Specific Nerve conditions

Question 1

What is Bell’s palsy?

Answer 1

This is an idiopathic facial nerve palsy which causes lower motor neuron symptoms in the facial nerve (CN VII).

It is an acquired condition which in more prevalent in pregnant women and is seen in the younger age group below the age of 40.

Question 2

Bell’s Palsy symptoms

Answer 2

– These have a very abrupt onset (can be overnight)

– Unilateral facial weakness of the whole face (including eyebrows)

– Ipsilateral numbness and pain around the ear

– Decreased taste –> due to damage to the chorda tympani

– Hypersensitivity to sounds –> stapedius palsy

Question 3

Bell’s Palsy tests

Answer 3

– These are done to rule out other causes

– Blood tests – rules out infection such as Ramsay Hunt syndrome

– CT/MRI – rule out tumours and stroke

Question 4

Bell’s Palsy management

Answer 4

– Prednisolone 1mg/kg for 10 days within 3 days, 95% make full recovery

– Protect the eye –> dark glasses and artificial tears to prevent drying

Question 5

What is trigeminal neuralgia?

Answer 5

This is a painful syndrome of the trigeminal nerve which is characterised by acute brief attacks giving electric shock-like unilateral facial pain.

Question 6

Trigeminal Neuralgia causes

Answer 6

Usually idiopathic, but associated with MS and tumour

Question 7

Trigeminal Neuralgia symptoms

Answer 7

– Facial pain, described as electric shock like, coming on and going away quickly (<1 minute)

– Light touch is a trigger for the pain e.g. washing/shaving/brushing teeth

– Patient reports trigger areas –> small areas around chin particularly susceptible.

Question 8

Trigeminal Neuralgia treatment

Answer 8

– 1st line Carbamazepine 100mg up to twice daily, titrating up until pain is relieved

– If patient does not respond or the drug is contraindicated refer to neurology for specialist treatment.

Question 9

What is horner’s syndrome?

Answer 9

This is a syndrome which is caused by damage to the sympathetic nerves which supply the head and neck.

– Sympathetic activity is responsible for the dilation of the pupils and stimulating sweat glands

Question 10

Horner’s syndrome causes

Answer 10

Central conditions:

– MS, tumours, syringomyelia

Pre-ganglionic lesions:

– Chest trauma, cervical rib or Pancoast tumour

Post-ganglionic lesions:

– Carotid artery dissection/aneurysm, cavernous sinus thrombosis, middle ear infection