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Neurology RIA > Facial weakness: Bell's palsy + Ramsay Hunt syndrome > Flashcards

Facial weakness: Bell's palsy + Ramsay Hunt syndrome Flashcards

1
Q

sudden onset of unilateral facial weakness, including forehead

A

Unilateral lower motor neurone facial nerve lesion

Bells palsy

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2
Q

sudden onset of unilateral facial weakness with sparing of forehead

A

Unilateral upper motor neurone lesion

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3
Q

peak incidence of Bell’s Palsy

A

20-40 years old

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4
Q

bell’s palsy is more common in….

A

pregnant women

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5
Q

symptoms that may precede the onset of facial weakness/paralysis in Bell’s palsy

A

post auricular pain

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6
Q

other symptoms in Bell’s Palsy (3)

A
  • hyperacusis
  • dry eyes
  • altered taste
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7
Q

4 causes of bilateral lower motor neurone facial weakness

A
  • Bilateral Bell’s palsy
  • GBS
  • Sarcoidosis
  • MG
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8
Q

causes of facial nerve lesion at the site of facial canal (3)

A
  • tumour deposits
  • middle ear infection
  • bells palsy
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9
Q

in which condition is there an infection of the geniculate ganglion?

A

Ramsay Hunt Syndrome

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10
Q

causes of lesions of the peripheral branches of the facial nerve

A
  • Parotid gland lesions: tumours infections, sarcoidosis

- infection

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11
Q

management of Bell’s Palsy

A

1mg/kg for 10 days, within 72 hours of onset of symptoms

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12
Q

what should be done to maintain eye care in Bell’s palsy

A
  • prescription of artificial tears
  • eye lubricants
  • taping of eye at night
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13
Q

by when does the facial weakness usually recover by in Bell’s palsy

A

4-6 months

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14
Q

causes of Bell’s palsy

A
  • idiopathic

- Herpes simplex virus activation

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15
Q

who is at risk of developing bells palsy

A

pregnant women in the 3rd trimester of pregnancy

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16
Q

if full recovery is not obstained within 3 months…

A

nerve damage may be more extensive + additional treatment required; referral to a specialist

17
Q

role of Botulinum injections for Bell’s palsy

A
  • decrease overactivity in muscles which are tight or twitchy
  • relax involuntary movements
  • restore a more balances facial expression
18
Q

DDx for Bell’s palsy (3)

A
  • Stroke
  • Ramsay hunt syndrome
  • Lyme disease
19
Q

what is Ramsay Hunt syndrome?

A

LMN facial palsy specifically due to Varicella Zooster virus

20
Q

what should be suspected in a patient experiencing severe pain around their ear, followed by rashes or blisters around; ear, scalp, hair line, mouth, throat

A

ramsay hunt syndrome

21
Q

In ramsay hunt syndrome, where can the rashes or blisters appear

A

ear, scalp, hair line, mouth, throat

22
Q

Pathogenesis of Ramsay hunt syndrome

A

Reactivation of the Varicella Zoster virus

23
Q

what can reactivation of the Varicella zoster virus result in

A

painful, maculopapular rash called; Herpes zoster

24
Q

what virus causes shingles + chicken pox

A

Varicella zoster virus

25
Q

what happens once the symptoms have subsided from chicken pox and shingles

A

the varicella zoster virus estalishes latency in the dorsal root + CN ganglia

26
Q

is the RHS rash contagious

A

yes, for people with no immunity to chicken pox can catch chicken pox by contact with the open rash or blister on the infected person

however, can not catch RHS

27
Q

risk factors for RHS

A
  • HIV/immunodeficiency
  • Chronic steroid use
  • Chemotherapy
  • Malignancy
28
Q

until the rash blisters scab over, individuals with RHS should avoid contact with:

A
  • newborns
  • pregnant women
  • weak immune system
  • anyone who’s never had chicken pox or vaccinated against chicken pox
29
Q

describe the course of the infection in RHS

A

erythematous maculopapular rash –> clear vesicles –> vesicles erruption occuring in segments innervated by the affected sensory ganglion

vesicles eventually pustulate and form crusts

30
Q

how long does it take for the rash blisters to resolve

A

4-5 weeks

31
Q

symptoms in RHS before rash onset

A

prodromal period with burning pain, 2-3 days prior to rash
AND
pain can persist for several months after the rash resolves

32
Q

RHS investigations (4)

A
  • full examination including ear and facial nerve function
  • Blood tests: Ab for VZV
  • Hearing tests
  • MRI
  • Nerve conduction studies
33
Q

management of RHS (4)

A
  • Aciclovir within 72 hours, for 7 days
  • short course of high dose steroids
  • painkillers
  • botulism toxin injections
34
Q

management if there is no signs of improvement after 1 month in RHS?

A
  • referral to facial palsy specialist: neurologist, plastic surgeon, ENT consultant
  • specialist facial therapist
35
Q

management if poor eye closure after 2-3 weeks in RHS

A

referral to ophthalmology

36
Q

otological symptoms in RHS

A
  • hearing loss on affected side
  • dizziness/vertigo
  • tinnitus

Neurology RIA (11 decks)

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