Other Flashcards
What is freidrich’s ataxia?
Most common of early onset heretediraty ataxia
Onset of FA
10-15 years
Features of FA
Absent ankle jerks, extensor plantars Cerebellar ataxia Optic atrophy High arched palate DM Hypertrophic obstructive cardiomuopathy
Evidence of cerebellar syndrome
DANISH dysdiadochokinesis ataxia nystagmus intention tremor scanning dysarthria heel-shin test positivity
Causes of cerebellar symtpms
Vascular lesion Alcohol Demyleination Tumours Paraneoplstic Hypothyroid Pheytoin toxicity Metabolic (wilson’s disease)
Whats the difference between bell’s palsy and facial stroke
If they cannot raise their eyebrows and cannot move the lower portion of their face they have Bell’s palsy and should be given steroids +/- antivirals.
If the lower portion of the face is paralyzed but the eyebrows rise symmetrically, then you have to be concerned for a stroke and should get imaging and further consideration of treatment (depending on time of presentation and cause) Bell’s Palsy is a peripheral nerve effect whereas a ischemic stroke is a central process.
As shown in the diagram, the forehead receives motor innervation from both hemispheres of the cerebral cortex. A stroke that compromised motor innervation of the face would therefore only result in paralysis of the lower half of the face - the forehead still receiving innervation from the unaffected hemisphere. A peripheral lesion, such as Bell’s Palsy, interrupts the innervation after the motor commands from both hemispheres have joined, so that the forehead is paralyzed.
Management bell’s palsy
Patients with Bell’s palsy should be given steroids within 72 hours of onset +/- antivirals, and +/- eye lubricant to prevent corneal abrasions or ulcers.
What is ramsay hunt syndrome?
Facial palsy due to VZV affecting the geniculate ganglion
Causes of facial nerve palsy
Idiopathic - bell’s
Pontine tumour (acoustic neuroma)
MS
Stroke
Infection - ramsay hunt syndrome
Inflammation - sarcoidosis
Middle ear surgery - parotid gland enlargement
