Focal weakness

Question 1

What is Bell’s palsy?

Answer 1

LMN unilateral facial nerve weakness within 72hrs

Question 2

What are the signs of Bell’s palsy?

Answer 2

• Isolated facial weakness involving the upper and lower parts of the face
• Pain behind ears
• Hearing changes (hyperacusis - louder sounds)
• Taste changes/dry mouth
• Incomplete eye closure

Question 3

What is the management of Bell’s palsy?

Answer 3

• Prednisolone 60mg 1 week
• Lubricated eye drops - Hypromellose
• Tape eye closed with microporous tape at night to prevent corneal damage

Most cases resolve within 4-6 months

Question 4

When would you urgently refer a patient with Bell’s palsy to ENT?

Answer 4

If paralysis shows no sign of improvement

Question 5

What are the features of an UMN facial palsy and what can cause it?

Answer 5

Sparing of the forehead as it is bilaterally innervated

Causes:
• Stroke
• Subdural haematoma
• Brain tumour

Question 6

What are the differentials for foot drop?

Answer 6

• Lumbar nerve root lesions (radiculopathy

* Common peroneal nerve palsy (mononeuropathy)

Question 7

What causes CPN palsy and what would you find on physical exam?

Answer 7

Compression at fibular head (kneeling/squatting)

• Weak ankle dorsiflexion
• Weak foot eversion

Question 8

What would you find on physical exam with L5 root compression?

Answer 8

• Weakness of inversion and eversion of the foot

Commonly affects S1 too
• Loss of ankle reflex

Question 9

What causes radial nerve/Saturday night palsy?

Answer 9

Compression of radial nerve against the mid-shaft of the humerus or injury in fracture of humerus

Question 10

What are the signs of radial nerve/Saturday night palsy?

Answer 10

• Wrist drop
• Sensory loss over dorsum of hand
• Loss of triceps tendon jerk
• Weakness pf brachioradialis (elbow flexor) and extensors of the arm (triceps), wrist and fingers

Question 11

What does compression of the medial nerve at the wrist show?

Answer 11

• Weakness of abductor pollicis brevis (thumb abduction)

* Sensory loss over radial 3.5 fingers and palm

Question 12

What does carpal tunnel compression show?

Answer 12

• Aching pain in hand and arm (night)
• Paraesthesia in thumb, index and middle fingers
• Sensory loss and weakness of abductor pollicis brevis
• Wasting of thenar eminences

Question 13

What is the ulnar nerve vulnerable to?

Answer 13

Elbow trauma

Question 14

What are the signs of compression of the ulnar nerve

Answer 14

• Wasting of interossei
• Weakness of finger abduction and abduction
• Weakness of thumb adduction
• Sensory loss on ulnar side of hand up to the medial half of the ring finger

Question 15

What can compress the lateral cutaneous nerve of the thigh?

Answer 15

Inguinal ligament

Question 16

What are the symptoms of compression of the lateral cutaneous nerve of the thigh?

Answer 16

• Paraesthesia of the lateral thigh