Nerve injuries Flashcards
Define Bell’s palsy
Acute, unilateral, idiopathic facial nerve paralysis
What are the features of bell’s palsy?
Lower motor neurone facial nerve palsy - forehead affected
Post-auricular pain
Altered taste
Dry eyes
What is the difference between upper and lower motor neurone facial lesions?
Upper = forehead sparing
How is Bell’s palsy diagnosed?
Clinical diagnosis of exclusion
What are some RFs for Bell’s Palsy?
Intranasal flu vaccine
Pregnancy
What is the management for Bell’s palsy?
Corticosteroid
e.g. Prednisolone reduces time for full recovery
Usually within 3-4 months
What are the features of third nerve palsy?
Down and out eye
Ptosis
What is ptosis?
Drooping or downward displacement of the upper eyelid
What are some differentials for ptosis?
Thyroid eye disease
Stroke
Orbital tumours
Involutional changes as a result of squinting
Uncommonly - MS, Myasthenia gravis, giant cell arteritis, horner’s, third nerve palsy
What is multiple sclerosis?
Demyelinating CNS conditions
2 separate episodes of neuro dysfunction in different anatomy
Who is a typical MS pt?
White women
20-40 years
Temporary visual and sensory weakness
What are some presenting features of MS?
Visual disturbance in one eye Peculiar sensory phenomena e.g. numbness, trigeminal neuralgia Increased muscle tone Increased reflexes Imbalance Spastic weakness Tremor
What are the investigations for MS?
MRI brain - periventricular plaques
Visual evoked potentials
What are the different forms of MS?
Relapsing-remitting
Secondary progressive disease
Primary progressive disease
What is the treatment for an acute MS relapse?
High dose steroids e.g. methylprednisolone
Hastens recovery
What are some disease modifying drugs used in MS?
Beta-interferon reduces relapse rate up-to 30%
Monoclonal ABs e.g. natalizumab
What can be used to treat spasticity?
Gabapentin
Diazepam
Physio
Define trigeminal neuralgia
Unilateral disorder characterised by brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve
What evokes pain in trigeminal neuralgia?
Light touch e.g. washing, shaving, smoking, talking , brushing teeth
What is first-line treatment for trigeminal neuralgia?
Carbamazepine
What comprises the term paraesthesia?
Tingling
Prickling
Pins and needles
Burning
What are some differentials for paraesthesia?
Carpal tunnel (3 digit weakness) Spinal cord compression MS DM Peripheral vascular disease
What are the main symptoms of peripheral neuropathy?
Pain Tingling Loss of sensation Loss of balance or weakness Poor healing wounds/lcers
What cases peripheral neuropathy?
Viral infection e.g. shingles
Alcohol excess
Medications
Diabetes
What is the initial management for neuropathic pain?
Amitriptyline Duloxetine Gabapentin Pregabalin One at a time
What conditions can case tremor?
Parkinsons Anxiety Essential tremor Thyrotoxicosis Hepatic encephalopathy CO2 retention Cerebellar disease
Define tremor
involuntary rhythmic oscillation of ≥1 body parts, mediated by alternating contractions of reciprocally acting muscles
Define essential tremor
progressive tremor of the upper extremities, present in posture and action, without other neurological signs or symptoms
postural tremor: worse if arms outstretched
improved by alcohol and rest
most common cause of titubation (head tremor)
How do you diagnose essential tremor?
Clinically
bilateral tremor with normal muscle tone and speed of movement; negative history and examination for Parkinson’s disease, hyperthyroidism, medications, and alcohol use
When is medical treatment considered for essential tremor?
Dysfunction or embarrassment
What are the treatment options for essential tremor?
Propanolol
Define ALS
Amyotrophic lateral sclerosis
Neurodegenerative disorder
Progressive muscle weakness and disability
Usually death from respiratory failure
What are some presenting feature of ALS?
Upper extremity weakness Stiffness Poor coordination and balance Painful muscle spasms Foot drop Muscle atrophy Hyper-reflexia Dyspnoea Slow speech
How is ALS diagnosed?
Clinically
presence of upper and lower motor neuron signs, disease progression, and absence of any other explanation for the presentation
What is the first line treatment for ALS?
Riluzole - Prolongs survival Supportive care NIV Counselling regarding prognosis Advance directives
What are the types of motor neurone disease?
AML - 50%
Primary lateral sclerosis - UMN signs only
Progressive muscular atrophy - LMN signs only
Progressive bulbar palsy
What are the features of progressive bulbar palsy?
palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei
carries worst prognosis
What can cause spinal cord compression?
Spine trauma Vertebral compression fracture Intervertebral disc herniation Primary or metastatic spinal tumour Infection
What can be presenting features of spinal cord compression?
Back pain Numbness Weakness or paralysis Bladder/bowel dysfunction Hyper-relflexia
What is the investigation for spinal cord decompression?
MRI Spine
What is the management for acute spinal cord injury?
Immobilisation e.g. cervical collar, backboard
Decompressive/stabilisation surgery
What is the management for cauda equina syndrome?
Decompressive laminectomy
What is the management for malignant spinal cord compression?
Corticosteroids - oral dexamethasone
Surgery - decompression laminectomy
Radiation therapy
