Peripheral

Question 1

True or false

Exclude central processes, such as stroke or spinal cord injury, before considering an acute peripheral lesion.

Answer 1

True

Question 2

What are hallmarks of cortical disease?

Answer 2

aphasia

apraxia, and

vision loss

Question 3

These symptoms require further investigation for a central rather than peripheral disorder.

Answer 3

Lateralization of weakness,

hyperreflexia,

positive Babinski’s sign

Question 4

is used to differentiate primary muscular or neuromuscular junction problems from peripheral nerve disorders.

Answer 4

Electromyography

Question 5

measure the speed of conduction by observing the response to nerve stimulation by distally placed electrodes, can differentiate between axonal loss and demyelination

Answer 5

Nerve conduction velocity studies

Question 6

are frequently required to confirm the diagnosis in acute or subacute inflammatory and infectious processes

Answer 6

Lumbar puncture and

cerebrospinal fluid analysis

Question 7

For patients at risk for diaphragmatic failure, measure baseline ______________or _____________ in the ED to assess whether there is an immediate need for respiratory support or admission to an intensive care unit.

Answer 7

forced vital capacity or negative inspiratory pressure

Question 8

Admit patients with acute peripheral neurologic ‘ conditions if there is _________,____________, ___________

Answer 8

potential respiratory or

autonomic compromise

severe or rapidly progressing weakness

Question 9

If a peripheral disorder is suspected and the patient does not require admission, arrange for neurologic follow-up within __________ days

Answer 9

7 to 10 days

Question 10

’ the most common cause of unilateral facial paralysis

Answer 10

Bell’s palsy

Question 11

Cranial nerve VII, the facial nerve, supplies

Answer 11

motor innervation to the muscles of expression of the face and scalp and the stapedius muscle and taste to the anterior two thirds of the tongue

Question 12

_________ virus may be the culprit in Bell’s palsy

Answer 12

herpes simplex

Question 13

Idiopathic Bell’s palsy may be preceded by pain around or behind the

Answer 13

ear

Question 14

Onset of facial paralysis is acute, with maxi- mal symptoms in

Answer 14

2 to 3 days

Question 15

On exam, patients will have

Answer 15

facial droop, effacement of wrinkles and forehead burrows, and inability to completely close the eye

Question 16

True or false

 Diagnosis of idiopathic Bell’s palsy is based on the history and physical exam and is a diagnosis of exclusion of other conditions that can cause facial palsy

Answer 16

True

Question 17

most important alternative diagnoses to exclude are

Answer 17

ear infections and stroke

Question 18

True or false

When a central process causes facial paralysis, the forehead will be spared, as the forehead is supplied by cranial nerve VII arising near the pontomedullary junction, with crossed innervation. Peripheral facial nerve palsies will manifest as weakness throughout the facial nerve distribution, including the forehead.

Answer 18

True

Question 19

Treatment with__________ has shown significant benefit in the treatment of Bell’s palsy

Answer 19

corticosteroids

Question 20

True or false

Any patient with facial paralysis sparing the forehead or inability to abduct an eye should undergo neuroimaging to assess for stroke.

Answer 20

 true

Question 21

Compare and contrast middle cerebral artery stroke and brainstem stroke

Answer 21

Middle cerebral artery ischemia or stroke consists of hemiparesis, facial plegia sparing the forehead, and sensory loss all contralateral to the affected cortex.

Rarely, a brainstem stroke may mimic Bell’s palsy if the stroke affects the area where the facial nerve wraps around the abducens (cranial nerve VI) nucleus.

Brainstem stroke findings include peripheral facial nerve palsy and ipsilateral gaze palsy due to ischemia of the abducens nucleus.

So, test extraocular muscle function in all patients suspected of having Bell’s palsy.

Question 22

In Bell’s palsy, most patients begin to recover within

Answer 22

3 weeks

Question 23

True or false

 Evidence from randomized controlled trials suggests a benefit when giving antiviral medications in combination with steroids over steroid therapy alone.

Answer 23

 True