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Ocular Disease 3 - Final > Facial Palsy > Flashcards

Facial Palsy Flashcards

1
Q

Muscles of facial expression and Stapedius are innervated by what special CN7 subgroup? a. General Somatic Afferent b. General Visceral Efferent c. Special Visceral Afferent d. Special Visceral Efferent

A

d. Special Visceral Efferent (Facial n./ motor nucleus

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2
Q

Sensory cutaneous, External auditory meatus and the back of the ear are innervated by what special CN7 subgroup? a. General Somatic Afferent b. General Visceral Efferent c. Special Visceral Afferent d. Special Visceral Efferent

A

a. General Somatic afferent (interm n.)

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3
Q

Taste of anterior 2/3 of the tongue (chorda tympani) is innervated by what special CN7 subgroup? a. General Somatic Afferent b. General Visceral Efferent c. Special Visceral Afferent d. Special Visceral Efferent

A

c. Special Visceral Afferent (interm n./solitary nucleus)

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4
Q

What innervates the Parasympathetic system of CN7 subtype? a. General Somatic Afferent b. General Visceral Efferent c. Special Visceral Afferent d. Special Visceral Efferent

A

b. General Visceral Efferent (interm n./salvatory nucleus)

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5
Q

What are the 5 branches of he visceral efferent or terminal motor branches of the facial nerve?

A
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6
Q

What type of pathway has the following characteristics:

  • incased in bone (either the fallopian or facial canal)
  • Have salivatory sensory
  • Exit cranial cavity via internal auditory meatus
  • Combined version of CN7 through tortuous facial canal
  • Geniculate Ganglion is involved
  • Exit occurs via stylomastoid foramen?
A

Intracranial Pathway

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7
Q

The extracranial pathway is located, distal or proximal, to the stylomastoid foramen?

A

Distal

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8
Q

True or False. Since the extracranial pathway, motor root, passes through the parotid gland, does it also innervate it too?

A

False.

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9
Q

What are two major structures that the CN7 intermediate nerve will emerge from?

A

Facial motor root and CN8

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10
Q

What are the two major functions of Visceral efferent of CN7 intermediate nerve?

A

Parasympathetic regulation of lacrimal and salivary system

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11
Q

What are the two major functions of Visceral afferent of CN7 intermediate nerve?

A

Anterior toungue taste and Somatsensory distribution

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12
Q

What can be affected by lesions along the CN7 pathway?

A
  • Facial muscles of expression + stapedius
  • Blink reflex
  • Salivation
  • Lacrimation
  • Tear drainage
  • Taste
  • Auditory
  • Cutaneous sensory
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13
Q

What is the clinical work up protocol for Facial Paralysis?

A

History (viral prodome)

Ear (mass or vesicles –> may have ear pain due to external canal

Additional CN assessment (CN5,6,8 –> in the area of CN7)

Taste: Bitter or sweet anterior 2/3 tongue affected side

Facial motor weakness

Parotid mass

and

Schirmer’s Test

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14
Q

What anatomical areas or structures are you observing when examing superior group?

A

Eyebrows, Forehead, Scalp, and Ears

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15
Q

What anatomical areas or structures are you observing when examing inferior group?

A

Smiling, lips, note flattening of nasolabial fold

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16
Q

What anatomical areas or structures are you observing when examing intermediate group?

A

tightly squeezing eyelids and ectropion

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17
Q

Where the numbers are listed, name the type lesion that can occur?

A
  1. Supranuclear
  2. Cerebellopontine angle
  3. Ramsay-Hunt
  4. Isolated ipsilateral tear deficiency
  5. and 6. Bell’s palsy (total facial palsy)
  6. Partial facial palsy per affected distal branches
18
Q

Contralateral “voluntary” paralysis of lower 2/3 of face means that there is a supranuclear lesion. What pathway has been affected?

A

Corticobulbar pathway

Signs/Symptoms:
a) Preserved frontalis volitional function because of “dual supply” to each CN VII motor nucleus from R and L corticobulbar tract.

b) Ipsilateral mostly innervates upper facial m.
c) Lesser preservation of o.o. function
d) Preserved taste, lacrimation, salivation
e) Rarely occur in isolation
f) May have ipsilateral hemiparesis

19
Q

What type of pathway will cause dissociation of voluntary and mimetic (emotional) response?

A

Supranuclear

20
Q

What are the 4 possible etiologies of a Supranuclear lesion?

A

a. Vascular (stroke)
b. Trauma
c. Neoplasm
- Look for VI n palsy (uni- or bi-lateral) resulting from elevated ICP
d. Infection

21
Q

With the following signs, what type of lesion is this?

a. Upper and lower facial paralysis
b. Preserved taste & secretory
c. Ipsilateral VI n involved & other CN likely
d. May have contralateral hemiparesis of extremities

A

Nuclear lesion

22
Q

What is the most common etiology for Nuclear lesion ?

