Neuro - Bell's Palsy, Normal Pressure Hydrocephalus, GBS

Question 1

Bell’s Palsy (BP) - what is it?

Answer 1

Defined as an acute, unilateral, idiopathic, facial nerve paralysis

Question 2

BP - what is the peak age incidence and who does it most commonly affect?

Answer 2

The peak incidence is 20-40 years and the condition is more common in pregnant women

Question 3

BP - does it affect the forehead?

Answer 3

It is a lower motor neuron facial nerve palsy - forehead affected

in contrast, an upper motor neuron lesion ‘spares’ the upper face

Question 4

BP - what are some other clinical features?

Answer 4

Post-auricular pain (may precede paralysis)

altered taste

dry eyes

hyperacusis (everyday sounds seem much louder than they should)

Question 5

BP - what is the management?

Answer 5

• oral prednisolone within 72 hours of onset of Bell’s palsy
  
  • eye care - prescription of artificial tears and eye lubricants

Question 6

Normal Pressure Hydrocephalus (NPH) - what is it?

Answer 6

Normal pressure hydrocephalus is a reversible cause of dementia seen in elderly patients

It is thought to be secondary to reduced CSF absorption at the arachnoid villi

Question 7

NPH - what does it usually present secondary to?

Answer 7

head injury, subarachnoid haemorrhage or meningitis

Question 8

NPH - what is the classic triad of features?

Answer 8

Dementia, bradyphrenia (slowness of thought)

Urinary Incontinence

Gait abnormality

Question 9

NPH - how long do symptoms take to present?

Answer 9

Symptoms typically develop over three months

Question 10

NPH - what do you see on imaging?

Answer 10

• hydrocephalus with ventriculomegaly in the absence of, or out of proportion to, sulcal enlargement

Question 11

Guillain-Barre Syndrome (GBS) - what is it?

Answer 11

Immune-mediated demyelination of the peripheral nervous system often triggered by an infection

Question 12

GBS - what is the classical causative infectious trigger?

Answer 12

Campylobacter jejuni

Question 13

GBS - clinical features?

Answer 13

• Symmetrical ascending weakness (starting at the feet and moving up the body)
• Reduced reflexes
• There may be peripheral loss of sensation or neuropathic pain
  
  • It may progress to the cranial nerves and cause facial nerve weakness

Question 14

GBS - when do symptoms normally start?

Answer 14

Within 4 weeks of the preceding infection

Question 15

GBS - how is the diagnosis made, and what investigations can be used to support the diagnosis?

Answer 15

A diagnosis of Guillain-Barré syndrome is made clinically

• Nerve conduction studies (reduced signal through the nerves)
• Lumbar puncture for CSF (raised protein with a normal cell count and glucose)

Question 16

GBS - managment?

Answer 16

IV immunoglobulins

Plasma exchange (alternative to IV IG)

Supportive care

VTE prophylaxis (pulmonary embolism is a leading cause of death)

Severe cases, respiratory failure, intubation, ventilation