Head/Facial Disorders (Exam #3) Flashcards
What condition involves acute CN VII palsy?
Bell’s Palsy
What is often the etiology of Bell’s Palsy? What are the two major RF associated with Bell’s Palsy?
IDIOPATHIC
- Consider DM, pregnancy
What condition involves sudden onset (hours) unilateral facial paralysis with inability to close eye, facial drooping with flattened nasolabial fold?
Bell’s Palsy
What three signs/sxs can be seen with Bell’s Palsy?
- Unilateral facial paralysis with inability to close eye
- Facial droop
- Flattened nasolabial fold
How can you differentiate Bell’s Palsy from the two ddx of Lyme Disease and Guillain-Barre?
- Bell’s Palsy = unilateral
- Lyme Disease and Guillain-Barre are BOTH bilateral
What is the preferred dx for Bell’s Palsy?
CLINICAL
What is the tx for ALL patients with Bell’s Palsy (2)? When is this best started?
Prednisone x7 days +/- Valacyclovir
- Best if started within 3 days of sxs onset
How can you differentiate a Peripheral Facial Palsy from a Central Facial Palsy (2)? What possible dx are associated with each?
- Peripheral = Bell’s Palsy: LMN lesion affecting ipsilateral side; forehead affected
- Central = stroke, tumor: UMN lesion affecting contralateral side; forehead spared
What side of the face is affected with Bell’s Palsy, and is the forehead affected or not?
- Lesion affects ipsilateral side
- DOES involve forehead
What condition involves “tic doulaureux”: pain along CN V?
Trigeminal Neuralgia
What is a major RF associated with Trigeminal Neuralgia?
HTN
What condition involves episodes of severe shooting pain lasting a few seconds?
Trigeminal Neuralgia
What sign is commonly seen in patients with Trigeminal Neuralgia?
Guarding
Is Trigeminal Neuralgia usually unilateral or bilateral? What distributions are most affected (2)?
UNILATERAL
- V2 and V3
What three requirements must be met to diagnose Trigeminal Neuralgia?
- 3+ episodes of unilateral facial attacks (shock-like/shooting)
- CN V distribution ONLY
- NO neuro deficits
What is the recommended tx for Trigeminal Neuralgia, and how is it often maintained/dosed?
Carbamazepine
- Increase gradually with typical maintenance dose of 600-800 mg/day
When treating a patient with Carbamazepine for Trigeminal Neuralgia, what MUST be tested before initiating?
HLA-B 15:02 allele in Asian population
What condition is often associated with Giant Cell Arteritis?
Polymyalgia Rheumatica (PMR)
If blindness is seen with Giant Cell Arteritis, occlusion of what artery shoud be considered? What about if stroke/brainstem infarct is seen?
- Blindness = Ophthalmic a. occlusion
- Stroke/brainstem infarct = Basilar a. occlusion
What are the two most common sxs seen with Giant Cell Arteritis?
- Jaw claudication
- New HA
What condition can involve transient blindness, and what is the specific name for this?
Giant Cell Arteritis
- Amaurosis fugax
What condition involves amaurosis fugax, and what is this?
Giant Cell Arteritis
- Transient blindness
What condition involves transient blindness, PMR sxs, unexplained fever or other constitutional sxs (fatigue, weight loss)?
Giant Cell Arteritis
How do you SCREEN for Giant Cell Arteritis? What will be seen?
ESR = elevated (50+)
How do you DIAGNOSE Giant Cell Arteritis? What will be seen?
Temporal Artery Biopsy (TAB)
- Shows multi-nucleated cells
How can you clinically dx Giant Cell Arteritis (5)?
3 of 5…
- 50+ years
- New/localized HA
- Temporal a. tenderness
- ESR of 50+
- +TAB
What are the two primary goals in tx of Giant Cell Arteritis?
- Prevent blindness
- Prevent stroke
What is the recommended tx for Giant Cell Arteritis?
HIGH-DOSE Prednisone
- Then taper (can be lifelong)
What condition involves pain associated with TMJ misalignment?
What gender and age group is it most often seen?
TMJ Dysfunction
- Female
- 20-40 years
What is a RF associated with TMJ Dysfunction?
RA
What area of the head does pain present with TMJ Dysfunction (2)? Where might it radiate to (3)?
Periauricular pain of TMJ and mastication muscles
- Possible radiation to ear, temple, periorybital regions
Which head condition involves crepitus with movement?
TMJ Dysfunction
What two signs may be seen on PE for TMJ Dysfunction?
- Jaw subluxation/dislocation (“catching” vs. “locking”)
- Decreased ROM
What is the dx for TMJ Dysfunction?
CLINICAL
What is the recommended tx for TMJ Dysfunction? What meds may be considered (3)?
Dental referral
- Tylenol
- NSAIDs
- Muscle relaxants
