Bell's Palsy And Trigeminal Neuralgia (Lauren🌭)

Question 1

What are some of the possible causes of facial palsy?

Answer 1

IDIOPATHIC**

Infections

Traumatic

Tumor

Stroke

Toxins

Question 2

What are the functions of the facial nerve that may get messed up if you have Bell’s palsy

Answer 2

Facial expression😖

Staepedius muscle📢

Lacrimal and salivary glands😢

Taste to front 2/3 of tongue👅

Question 3

What causes Bell’s palsy?

Answer 3

Unknown, but we think HSV might have something to do with it

Question 4

What are 2 conditions that increase your risk of developing Bell’s Palsy?

Answer 4

Pregnancy, especially 3rd trimester or immediately post partum 🤰🏻

Diabetes 🧁

Question 5

Bell’s palsy develops (Suddenly/gradual)

Answer 5

Suddenly.

Patients often wake up with it and notice it when they look in the mirror to brush their teeth

Question 6

What will someone with Bell’s palsy look like?

🐝🐝🐝🐝🐝

Answer 6

Unable to CLOSE eye

Forehead does NOT wrinkle on that side

Facial drooping with flattening of nasolabial fold

Decreased tears

Hyperacusis (due to stapedius muscle)

+/- loss of taste to anterior 2/3 of tongue

Question 7

What are 5 possible things that need to be on your differential when someone presents with Bell’s palsy symptoms?

Answer 7

Herpes zoster: Ramsay Hunt syndrome

Otitis Media

Lyme disease

Guillan-Barre

Tumor

Stroke (central lesion)

Question 8

How would you know if it’s due to herpes zoster (Ramsay Hunt Syndrome)

Answer 8

Vesicles near external meatus

Preherpetic neuralgia (painful prodrome)

Question 9

How would you know if someone’s facial drooping was due to Lyme disease?

Answer 9

It would probably be bilateral

They might have erythema/swelling prior to the palsy

Question 10

How would you know if someone’s facial drooping was due to guillain-barre?

Answer 10

It would be bilateral and progressive

Question 11

How would you know if someone’s facial drooping was due to a tumor?

Answer 11

It would have a gradual onset

Question 12

How would you know if someone’s facial drooping was due to a central stroke?

Answer 12

They WILL be able to wrinkle their forehead!!****

(Of course you can’t completely rule out stroke if they can’t wrinkle forehead, but for the purposes of this exam you probably can)

Question 13

Central or peripheral facial palsy:

UMN lesion affects contralateral portion of the lower face

Answer 13

Central

Question 14

Central or peripheral facial palsy:

LMN lesions afffescts the ipsilateral side of the face

Answer 14

Peripheral

Question 15

Central or peripheral facial palsy:

Forehead spared (can wrinkle forehead)

Answer 15

Central

Question 16

Central or peripheral facial palsy:

Involves forehead (can’t wrinkle forehead)

Answer 16

Peripheral

Question 17

Central or peripheral facial palsy:

Stroke

Tumor

MS

Trauma

Answer 17

Central

Question 18

Central or peripheral facial palsy:

Bell’s palsy

Guillan barre

Otitis media

Lyme

Ramsay hunt syndrome

Answer 18

Peripheral

Question 19

What is the name for herpes zoster that affects the facial nerve and causes facial drooping?

Answer 19

Ramsay hunt syndrome

Question 20

True or false:

Bell’s palsy is a clinical diagnosis

Answer 20

True.

Based on:
1. Diffuse facial nerve involvement (forehead and eye affected)

2. Acute onset in 1-2 days. Maximum severity within 3 weeks. Improvement or recovery in 6 months

Question 21

If Bell’s palsy is not getting better in _________weeks, you need to start looking for some other cause

Answer 21

3

Question 22

When would you need to do diagnostic studies for someone with Bell’s palsy?

Answer 22

Getting worse after 3 weeks

No significant improvement in 4 months

Atypical symptoms

Question 23

What kinds of diagnostic studies can you do to work up weird Bell’s palsy?

Answer 23

Serologic testing for Lyme and HSV

Fasting blood glucose

EMG/NCS

CT/MRI

Question 24

If you suspect Bell’s palsy and your patient tests positive for HSV, that will (support/hurt) the diagnosis of Bell’s palsy

Answer 24

Support

Question 25

What is the pharmacological management of Bells Palsy?

