Facial weakness

Question 1

presentation of Bells palsy

Answer 1

unilateral facial weakness or paralysis
facial sensation okay
no headache or other symptoms
onset of symptoms 1-2 hours but can be unto 48 hours
difficulty/unable to close eye - if able to partially close eye good prognostic sign

Question 2

prognosis of bells palsy

Answer 2

weakness can worsen over the first few days
majority recover completely - average 4-6 months
reoccurrence uncommon

Question 3

who’s at greater risk of bells palsy

Answer 3

pregnant women (third trimester), DM, those recovering from influenza or RTI

Question 4

investigation and management of bells palsy

Answer 4

no neurological imaging required, isolated focal weakness which is idiopathic
cause unknown, viral aetiology suspected

high dose oral prednisolone
acyclovir - no evidence
tape eye closed at night

Question 5

what is Ramsay hunt syndrome

Answer 5

compilation of shingles

herpes zoster affects facial nerve and it becomes inflamed and irritated

Question 6

signs of Ramsay hunt

Answer 6

rash/blisters in or around ear, scalp, hair line and in mouth
painful and burning over affected area 
difficulty closing eye
altered taste
ear, face, head pain
hearing loss on affected sign
dizziness, vertigo, tinnitus

Question 7

management of Ramsay hunt

Answer 7

acyclovir, high dose steroids, pain killers

if acyclovir is given <72 hours 70% of recovery, after this 50%

Question 8

what is the nerve involved in foot drop

Answer 8

common perineal nerve

Question 9

causes of foot drop

Answer 9

prolonged kneeling - common perennial palsy is often painless and ankle reflex is preserved

most common:
prolapsed intervertebral disc causing compression of L5 root - L4/5 always associated with lower back pain and loss of ankle reflex on the same side (almost always involves S1 hence ankle reflex loss)

Question 10

management of foot drop

Answer 10

nerve conduction studies to confirm diagnosis and predict prognostic:
most are demyelinating = conduction is slow, full recovery is suspected usually within weeks
axonal = reduced/denervation changes, more severe, take longer to recover and may be incomplete

foot drop splint

Question 11

wrist drop

which nerve

Answer 11

compression of radial nerve against mid shaft of humerus
Saturday night palsy
nerve conduction studies for diagnosis and prognostic info

wrist drop splint to help improve function pending recovery