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NEUROPATH 1 > Lecture 11- PNS Pathologies: Peripheral nerve injuries and diseases > Flashcards

Lecture 11- PNS Pathologies: Peripheral nerve injuries and diseases Flashcards

1
Q

where does the facial nerve originate from?

A

pon

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2
Q

what type of nerve fibers is the facial nerve?

A

mixed - somatic (sensory and motor) and automatic fibers

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3
Q

what is the somatic sensory function of the facial (CN VII) nerve?

A

sensation of touch, pain, temp and proprioception

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4
Q

what is the somatic motor function of the facial nerve?

A

facial expression (innervates scalp, facial and neck muscles)

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5
Q

what is the autonomic motor (parasympathetics) function of the facial nerve?

A

-secretion of saliva and tears
-taste of anterior 2/3 of tongue (supply taste buds)
(salivary, sublingual, parotid, lacrimal glands)

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6
Q

what is another name for idiopathic facial paralysis?

A

Bell’s palsy

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7
Q

what is Bell’s Palsy?

A

facial nerve is unilaterally affected = paralysis of facial muscles - most commonly seen in 15-45 year olds (can affect any age group)

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8
Q

is Bell’s palsy unilateral or bilateral?

A

it can be either, but more commonly unilateral

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9
Q

what are 2 possible characteristic presentation of Bell’s palsy, noted days before onset?

A

severe pain in mastoid area

sensation of fullness in ears

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10
Q

what is a viral component associated with Bell’s palsy?

A

reactivated latent HERPES ZOSTER virus (shingles)

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11
Q

what is a bacterial component associated with Bell’s palsy?

A

bacteria that causes lyme disease could damage facial nerver

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12
Q

what canal does the facial nerve lie in?

A

auditory canal

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13
Q

what are 2 possible outcomes of a mass developing in the auditory canal?

A

compression of the facial nerve leading to swelling (inflammation) and demylinisation of the facial nerve

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14
Q

how can acoustic neuromas impact the facial nerve?

A

they may compress the facial nerve- but symptoms are slow progressing

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15
Q

what are 2 systemic risk factors related to an increased risk of Bell’s palsy?

A

DM (impacts somatic and autonomic nerves due to impacted/damaged blood supply)
pregnancy (hormones by placenta may = nerve damage)

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16
Q

does unilateral facial paralysis develop slow or fast?

A

rapidly (over night)

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17
Q

what are 4 presentations seen with paralysis of the muscles of facial expression?

A

asymmetrical facial appearance
corner of mouth drops
nasolabial fold is flattened
palpebral fissure is widened (eye does not close)

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18
Q

what can happen is the stapedius muscle (innervated by facial nerve) is damaged (Bell’s palsy)?

A

sounds will be louder than normal

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19
Q

what can happen is the autonomic fibers of the facial nerve are damaged?

A 
loss of taste on affected side of tongue (ant 2/3)
less/thicker saliva (salivary gland impacted)
dry eyes (lacrimal gland impacted)
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20
Q

how much may pairing corticosteroids with antiviral treatment, increase the recovery rate from Bell’s palsy?

A

may increase recovery rate to 95%

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21
Q

what is an ASAP treatment of Bell’s palsy?

A

high dose of corticosteroid for 5 days than lowered for 5 more days to prevent permanent damage

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22
Q

what is the difference in recovery rate from Bell’s palsy if treated within 3 days of onset, compared to 4 days after?

A

within 3 days = 100%

after 4 days = 86%

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23
Q

why might an eye patch be used in the treatment plan of Bell’s palsy?

A

to protect the cornea of the open eye (due to palpebral fissure widening)

24
Q

what are 3 categories that can result in a poor prognosis of Bell’s palsy?

A

60+
co morbidities: diabetes or HBP
ANS involvement

25
Q

what is the sensory function of the trigeminal nerve?

A

touch, pain and temp sensation

26
Q

what is the motor function of the trigeminal nerve?

A

mastication (innervates chewing muscles)

27
Q

what is the characteristic presentation of trigeminal neuralgia?

A

intense paroxysms

28
Q

define ‘intense paroxysm’ in relation to trigeminal neuralgia?

A

attack of lancinating (piercing/ stabbing) pain within the trigeminal nerve distribution

29
Q

what is another name for trigeminal neuralgia?

A

tic douloureux

30
Q

what group does trigeminal neuralgia typically affect?

A

women age 50-70

31
Q

what are 6 possible causes of trigeminal neuralgia?

A 
herpes zoster virus
MS (affects myelin sheath)
vascular lesions
tumors (nerve infiltration)
lack of B12 (vit D possibly too)
idiopathic
32
Q

what is a hypothesis for the pathogenesis of trigeminal neuralgia?

