Y4 Nerve Palsy Flashcards
does intracranial sinus thrombosis have sudden or progressive onset?
progressive onset over couple of weeks
does bells palsy have sudden onset or progressive onset ?
very sudden onset
- wake up one morning with it
state the features of bells palsy ?
Complete, unilateral facial weakness in 24-72h
Failure of eye closure → dryness
Bell’s sign: eyeball rolls up on attempted closure Drooling, speech difficulty
Numbness or pain around ear
↓ taste (ageusia)
Hyperacusis: stapedius palsy
what nerve palsy causes bells palsy ?
facial nerve
is bells palsy UMN and LMN condition ?
LMN
is the forehead spared in bells palsy ?
no
- forehead is paralysed
what three investigations should be done for bells palsy ?
Serology: Borrelia or VZV Abs
MRI: SOL, stroke, MS
LP
what is the manegment of bells palsy ?
Give prednisolone w/i 72hrs
60mg/d PO for 5/7 followed by tapering
Valaciclovir if zoster suspected
Otherwise antivirals don’t help
Protect eye
what is the cause of bell palsy ?
idiopathic viral cause (HSV1)
what is the prognosis of bells palsy ?
Incomplete paralysis: recovers completely w/i wks
Complete: 80% get full recovery
what are two complications of bells palsy ?
Synkinesis:
Crocodile tears:
what is crocodile tears?
eating stimulates unilateral lacrimation, not salivation
what is synkinesis ?
e.g. blinking causes up-turning of mouth
facial palsy with bilateral symptoms could be caused by?
Bilat symptoms: Lyme, GBS, leukaemia, sarcoid, MG
facial palsy with UMN symptoms could be caused by?
UMN signs: sparing of frontalis and orbicularis oculi
Due to bilateral cortical representation
what is Ramsay Hunt syndrome (RHS)?
Ramsay Hunt syndrome (RHS) is a complication of shingles. It is the name given to describe the symptoms of a shingles infection affecting the facial nerve.
what are the features of ramsay hunt syndrome ?
Preceding ear pain or stiff neck
Vesicular rash in auditory canal ± TM, pinna, tongue,
hard palate (no rash = zoster sine herpete)
Ipsilateral facial weakness, ageusia, hyperacusis,
May affect CN8 → vertigo, tinnitus, deafness
what is the management of ramsay hunt syndrome ?
If Dx suspected give valaciclovir and prednisolone w/i first 72h
what are the main causes of a peripheral sensory neuropathy ?
Alcohol
B12
CRF and Ca (paraneoplastic) DM
Every vasculitis
what nerve fibre does B12 deficiency affect?
Large Myelinated Fibres (A)
what symptoms of B12 deficiency cause?
Loss of proprioception → ataxia
Pins and needles
what nerve fibre does alcohol abuse affect?
Small Unmyelinated Fibres (C)
what symptoms of alcohol abuse cause?
Loss of pain and temperature sensation
Painful dysesthesia: e.g. burning, hyperalgesia
what are the main causes of motor neuropathy ?
GBS (+ botulism)
HMSN / CMT (Charcot-Marie-Tooth disease) - genetic
Paraneoplastic
Lead poisoning
state some causes of autonomic neuropathy ?
DM
HIV
SLE
GBS, LEMS
what are some features of autonomic neuropathy?
Postural hypotension ED, ejaculatory failure ↓ sweating Constipation / Nocturnal diarrhoea Urinary retention Horner’s
what are two tests to check for autonomic neuropathy ?
BP: Postural drop > 20/10mmHg
ECG: variation >10bpm ̄c respiration
what investigations can be done for peripheral neuropathy ?
LFTs, U+E, glucose, ESR, B12 TFTs B1, ANA, ANCA Genetic tests: e.g. PMP22 in CMT Nerve conduction studies EMG
where abouts do peripheral neuropathies affect in the body?
Distribution is symmetrical and widespread
Distal weakness and sensory loss (glove + stocking)
what is the commonest cause of Charcot-Marie-Tooth disease?
HMSN1
what is the pathophysiology of HMSN1?
demyelination
what is the pathophysiology of HMSN2?
axonal degeneration
what mutuation causes HMSN1?
AD mutation in the peripheral myelin protein 22 gene
when is the onset of HMSN?
puberty
what nerve is most affected by HSMN?
common peroneal
what motor dysfunction does HSMN cause ?
Foot drop → high stepping gait
Weak ankle dorsiflexion and toe extension
Absent ankle jerks
Symmetrical muscle atrophy: mainly distal
Peroneal muscles → “Champagne Bottle”
Hand and arm muscles → “Claw Hand”
Pes cavus (high-arched feet)
what investigations can be done for HSMN?
Genetic tests: PMP22 gene mutation
Nerve conduction studies: ↓ conduction speed in HSMN1
what is the management for charcot maire tooth disease?
Supportive
Physio
Podiatry
Orthoses
what are the three classifications of guilian barre syndrome ?
AIDP: Acute autoimmune demyelinating polyneuropathy
AMAN: Acute motor (± sensory) axonal neuropathy
Miller-Fisher:
what three things does miller fisher have?
Ophthalmoplegia + ataxia + areflexia
what features does guillian barre syndrome have?
Growing Weakness
- Symmetrical, ascending flaccid weakness / paralysis
- LMN signs: areflexia, fasciculations may occur Proximal > distal (trunk, respiratory, CNs [esp. 7])
- Progressive phase lasts 4wks
Breathing and Bulbar Problems Back Pain
Back / limb pain is common
Sensory disturbance
- Paraesthesia in extremities
- Sensory ataxia in Miller-Fisher
Autonomic Neuropathy
what is the cause of guillain barre syndrome ?
Abs cross-react to gangliosides
- from bacteria, virus or vaccine
what three investigations can be done for guillian barre syndrome ?
Immune Serology for anti-ganglioside Abs Evidence of infection: e.g. stool sample Demyelinating Nerve Conduction Studies Slow conduction velocities Protein in CSF Protein often > 5.5g/L
what is the management of guillian barre syndrome ?
Supportive
Airway / ventilation: ITU if FVC < 1.5L
Analgesia: NSAIDs, gabapentin
Autonomic: may need inotropes, catheter
Antithrombotic: TEDS, LMWH
Immunosuppression
IVIg
Plasma exchange
Physiotherapy
Prevent flexion contractures
what is the prognosis of guillian barre syndrome ?
85% complete recovery
what three investigations can be done for MND?
Brain/cord MRI: exclude structural cause Cervical cord compression → myelopathy Brainstem lesions LP: exclude inflammatory cause EMG: shows denervation
state the features of paralytic polio?
Asymmetric LMN paralysis
No sensory involvement
what part of the spinal cord does polio affect?
Affects anterior horn cells
