Facial palsy

Question 1

what is bells palsy?

Answer 1

An acute mononeuropathy of facial nerve

Question 2

T/F is an upper motor neurone lesion

Answer 2

F it is a lower motor neurone which means forehead is NOT spared

Question 3

what causes bells palsy?

Answer 3

inflammation of the facial nerve within the stylomastoid canal which can also be associated with demyelination

Question 4

how can permanent facial palsy develop?

Answer 4

oedema can lead to a reduction in vascular supply and cause permanent palsy

Question 5

what is the incidence of bells palsy?

Answer 5

10/100 000
more common amongst young adults(15-45)
M=F

Question 6

what are the predisposing factors for bells palsy?

Answer 6

pregnancy, lymphoma, hypertension, diabetes

Question 7

what are the causes of bells palsy?

Answer 7

HHOLSKI
Herpes simplex/other herpes
HIV
Otitis media
Lyme disease
systemic sclerosis
Kawasaki disease
Idiopathic

Question 8

what are the 4 clinical features of bells palsy?

Answer 8

unilateral facial weakness
hyperacusis and loss of taste if proximal to syltomastoid canal
diminshed blinking

Question 9

how long does it take bells palsy to set in?

Answer 9

a few hours

Question 10

10% of people with bells palsy have what?

Answer 10

positive family histpry and recurrent episodes

Question 11

how do you investigate facial palsy?

Answer 11

cranial nerve exam
general neurological exam: gait, speech, arm raise
consider MRI if symptoms get worse
Blood tests for diabetes, HSV, HIV, sarcoidosis, Autoimmmune screen to rule out autoimmune diseases, Lyme disease screen if pateint been near deer

Question 12

which three syndromes are associated with bells palsy?

Answer 12

Heerfordt syndrome: mainifestation of bells palsy
Ramsay hunt
melerson-rosnthall syndrome

Question 13

what is ramsay hunt syndrome?

Answer 13

herpes zoster infection of facial neerve ganglion
vesicular rash in palate ear and facial palsy

treat with aciclovir and prednisalone

Question 14

what is the differential diagnosis of facial nerve palsy?

Answer 14

CLIMMMPS TV
CTD
Lymes disease
ID block
Meningitis
Middle ear disease
Multiple sclerosis
Psedobulbar and bulbar palsy
Sclerosis/sclerderma

Trauma, tumour
Vascualr lesion

Question 15

how do you treat facial nerve palsy?

Answer 15

most people recover within 60-85%
need to treat all cases quickly to prevent long term damage (within 72 hours)
systemic sterioids (80-95% recovery) +/- aciclovir
eye patch

Question 16

what are the extracranial causes of sensory neuropathy?

Answer 16

TIN CAN BED
Trauma
Infection: Syphilis, Herpes, Lymes disease, Multiple sclerosis
Neoplasm: B’s thyroid, kidney, breast, prostate, bronchus

Congential/CTD: sarcoidosis
Autoimmune: X linked
Nervous system: B Vitamins/folate

Blood/Bone: Pagets disease, osteomyelitis, vasculitides
Endocrone; Diabetes and thyroid
Drugs: alchohol, labetol, ritonavir, metronidazole

Question 17

causes of intracranial sensory neuropathy?

Answer 17

TIN B
Trauma
inflammation/infection: CTD, HIV, Sacroidosis, MS
Neoplasm
Blood/Inflammation: Cerebrovascular disease

Question 18

mononeuritis multiplex is associated with which diseases?

Answer 18

WARDS PLC
Wegners 
Amyloidosis
Rheumatoid
Diabetes
Sarcoidosis
Polyarterirtis
Leprosy
Carcinomatosis

Question 19

what tests should you consider when investigating sensory neuropathies?

Answer 19

CATS VU
CXR
Autoimmune screen
Thyroid screen/LFT
sedimentation rate (ESR)

Vitamin B12
Urea and eletrolytes/urine

Question 20

what are the causes of abnormal taste?

Answer 20

xerostomia/old age/smoking
MS/Neuropathies/LN damage/psychogenic/Cancer
URTI
B12 zinc deficeincy