A

damaged nerve demylinisation can cause paroxysm of pain

33
Q

how can the pain be described by someone suffering from trigeminal neuralgia?

A

lightening bolt pain inside head that may last seconds to minutes

34
Q

what is the primary area most commonly involved in pain sensation of trigeminal neuralgia?

A

maxillary division (ophthalmic division is less likely involved)

35
Q

with trigeminal neuralgia what are a few mechanical stimuli that may trigger the pain?

A

chewing, smiling, breeze

36
Q

is trigeminal neuralgia unilateral or bilaters?

A

mostly unilateral (10% bilateral)

37
Q

what anticonvulsant medication is prescribed for the treatment of trigeminal neuralgia?

A

oral carbamazepine = tegretol (depresses nervous system/nerve relay)

38
Q

what are 6 side effects of using tegretol to treat trigeminal neuralgia?

A 
blurred vision
dizziness
drowsiness
anemia
hepatotoxicity
teratogenic
39
Q

list 4 surgery options for treatment of trigeminal neuralgia?

A
  • radio frequency
  • decompression surgery (ex removal of tumor that is compressing nerve)
  • nerve section (cut out damaged nerve section and reconnect)
  • alcohol ablation (concentrated alcohol injected directly into nerve)
40
Q

what is the mechanism of radio frequency based surgery for treating trigeminal neuralgia?

A

an electrical current produced by a radio wave is used to heat up a small area of nerve tissues, which will decrease pain signals from that specific area.

41
Q

what is Erb’s palsy?

A

paralysis of the upper limb from TRACTION INJURY to brachial plexus (C5-C6) at birth

42
Q

what are 6 common symptoms of Erb’s palsy?

A
  1. infant unable to move upper or lower arm/hand from shoulder
  2. arm is limp/bent at elbow and held against body
  3. decreased grip strength
  4. inability to externally rotate arm
  5. loss of motor and/or sensory function over lateral PROX arm
  6. partial/complete arm paralysis
43
Q

what are 2 methods of treatment for Erb’s palsy?

A
  1. non surgical (gentle massage/ ROM of affected arm; intermittent immobilization; electrical stimulation)
  2. surgery (if neurological function does not return in 6-8 weeks)
44
Q

why can intermittent immobilization be beneficial for treatment of Erb’s palsy?

A

helps prevent contractures

45
Q

what is the difference between Erb’s and Klumpke’s palsy?

A 
Erb's = C5-C6
Klumpke's = C8 - T1
46
Q

what are 2 other names for Klumpke’s palsy?

A

Klumpke’s paralysis or Dejerine-Klumpke palsy

47
Q

what are 2 causes of Klumpke’s palsy?

A 
difficult vaginal birth
sports injuries (adults or older children)
48
Q

what are 6 signs and symptoms of Klumpke’s palsy?

A
  1. severe pain
  2. C8-T1 dermatome distribution numbness
  3. weakness/lack of ability to use specific muscles of shoulder, arm, hand
  4. limp/paralyzed arm
  5. stiff joints
  6. atrophy of muscles = “claw hand”
49
Q

what are 3 treatment methods for Klumpke’s palsy?

A

RMT
PT
immobilization
(very similar to Erb’s)

50
Q

what area does the phrenic nerve supply?

A

diaphragm (C3-C5 *somatic fibre)

51
Q

how does unilateral diaphragmatic paralysis present?

A

asymptomatic in most patients

52
Q

what is the most common diagnosed cause of unilateral diaphragmatic paralysis?

A

a malignant lesion (metastatic lung cancer) leading to nerve compression (30% of patients)

53
Q

if malignancy is not the cause of unilateral diaphragmatic paralysis, what is the cause?

A

if not malignancy, many times etiology cannot be determined -but could be: blunt cervical trauma or surgical trauma to thoracic region; HERPES ZOSTER; cervical spondylosis; upper cervical radiculopathies

54
Q

if the etiology is not know, can unilateral diaphragmatic paralysis go away?

A

if unknown etiology, usually resolves on its own (month to more than year)

55
Q

what are the 4 most common causes of BILATERAL diaphragmatic paralysis?

A
  1. secondary to motor neuron disease ( ALS; post-polio syndrome)
  2. thoracic trauma (cardiac surgery)
  3. MS, myopathies, muscular dystrophy
  4. Guillain-Barre syndrome
56
Q

what is the main treatment of bilateral diaphragmatic paralysis if respiratory failure develops?

A

invasive ventilation (endotracheal tube)

57
Q

how can patients without intrinsic lung pathology be treated for bilateral diaphragmatic paralysis?

A

use of non-invasive ventilation = not using endotracheal tube

NEUROPATH 1 (11 decks)

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