Peripheral Nerve disease

Question 1

Bells Palsy: causes, presentation, management

Answer 1

Dysfunction of CN7 causing unilateral facial weakness

Causes: idiopathic, viral (HSV, VZV may contribute to development)

Presentation

• Sudden onset
• Unilateral facial weakness, forehead affected (UMN =forehead spared)
• drooping of eyelids
• loss of nasolabial fold
• Reduced tasted
• Drooling, difficult chewing, dry mouth
• Hyperacusis
• Ear pain

Management
Majority of pts recover over several week h/e can take up to 13m.
- High dose prednisolone if syx <72hrs
- Lubricating eye drops
- Tape to close eye
- Referral to ophthalmology if eye pain/exposure keratopathy

Question 2

Diabetic peripheral neuropathy: presentation + mx

Answer 2

Nerves in body’s extremities such as hand/feet/arm are damaged due to long term hyperglycaemia.

Presentation

• Sensory loss usually feet: loss of coordination/ pain/temp, ‘glove and stocking’ distribution, lead to infections or ulcers.
• Numbness/tingling
• Burning or shooting pains
• O/e: loss of reflexes may be present

Management

• Regular surveillance for signs of neuropathy to allow for early intervention
• Tight glycemic control
• Foot care, education, prevention of foot trauma
• For neuropathic pain: amitriptyline, duloxetine, gabapentin or pregabalin

Question 3

GBS: causes, presentation, dx, mx

Answer 3

Causes: campylobacter jejuni (gastroenteritis), CMV

Presentation - Syx 4w post infection

• Symmetrical ascending weakness: starts from feet
• Reduced reflexes
• Peripheral sensory loss/paraesthesia
• Neuropathic pain
• May progress to CN7 weakness

Dx made clinically.

• Brighton criteria can help with dx + assess risk
• Can be supported by: nerve conduction studies = reduced , LP = raised protein.

Management

• IV Ig or plasma exchange
• VTE prophylaxis, PE leading cause of death
• If resp failure – intubation and ICU