A

Vascular

most common – basilar and vertebral a. branches

23
Q

What are the signs of Ramsey-Hunt?

A

Facial paralysis
Loss of taste, secretory
Hearing loss, tinnitus
Vertigo

24
Q

Where does the lesion occur with Cerebellopontine Angle?

A

Pre geniculate - before it exits the ear

25
Q

What are the signs of cerebellopontine angle?

A

-Total ipsilateral facial weakness
-Facial pain and twitching
w/absent tearing, hyperacusis, loss of taste
-Can associate w/ CN V, VI, VIII, Horner’s, gaze palsy, nystagmus, papilledema, cerebellar dysfunction

26
Q

The following signs display what type of lesion?

  • Complete ipsilateral facial paralysis, hyperacusis, impaired secretory functions
  • Definite loss of taste anterior 2/3
  • Impaired ipsilateral lacrimation (measure w/ Schirmer’s)
  • Knocks out all visceral afferent and parasympathetic
  • Complete lesion here produces permanent loss of taste and sensory
  • Preganglionic fibers can regenerate aberrantly

-Crocodile tears

A

Lesion proximal to geniculate ganglion

27
Q

With the following signs, where has this lesion occurred?

  • Complete ipsilateral facial paralysis PLUS
  • Possible hyperacusis
  • Possible impaired salivary function
  • Preganglionic parasympathetics
  • Often ipsilateral loss of taste anterior 2/3
  • Special visceral afferents
A

Lesion distal to geniculate g. & pre stylomastoid foramen

28
Q

The most common cause of facial paralysis is?

A

Bell’s Palsy

29
Q

What type of lesion is this?

A

Bell’s Palsy

30
Q

What are the peipheral lesions of Bell’s Palsy?

A

Complete ipsilateral VII weakness

No other associated CNS deficits

Epiphora vs dry?

Droopy lid vs widened fissure?

Rarely: pain in ear canal

Progresses over 2-10 days

Absent corneal reflex but intact sensation

May have widened palpebral fissures

31
Q

What are the signs/symptoms and associated issues of cerebellopontine angle?

A

-Total ipsilateral facial weakness
w/absent tearing, hyperacusis, loss of taste
-Can associate w/ CN V, VI, VIII, Horner’s, gaze palsy, nystagmus, papilledema, cerebellar dysfunction

32
Q

lesion at bend of facial canal & proximal to geniculate ganglion (parasymp via greater petrosal n) will show an absence in?

A

Reflex tearing

33
Q

A lesion distal to bend of facial canal & geniculate g will POSSIBLY cause what issue?

A

Hyperacusis (absent stapedius reflex)

34
Q

Absent of taste leads to what type of lesion?

A

Chorda tympani - mid facial lesion

35
Q

What are the signs of Idiopathic CN7 palsy?

A
  • Can have all the signs of infranuclear lesion
  • 40,000 Americans yearly
  • Gender female=male
  • Age 15-60 yo
  • More common in diabetics & recent URI
36
Q

What is the course and prognosis of facial palsy?

A

1) Spontaneous resolution (90%) over 1-3 months
}No tx for incomplete non-progressive dz
}MRI if not resolving by 3 months

2)For complete paralysis:
Steroids may speed resolution
Prednisone 60mg po qd 4d, taper over 10d to 5mg
Surgical decompression controversial.

3) Incomplete resolution possible (no test to predict)
Synkinesis – simultaneous contracture of facial muscles
Asynchronous contracture of facial muscles

4) Aberrant regeneration
Crocodile tears
Blinking with mouth movement

37
Q

Lesion at the Vidian n. will show what deficiency?

A

Ipsilateral tear deficiency

Note: Associated with CN6, if with Cavernous Sinus

38
Q

What are the signs and symptoms of Guillian Barre?

A

1) Autoimmune polyneuropathy
Progress over days to weeks
Following infection (GI campylobacter most common)
Lower motor weakness early
Facial involvement 50% (uni or bilateral)

2) Ophthalmoplegia (CN III, IV, VI) w/ ptosis
3) Optic neuritis maybe

39
Q

What are two issues are associated with CN7 spasm?

A

1)Facial myokymia
Eyelid involvement frequent
Hemifacial spasm –often start with eye
Pontine disorder; vascular compression of VII
Tx if benign: clonazepam, botox, surgical isolation of VII

2)Blepharospasm
Bilateral contraction of o.o.
Age 60-70
Female:male 3:1
Disorder of basal ganglion?

40
Q

What is the treatment for CN7 spasm?

A

Tx clonazepam, botox, surgical CN VII resection

41
Q

If there is a lesion at the extrapyramidal lesion (basal ganglia), what are the consequences?

A

Mimetic paralysis with preserved voluntary movement.

Slide 20

Ocular Disease 3 - Final (6 decks)

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