nerve palsy Flashcards
what is Bell’s palsy
acute, unilateral idiopathic facial nerve paralysis
features of bell’s palsy
lower motor neuron facial nerve palsy-> forehead affected
also:
- post auricular pain
- altered taste
- dry eyes
- hyperacusis
management of bell’s palsy
oral prednisolone within 72 hours of onset
- if severe may add antiviral?
eye care: artificial tear and lubricants
follow up for bell’s palsy
if no improvement after 3 weeks: urgent referral to ENT
facial nerve supply
face, ear, taste, tear
muscles of facial expression
nerve to stapedius
supplies anterior 2/3rds of tongue
parasympathetic fibres to lacrimal glands and salivary
causes of bilateral facial nerve palsy
sarcoidosis
GB syndrome
lyme disease
bilateral acoustic neuromas (neurofibromatosis type 2)
LMN vs UMN facial palsy
UMN: spares upper face (forehead)
LMN: affects all facial muscles
what is the CNIV (trochlear) responsible for
rotating the eye down and out
innervating the superior oblique muscle
- look down when adducted
features of a fourth nerve palsy
vertical diplopia (when reading)
torsional diplopia- image appear tilted?
- may develop a head tilt
affected eye appears deviated upwards and is rotated outwards
features of third nerve palsy
eye is deviated down and out
ptosis
pupil may be dilated
causes of third nerve palsy
diabetes mellitus
vasculitis
false localising sign- uncal herniation
posterior communicating artery aneurysm
cavernous sinus thrombosis
weber’s syndrome
amyloid
MS
painful third nerve palsy where is the lesion
posterior communicating artery aneurysm
