Q

Tests for vestibulocochlear nerve palsy

A

Audiometry

Vestibular function - electronystagmography, rotation test

CT/MRI

21
Q

Aetiology of glossopharyngeal nerve palsy

A

Idiopathic

Compression of nerve by a blood vessel

22
Q

Clinical features of glossopharyngeal nerve palsy

A

Loss of gag reflex (afferent limb)

Loss of carotid sinus reflex

Sensory loss over soft palate, upper pharynx, and posterior third of tongue (inc. loss of taste)

Mild dysphagia

Glossopharyngeal neuralgia (throat and ear pain)

23
Q

Test for glossopharyngeal nerve palsy

A

Diminished or absent gag response

Loss of taste in posterior third of the tongue

24
Q

Aetiology of vagus nerve palsy

A

Trauma

Diabetes

Inflammation

Aortic aneurysms

Tumours

Surgery (e.g. recurrent nerve injury during thyroidectomy)

25
Q

Clinical features of vagus nerve palsy

A

Flaccid paralysis and ipsilateral lowering of soft palate → nasal speech & deviation of uvula away from lesion

Dysfunction of pharyngeal muscles → dysphagia, aspiration

Loss of gag reflex (efferent limb) and/or cough reflex (afferent limb)

Recurrent laryngeal nerve injury:
Lesion of one nerve: unilateral vocal cord paralysis → dysphonia (hoarseness)
Lesion to both nerves: bilateral vocal cord paralysis → aphonia and inspiratory stridor

Gastroparesis

Cardiovascular dysfunction e.g. tachycardia

26
Q

Test for vagus nerve palsy

A

Diminished/absent gag and/or cough reflex

Saying “ahhh” will cause uvula to deviate away from affected side

Indirect laryngoscopy - vocal cord possibly in paramedian or intermediate position

Water swallow tests - coughing, choking or dysphonia

Increased resting heart rate

Gastroparesis on endoscopy

27
Q

Aetiology of accessory nerve palsy

A

Iatrogenic

Most commonly from surgical resection of cervical lymph nodes

28
Q

Clinical features of accessory nerve palsy

A

Paresis, atrophy and/or asymmetry of SCM

Paresis, atrophy and/or asymmetry of the trapezius muscle → ipsilateral shoulder drooping and lateral winging scapula

29
Q

Test for accessory nerve palsy

A

Possibly asymmetrical neckline

Shrug shoulders → weakness during elevation of ipsilateral shoulder

Turn head from side to side → weakness turning head towards contralateral side

30
Q

Aetiology of hypoglossal nerve palsy

A

Tumours

Trauma

Dissection of internal carotid artery

31
Q

Clinical features of hypoglossal nerve palsy

A

Atrophy

Fasciculation of the tongue on the side of the lesion

32
Q

Test for hypoglossal nerve palsy

A

Signs of unilateral lower motor neurone damage: tongue atrophy, fasciculations, asymmetry

Tongue deviates to side of lesion due to weakness of ipsilateral muscles

33
Q

What is Bell’s palsy?

A

An acute, unilateral, idiopathic, facial nerve paralysis

34
Q

Clinical features of Bell’s palsy

A

LMN facial nerve palsy - forehead affected

UMNL “spares” the upper face

Post-auricular pain

Altered taste

Dry eyes

Hyperacusis

35
Q

Management of Bell’s palsy

A

Oral prednisolone within 72hrs onset

Eye care - artificial tears/lubricants

36
Q

What is Horner’s syndrome?

A

Ptosis and meiosis with or without anhydrosis

37
Q

Aetiology of Horner’s syndrome

A

Pancoast tumour (affecting sympathetic nerve supply)

Stroke

Carotid artery dissection

Neurology (20 decks)

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