Answer 25

Prednisone 60-80mg x 7 days (or some crazy tapering dosage) +/- Valacyclovir 1g TID x 7 days Best results if tx initiated within 3 days of onset

Question 26

You should start prednisone and valacyclovir within _____ days of symptom onset for Bell’s palsy

Answer 26

3

Question 27

Do you need to do anything else for Bell’s palsy patients other than prednisone and valacyclovir

Answer 27

EYE CARE 🌵👁 (They cant close one eye)

Question 28

How do you keep someone’s eye from drying out if they have Bell’s palsy?

Answer 28

Artificial tears every hour during the day Eye ointments at night +/- patch Sunglasses 😎

Question 29

How long will it take for someone with Bell’s palsy to return to normal function?

Answer 29

3-6 months

Question 30

What is the fancy name for trigeminal neuralgia?

Answer 30

Tic doulaureux

Question 31

Trigeminal neuralgia pain is described as:

Answer 31

attacks of electrical shock-like pain that lasts a few seconds and can occur repetitively Episodes happen daily or several times a month Episodes of remission last for 6+ months

Question 32

What age is typically diagnosed with trigeminal neuralgia?

Answer 32

>50

Question 33

Overall, what causes Trigeminal neuralgia?

Answer 33

Compression of trigeminal nerve that causes demyelination

Question 34

What are the 2 classifications of trigeminal neuralgia?

Answer 34

Classic- idiopathic or vascular compression Secondary/painful trigeminal neuropathy- compression is caused by other reasons (Multiple sclerosis, herpes zoster, vestibular Schwannoma, meningioma, cyst)

Question 35

Trigeminal neuralgia is usually (unilateral/bilateral)

Answer 35

Unilateral

Question 36

Which branches of CNV are usually affected by trigeminal neuralgia?

Answer 36

V2 and V3

Question 37

If V1 is affected by trigeminal neuralgia, what other symptoms would you expect to see?

Answer 37

Autonomic symptoms (which would make it look like a cluster headache)

Question 38

What can trigger an attack of trigeminal neuralgia?

Answer 38

Light touch Chewing Talking Shaving Brushing teeth Cold air

Question 39

What is pretrigeminal neuralgia?

Answer 39

Prodrome of an achey jaw prior to an attack of trigeminal neuralgia (People often go to the dentist)

Question 40

What kind of imaging do you NEED to do when someone shows up with symptoms of trigeminal neuralgia?

Answer 40

MRI brain with and without contrast Maybe an MRA to look for vascular compression if they have the classic presentation

Question 41

What is the pharmacologic treatment for trigeminal neuralgia?

Answer 41

Carbamazepine 100-200mg BID | Increase gradually to 600-800mg total daily

Question 42

What are the side effects of carbamazepine?

Answer 42

Drowsiness Dizziness N/V Leukopenia Aplastic anemia

Question 43

What lab test do you need to monitor when someone is on carbamazepine?

Answer 43

CBC (due to the risk of leukopenia and aplastic anemia)

Question 44

What genetic test do you need to do before you start someone on carbamazepine, especially Asian patients?

Answer 44

HLA-B 1502 due to the risk of Stevens Johnson Syndrome

Question 45

What treatments other than carbamazepine may be helpful for trigeminal neuralgia?

Answer 45

Other anticonvulsants (oxcarbazepine, gabapentin, phenytoin, Lamotrigine) Baclofen can be used alone OR in combo with carbamazepine Topical lidocaine Opioids (require high dose, just dont do this ok?)

Question 46

What two titers should be drawn when a patient presents with Bells Pasly?

Answer 46

Herpes simplex Lyme

Question 47

What 2 clinical conditions increase the risk for Bell’s palsy

Answer 47

Pregnancy Diabetes

Question 48

A patient has a flat nasolabial fold, cant close his right eye, and cant wrinkle the right side of his forehead. On exam you note vesicles in the right ear canal. What is the diagnosis =

Answer 48

Ramsay Hunt Syndrome

Question 49

A patient presents with jaw pain, no trauma, ROM is diminished with attempts to open the mouth. What is the diagnosis?

Answer 49

TMJ dysfucntion

Question 50

What neurological condition os most commonly seen with trigeminal neuralgia: A. Myasthenia gravis B. Guillan barre C. Parkinson’s D. Multiple Sclerosis

Answer 50

D. Multiple Sclerosis

Question 51

What rheumatic condition may be associated with giant cell arteritis?

Answer 51

Polymyalgia rheumatica

Question 52

What is the treatment of choice for Giant Cell arteritis?

Answer 52

High dose oral steroids