Disordens de pares cranianos Flashcards
Qual o tratamento da neuralgia do trigemio?
(1) Drug therapy with carbamazepine is effective in ∼50– 75% of patients. Carbamazepine should be started as a single daily dose of 100 mg taken with food and increased gradually (by 100 mg daily in divided doses every 1–2 days) until substantial (>50%) pain relief is achieved. Most patients require a maintenance dose of 200 mg qid. Doses >1200 mg daily provide no additional benefit. Dizziness, imbalance, sedation, and rare cases of agranulocytosis are the most important side effects of carbamazepine. If treatment is effective, it is usually continued for 1 month and then tapered as tolerated. Oxcarbazepine (300–1200 mg bid) is an alternative to carbamazepine, has less bone marrow toxicity, and probably is equally efficacious. If these agents are not well tolerated or are ineffective, lamotrigine 400 mg daily or phenytoin, 300–400 mg daily, are other options. Baclofen may also be administered, either alone or in combination with an anticonvulsant. The initial dose is 5–10 mg tid, gradually increasing as needed to 20 mg qid.
(2) The most widely used method currently is microvascular decompression to relieve pressure on the trigeminal nerve as it exits the pons. This procedure requires a suboccipital craniotomy. Based on limited data, this procedure appears to have a >70% efficacy rate and a low rate of pain recurrence in responders; the response is better for classic tic-like symptoms than for nonlancinating facial pains. In a small number of cases, there is perioperative damage to the eighth or seventh cranial nerves or to the cerebellum, or a postoperative CSF leak syndrome. Highresolution magnetic resonance angiography is useful preoperatively to visualize the relationships between the fifth cranial nerve root and nearby blood vessels. Another procedure, radiofrequency thermal rhizotomy, creates a heat lesion of the trigeminal (gasserian) ganglion or nerve. It is used less often now than in the past. Short-term relief is experienced by >95% of patients; however, long-term studies indicate that pain recurs in up to one-third of treated patients. Postoperatively, partial numbness of the face is common, masseter (jaw) weakness may occur especially following bilateral procedures, and corneal denervation with secondary keratitis can follow rhizotomy for first-division trigeminal neuralgia
Qual o tratamento da paralisia de Bell?
(1) the use of paper tape to depress the upper eyelid during sleep and prevent corneal drying, and
(2) massage of the weakened muscles.
(3) A course of glucocorticoids, given as prednisone 60–80 mg daily during the first 5 days and then tapered over the next 5 days, modestly shortens the recovery period and improves the functional outcome.
(4) Although two large recently published randomized trials found no added benefit of antiviral agents valacyclovir (1000 mg daily for 5–7 days) or acyclovir (400 mg five times daily for 10 days) compared to glucocorticoids alone, the overall weight of evidence suggests that the combination therapy with prednisone plus valacyclovir may be marginally better than prednisone alone, especially in patients with severe clinical presentations
Quais as principais síndromes de nervos cranianos?
(1) Sphenoid fissure (superior orbital) III, IV, first division V, VI Invasive tumors of sphenoid bone; aneurysms
(2) Lateral wall of cavernous sinus III, IV, first division V, VI, often with proptosis
Infection, thrombosis, aneurysm, or fistula of cavernous sinus; invasive tumors from sinuses and sella turcica; benign granuloma responsive to glucocorticoids
(2) Retrosphenoid space II, III, IV, V, VI Large tumors of middle cranial fossa
(3) Apex of petrous bone V, VI Petrositis; tumors of petrous bone
(4) Internal auditory meatus VII, VIII Tumors of petrous bone (dermoids, etc.); infectious processes; acoustic neuroma
(5) Pontocerebellar angle V, VII, VIII, and sometimes IX Acoustic neuroma; meningioma
(6) Jugular foramen IX, X, XI Tumors and aneurysms
(7) Posterior laterocondylar space IX, X, XI, XII Tumors of parotid gland and carotid body and metastatic tumors
(8) Posterior retroparotid space IX, X, XI, XII, and Horner syndrome Tumors of parotid gland, carotid body, lymph nodes; metastatic tumor; tuberculous adenitis
Como faco o diagnostico da paralisia de Bell?
The diagnosis of Bell’s palsy can usually be made clinically in patients with (1) a typical presentation, (2) no risk factors or preexisting symptoms for other causes of facial paralysis, (3) absence of cutaneous lesions of herpes zoster in the external ear canal, and (4) a normal neurologic examination with the exception of the facial nerve. Particular attention to the eighth cranial nerve, which courses near to the facial nerve in the pontomedullary junction and in the temporal bone, and to other cranial nerves is essential. In atypical or uncertain cases, an ESR, testing for diabetes mellitus, a Lyme titer, angiotensin-converting enzyme and chest imaging studies for possible sarcoidosis, a lumbar puncture for possible Guillain-Barré syndrome, or MRI scanning may be indicated.
