Vertigo & Facial Nerve Disorder Flashcards
1
Q
- Type of paralysis that is forehead sparing(CNS)?
- involves upper motor neuron damage
- patient will have paralysis of only lower muscles of facial expression
- upper muscles (forehead) spared due to bilateral innervation
A
cenral paralysis
2
Q
- type of paralysis that is outside CNS and is not forehead sparing?
- many causes
- damage to lower motor neurons
- results in paralysis of upper and lower muscles of facial expression
- causes can be idopathic (bells) infectious (vzv, lyme), trauma, neoplasm(parotid masses, schwannoma) iatrogenic (parotidectomy)
A
peripheral paralysis
3
Q
- similar presentation to bells
- will often have intense pain in auricle
- will see lesions on auricle, in EAC and TM
- more often have associated hearing loss, balance disturbance
- worse prognosis then bells
- refer to ENT, begin otic drop (ciprodex e.g) steroids
A
Ramsay Hunt (VZV)
4
Q
- typically from temporal bone fracture
- can have direct injury to nerve- division, crush
- paralysis can be from direct injury or local inflammation
- must document if paralysis immediate or delayed- dictates type of tx needed
A
Trauma
4
Q
- partoid lesions
- paralysis can be seen with lesions- be sure to palpate gland, image (contrast neck CT vs soft tissue MRI)
- facial nerve lesions (neruoma, schwannoma)
A
Neoplasm
5
Q
symptoms of facial paralysis?
A
- facial weakness
- tearing
- trouble eating
- inability to close eye
- pain/numbness
- taste disturbance
- possible HL, vertigo
6
Q
Differentiate between vertigo and dizziness?
A
- vertigo is an illusionary sense of movement (internal or external)
- dizzy is a sense of lightheadednes, fogginess, floating- its subjective- could mean vertigo, lightheaded or imbalance
7
Q
common causes of central dizziness? peripheral?
A
- central: vestibular migraine
- peripheral: BPPV, menieres
8
Q
- seldom severe
- lasts weeks/months
- less classic vertigo
- possible nystagmus
- rare auditory symptoms
A
Central
9
Q
- typically severe
- lasts weeks/months
- classic vertigo
- frequent nystagmus
- frequent auditory sx
A
peripheral
10
Q
- caused by viral infection of inner ear
- rapid onset symptoms- vertigo, N/V
- can include sudden loss of hearing (labryrinthitis)- refer to ENT
- symptoms of vertigo sever for 1 or more days, then slowly improve
- can see recurent episodes from viral reactivation
A
labryinthitis/ vestibular neuronitis
11
Q
treatement of neuronitis?
A
- vestibular suppressants/anti-emtics for symptom control
- meclizine for short term use only- prolonged use will prevent compensation (favor benzodiazepines such as lorazepam
- possible PT- for prolonged imablance or onset of positional symptoms
12
Q
- caused by otoliths in semicircular cancals
- brief (20-30sec) attacks of vertigo assoc. with certain head movements
- can have mild, generalized instability, but not prolonged vertigo
- no associated auditory symptoms
- will see classic nystagmus with Dix-hallpike (torsional/rotatory)
- often self-limiting and recurrent
A
BBPV
13
Q
treatment of BPPV?
A
- observation- symptoms often resolve within a few weeks to months
- physical therapy- (refer to a PT clinic that does vestibular rehab)
- sugery- plugging of involved semi-circular canal. Rare to perform
14
Q
- caused by change in inner ear fluid pressure (Endolymphatic hydrops) exact pathophysiology unclear
- classic sx: vertigo lasting hours, with unilateral hearing loss, tinnitus, fullness
- episodic with return to normal status between attacks (early in disease)
- triggers include salt, caffeine, stressors , weather change, allergies
- can be seen comorbidly with migraine
A
meniere’s disease
