Horner's, Bells, Bulbar, Pseudobulbar Flashcards
What is Horner’s syndrome?
A rare condition that results from the disruption of the sympathetic nerves.
Clinical presentation of Horner’s syndrome?
1) Partial ptosis - upper eyelid drooping
2) Miosis - pupil constriction
3) UNILATERAL anhidrosis - absence of sweating on the forehead: Presence of anhidrosis suggests lesion proximal to the carotid plexus, and distal would mean sweating intact. Distribution and presence of anhidrosis can indicate lesion location.
Aetioloy of Horner’s syndrome?
Central lesions - anhidrosis of the face, arm and trunk: Stroke, MS, tumour, encephalitis.
Pre-ganglionic lesions - anhidrosis of the face: Pancoast tumour (apex of lung), trauma, thyroidectomy.
Post-ganglionic lesion - no anhidrosis: Carotid artery dissection, carotid aneurysm, cavernous sinus thrombosis.
Diagnosis of Horner Syndrome?
CXR - shows apical carcinoma of lung (Pancoast tumour)
CT/MRI - stroke, other causes
Treatment of Horner syndrome?
Treat cause
What is Bells palsy?
Acute, idiopathic, UNILATERAL facial nerve (CN7) paralysis. 70% of facial nerve palsies.
Risk factors of Bells palsy?
Pregnancy (3 times risk)
Diabetes (3 times risk)
Pathophysiology of Bells palsy?
Unclear cause but is thought to be due to the inflammatory oedema from the entrapment of the facial nerve in the narrow bony facial canal.
Clinical presentation of Bells palsy?
1) Abrupt onset (overnight or after nap) with full weakness within 24-72 hours, unilateral facial weakness.
2) Mouth sags (unilateral), dribbling and watered eyes, impaired brow wrinkling, blowing, whistling, puffing cheeks, taste and speech.
Diagnosis of Bells palsy?
Clinical
Treatment of Bells palsy?
1) Oral Prednisolone regimen (5-10 days) to help recovery.
2) Keep eyes lubricated - drops and artificial tears, ointment at night, consider eye patch.
If cornea exposed on trying to close seek ophthalmology advice.
What is Bulbar Palsy?
Lower motor neurone palsy - a result of diseases affecting cranial nerves 9-12 due to low motor neurone lesions.
Causes of Bulbar Palsy?
1) Diptheria, poliomyelitis
2) GBS, MND
3) Brainstem tumours
Pathophysiology of Bulbar Palsy?
A speech deficit occurs due to paralysis or weakness of the muscles of articulation, swallowing, and facial muscles which are supplied by CN9-12.
Clinical presentation of Bulbar Palsy?
1) Speech - hoarse, quiet, nasal
2) Difficulty articulation
3) Fasciculations/flaccidity of the tongue
4) Loss of function of tongue, muscles of chewing and swallowing +/- facial muscles (weakness)
5) Lip trembling
6) Drooling
