Presentations Flashcards
Which facial palsy is a diagnosis of exclusion?
Bells palsy
Anatomy of facial nerve- Intracranial and extracranial branches
arises in PONS (separate sensory and motor roots) fuse together in facial canal intracranial branches: greater petrosal nerve, nerve to stapedius and chorda tympani
exits facial canal via stylomastoid foramen
extracranial branches: posterior auricular nerve, nerve to digastric and nerve to styloid.
presentation of Bells plasy
LMN weakness of facial muscles
Inabilty to close eye
metallic taste
reduced lacrimation
how is the cause of a facial palsy distinguished (UMN or LMN)?
forehead sparing in patient with UMN palsy
how is severity of facial palsy graded?
House-brackmann classification
Differentials of Bells palsy?
UMN causes: stroke, subdural heamatoma, brain tumour
LMN causes: infective (acute OM, cholesteatoma, viral infection, parotid malignancy, trauma/ iatrogenic
Management of Bells palsy?
Eye care: lubricating drops hourly/ ointment at night
Oral steroids
Surgical referral of recurrent/ diagnostic uncertainty - botox injections, nerve graft
complications of Bells palsy
85% fully recover
poor prognosis: complete palsy, >60yrs, Ramsay Hunt Syndrome, Assoc DM, Hypertension, pregnancy
what causes Ramsay Hunt Syndrome
unilateral facial palsy caused by reactivation of varicella zoster virus from the geniculate nucleus (nucleus of facial nerve)
presentation of Ramsay Hunt Syndrome
mod-severe ear pain → unilateral facial palsy w ipsilateral vertigo, tinnitus
vesicles visible in latter period (covers concha/ ant 2/3rd of tongue/ soft palate
only 10% completely recover
diagnosis and treatment of Ramsay Hunt Syndrome?
clinical diagnosis. Treat with prednisolone and aciclovir.
investigation for patient presenting with hoarse voice?
flexible nasal endoscopy (FNE) to allow visualisation of larynx and vocal cords
(Stroboscopy is used in specialist voice clinic)
innervation of the true vocal cords?
recurrent and superior laryngeal nerve
benign laryngeal cord lesions?
vocal cord nodules, muscle tension dysphonia, polyps, reinkes oedema, laryngeal papillomas
infective: laryngitis, acute epiglottitis
which nerve palsy can cause a hoarse voice?
recurrent laryngeal nerve
causes by: thyroid/ lung malignancy, MS, stroke, aortic aneurysm
possible causes of neck lump?
infective: lymphadenopathy, sialadentis
neoplastic: lymphoma, head & neck cancer, mets, skin lump
vascular: carotid body tumout
inflammatory: sarcoidosis
traumatic: haematoma
autoimmune: thyroid disease
congenital
congential causes of neck lumps?
cystic hygroma
thyroglossal cyst
branchial cyst
dermoid cyst
investiation for neck lump?
US +/- FNA
CT/ MRI if further imaging needed
a 1 year old presents with a soft, fluctuant painless mass in the neck. Whats the likely diagnosis?
Cystic hygroma
surgical excision to treat
pulstaile painless neck lump with a bruit. can be moved side to side but not up and down. Likely diagnosis
carotid body tumour: benign neuroendocrine tumour from preganglion cells of carotid body
manage conservativiely or with surgica resection
a teenage boy presents with a painless midline mass that moves up with protrusion of the tongue. whats the likely diagnosis?
<20yrs old = Thyroglossal cyst
surgical resection
a palpable mass in the neck anterior to the sternocleidomastoid is likely ot be what?
Branchial cyst
US guided FNA is important prior to excision to rule out SCC met from heand & neck region
under what circumstances would someone presentign with tinnitus be reffered as an otological emergency?
sudden onset pulsatile tinnitus
signifcant neurology
severe vertigo
secondary to head trauma
unexplained sudden hearing loss
investigations for someone with tinnitus
pure tone-audiogram, tympanometry, BP, FBC, TFT and BG
management optiosn in tinnitus
tinnitus retrainign therapy, CBT
hearign aids in some patients
which benign tumour arises from schwann cells commonly found at the cerebellopontine angle?
acoustic neuroma (vestibular schwannoma)
derive from abnormalities in TS gene on chromosome 22
bilateral vestibular scwannomas are associated with which condition?
neurofibromatosis type 2
unilateral hearign loss, tinnitus and vertigo is the triad classically seen in which condition?
vestibular schwannoma
maagement of vestibular scwhannoma
MRI head with contrast to monitor growth
stereotactic radiosurgery
surgical removal for large tumours
what causes BPPV
what can be given during attacks of menieres to try and help with symptoms?
prochlorperazine
vertigo lastign for days is likeluy to be what?
vestibular neuritis
