Neurology- Cranial Nerves & Spinal Cord

Question 1

Bell Palsy

Answer 1

Peripheral neuropathy involving CNVII characterized by facial weakness of both upper and lower face. Caused by reactivation of neurotrophic virus.

Question 2

Signs and symptoms of Bell Palsy

Answer 2

UPPER FACE INVOLVEMENT 
Unilateral mouth droop
Loss nasolabial fold
Decreased ipsilateral lacrimation
Hyperacusis
Decreased taste anterior tongue 

Occurs over night, pt awaken with droop

Question 3

Pathophys of Bell Palsy

Answer 3

Reactivation of neurotrophic virus (herpes simplex) –> inflammation & edema CNVII and degeneration of myelin sheath

Question 4

Tx Bell Palsy

Answer 4

BIT: glucocorticoids

can add valacyclovir.

Question 5

Nerves innervated by corticobulbar tract

Answer 5

CN 5, 7, 9, 10, 11, and 12

Question 6

Symptoms of corticobulbar tract stroke

Answer 6

Lower facial weakness
Spearing forehead
Tongue deviation

Question 7

Mechanism of corticobulbar stroke symptoms

Answer 7

CN XII and CN VII only cortical CN never that carry unilateral input. Symptoms highlight CN 12 and 7. No CN5,9, or 10 symptoms

Question 8

Cranial Nerves in the Cavernous sinus

Answer 8

CN 3, 4, 5, and 6

Question 9

Symptoms of cavernous sinus thrombosis

Answer 9

Headache
Binocular palsies
Periorbital edema
Hypo/hyperesthesia (V1V2 distribution)
Ophthalmoplegia

can begin unilateral and become bilateral or begin bilateral.

Question 10

S&S paraneoplastic myelopathy of the spinal cord

Answer 10

Flaccid/ spastic paraplegia or quadriplegia
Sensory deficits
Urinary/ fecal retention or incontinence

Question 11

Central cord syndrome

Answer 11

Pt with stenotic cervical spinal canal experiences hypertension injury to the neck. Compresses the spinal cord between a hypertrophied ligament flavor posteriorly and a bulging disc/osteophyte complex anteriorly

Question 12

Diagnosis central cord syndrome

Answer 12

Initial: X-ray

Cervical myelogram ( diagnostic)

Question 13

Tx central cord syndrome

Answer 13

Glucocorticoids

Surgery