Peripheral Flashcards
True or false
Exclude central processes, such as stroke or spinal cord injury, before considering an acute peripheral lesion.
True
What are hallmarks of cortical disease?
aphasia
apraxia, and
vision loss
These symptoms require further investigation for a central rather than peripheral disorder.
Lateralization of weakness,
hyperreflexia,
positive Babinski’s sign
is used to differentiate primary muscular or neuromuscular junction problems from peripheral nerve disorders.
Electromyography
measure the speed of conduction by observing the response to nerve stimulation by distally placed electrodes, can differentiate between axonal loss and demyelination
Nerve conduction velocity studies
are frequently required to confirm the diagnosis in acute or subacute inflammatory and infectious processes
Lumbar puncture and
cerebrospinal fluid analysis
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.
forced vital capacity or negative inspiratory pressure
Admit patients with acute peripheral neurologic ‘ conditions if there is _________,____________, ___________
potential respiratory or
autonomic compromise
severe or rapidly progressing weakness
If a peripheral disorder is suspected and the patient does not require admission, arrange for neurologic follow-up within __________ days
7 to 10 days
’ the most common cause of unilateral facial paralysis
Bell’s palsy
Cranial nerve VII, the facial nerve, supplies
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
_________ virus may be the culprit in Bell’s palsy
herpes simplex
Idiopathic Bell’s palsy may be preceded by pain around or behind the
ear
Onset of facial paralysis is acute, with maxi- mal symptoms in
2 to 3 days
On exam, patients will have
facial droop, effacement of wrinkles and forehead burrows, and inability to completely close the eye
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
True
most important alternative diagnoses to exclude are
ear infections and stroke
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.
True
Treatment with__________ has shown significant benefit in the treatment of Bell’s palsy
corticosteroids
True or false
Any patient with facial paralysis sparing the forehead or inability to abduct an eye should undergo neuroimaging to assess for stroke.
 true
Compare and contrast middle cerebral artery stroke and brainstem stroke
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.
In Bell’s palsy, most patients begin to recover within
3 weeks
True or false
 Evidence from randomized controlled trials suggests a benefit when giving antiviral medications in combination with steroids over steroid therapy alone.
 True
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