Facial Sensory Loss And Weakness

Question 1

Facial sensory disturbance may result from?

Answer 1

1. Disorders affecting the trigeminal nerve or its central connections within the brain stem
2. Upper cervical nerves (C2,C3), supply sensation to small part of face, along lower jaw as well as back of head and under chin
3. Seventh cranial nerve and its central connections in brainstem

Question 2

Where does the trigeminal nerve arise from?

Answer 2

1. Arises from the inferolateral aspect of the pons and has large sensory and small motor root
2. Opthalmic, Maxillary and Mandibular branch

Question 3

Differential diagnosis of facial sensory loss

Answer 3

1. Sensory component mostly affected
2. Motor involvement: weakness of muscles of mastication
3. Jaw jerk may be affected

Question 4

Supranuclear lesions

Answer 4

1. Ipsilateral pyrimidal weakness
2. Ipsilateral lower facial weakness (umn)
3. Other cortical signs such as dysphasia, inattention, apraxia and hemianopia

Question 5

Causes of supranuclear lesions

Answer 5

1. Cerebral infarction/hemorrhage
2. Demyelination MS
3. Neoplasms

Question 6

Brain stem lesions, include lesions of the pons for all sensory modalities and the medulla/upper cervical cord for pain and temp sensation only

Answer 6

1. Contralateral pyramidal weakness
2. Ipsilateral cranial nerve lesions
3. Horizontal conjugate gaze palsies
4. Lesions of the lower pons

Question 7

What are the cause of Brain stem lesions

Answer 7

1. Infarction
2. Demyelination
3. Neoplasia

Question 8

Cavernous Sinus Lesion?

Answer 8

May have lesions involving third, fourth and sixth nerves as well as opthalmic and maxillary branch of fifth nerve

Question 9

Cause of Cavernous sinus lesions?

Answer 9

1. Meningioma
2. Aneurysm
3. Metastatic infiltration
4. Granulomatous conditions

Question 10

Lesions of the trigeminal root ganglion and peripheral branches of the nerve?

Answer 10

1. Herpes Zoster
2. Skull fractures
3. Neoplastic infiltration
4. TB, sarcoidosis
5. Shortens syndrome, SLE
6. Trigeminal neuralgia

Question 11

Cerebellum?

Answer 11

Responsible for the coordination of skilled voluntary movement, posture and gait

Question 12

Clinical features of cerebellar dysfunction are?

Answer 12

1. Ataxia of limb and gait
2. Dysarthria
3. Nystagmus
4. Postural tilt or hypotonia