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CMT > Bells Palsy & Trigeminal Neuralgia > Flashcards

Bells Palsy & Trigeminal Neuralgia Flashcards

1
Q

Bells Palsy

what is the most common etiology?

A

unilateral facial nerve palsy

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2
Q

Bells Palsy

epidemiology (age, gender, seasonality)

A
  • usually adults, peak ages 20-40 y/o
  • men and women equally affected
  • rarely occurs in the summer
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3
Q

Bells Palsy

risk factors?

5

A
  1. DM
  2. immunocompromised
  3. pre-eclampsia
  4. recent URI
  5. recent pfizer vax
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4
Q

Bells Palsy

differentiate upper and lower motor neuron lesions

A
  • UMN: lesions affecting the corticobulbar tract
  • LMN: lesions affecting individual branches
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5
Q

Bells Palsy

pathophys

A

may affect any/all four fiber types carried by facial nerve
* somatomotor axons to facial muscle (presents as facial weakness)
* axons supplying stapedial muscle (hyperacusis)
* gustatory fiber insult (hypo or dys geusia)
* sensory fiber insult (otalgia and post-auricular pain, lacrimal/salivary gland dysfunction)

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6
Q

Bells Palsy

describe the HSV hypothesis

A
  • cause causing primary infection on the lips (cold sores), the virus travels up sensory nerve axons and then reactivates and causes damage to myelin
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7
Q

Bells Palsy

may be secondary to?

A
  • autoimmune reactions that cause facial nerves to demyelinate
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8
Q

Bells Palsy

within how long do sx evolve?

A

72 hours

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9
Q

Bells Palsy

presentation of illness

5 components

A
  • unilateral facial palsy of acute onset
  • ipsilateral post-auricular pain, mild to mod otalgia, hyperacusis, or phonophobia
  • hypo or dysgeusia
  • subjective tongue or facial hypoesthesia
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10
Q

Bells Palsy

PE Exam components which will be unremarkable

A
  1. focused neuro exam
  2. complete head/neck exam (CN exam, otoscopy, tuning fork exams)
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11
Q

Bells Palsy

what is Bell Phenomenon

A

L eye rolls upward and inward

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12
Q

Bells Palsy

which side of the face is usually affected?

A

R side of the face

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13
Q

Bells Palsy

sparing of the brow on PE indicates?

A

upper motor neuron lesion

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14
Q

Bells Palsy

essentials of dx

3 essentials +/- 2 others

A
  • sudden onset of lower motor neuron facial palsy
  • hyperacusis or impaired taste
  • no other neurologic abnormalities
  • post-auricular pain or trigeminal neuralgia
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15
Q

Bells Palsy

diagnosis to exclude

A
  • facial palsy of known etiology or a palsy that is progressive, waxing, waning, or affects facial zones in an uneven fashion

IS NOT BELLS PALSY

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16
Q

Bells Palsy

what would uneven distribution of weakness indicate?

A

neoplasm

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17
Q

Bells Palsy

what if it was vesicular palsy?

A

zoster

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18
Q

Bells Palsy

diagnostics

3 components

A
  • “if it looks like a horse, it’s probably a horse”
  • imaging PRN to r/o stroke or neoplasm
  • Lyme testing if indicated
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19
Q

Bells Palsy

differentials

8

A
  • Herpes Zoster
  • Lyme Disease
  • Benign Facial Nerve Tumor
  • Malignant Facial Nerve Tumor
  • Delayed onset palsy from facial trauma
  • chronic otitis media or cholesteotoma
  • otitis externa
  • CVA
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20
Q

Bells Palsy

Tx (firstline)

A
  • corticosteroids w/in 72 hrs of sx osnet
  • burst and toper
  • Anti virals (if HSV; valacyclovir or acyclovir)
21
Q

Bells Palsy

tx: eye protection

A
  • artificial tears during the day
  • tape shut at night w/ lubricant
22
Q

Bells Palsy

where to refer for severe cases?

A
  • neuro-opthalmologist
  • neurologist
23
Q

Bells Palsy

recovery for incomplete vs complete paralysis

A
  • incomplete paralysis: 94% recovery
  • complete paralysis: 61% recovery
24
Q

Bells Palsy

poor prognosis w/

4 things

A
  1. advanced age
  2. DM
  3. taste disturbance
  4. pregnancy
25
Q

Bells Palsy

follow up

A

within 1-2 wks to monitor response to therapy and follow condition of affected eye

26
Q

Trigeminal Neuralgia

AKA

A

tic douloureux

27
Q

Trigeminal Neuralgia

epi (gender, age, risk factor)

A
  • more common in females than males
  • usually begins after age 40 (most common onset 60-70 yrs)
  • HTN is risk factor
28
Q

Trigeminal Neuralgia

etiology

A

unclear and likely multi factorial

29
Q

Trigeminal Neuralgia

essentials of diagnosis

3

A
  • brief episodes of stabbing facial pain
  • pain is in the territory of the 2nd and 3rd division of the trigeminal nerve
  • pain is exacerbated by touch
30
Q

Trigeminal Neuralgia

which CN is attaked and causing stabbing facial pain?

A
  • CN V
31
Q

Trigeminal Neuralgia

International Headache Society Classifications

A

A: paroxysmal attacks of pain lasting from a fraction of a second to 2 min, affects 1+ divisions of trigeminal nerve
B: pain is at least: intense/sharp/superficial/stabbing OR precipitated from trigger areas/factors
C: attacks stereotyped in the individual pt
D: no clinically evident neurologic deficit
E: not attributed to another disorder

32
Q

Trigeminal Neuralgia

where does pain shoot from in 60% of pts?

A

from corner of mouth to angle of jaw

33
Q

Trigeminal Neuralgia

where does pain commonly run?

A

along line dividing either mandibular and maxillary nerves or maxillary and ophthalmic portions or nerve

34
Q

Trigeminal Neuralgia

where does pain jolt from in 30% of cases?

A
  • upper lip or canine teeth to eye/eyebrow
  • spares the orbit itself
35
Q

Trigeminal Neuralgia

fewer than 5% of cases involve what?

A

ophthalmic branch

36
Q

Trigeminal Neuralgia

triggers

4

A
  1. chewing, talking, smiling
  2. drinking hold/cold fluids
  3. touching, shaving, brushing teeth, blowing nose
  4. encountering cold air from open car window
37
Q

Trigeminal Neuralgia

what are 2 things that pts may try to do to avoid triggering?

A
  1. rubbing the face/trigger area
  2. hold face still while talking
38
Q

Trigeminal Neuralgia

3 components of the trigeminal nerve

A
  • V1: opthalmic nerve
  • V2: maxillary nerve
  • V3: mandibular nerve
39
Q

Trigeminal Neuralgia

describe associated pain

6

A
  1. severe, paroxysmal, lancinating
  2. starts as sensation of electrical shocks in the affected area
  3. crescendos in < 20s to excruciating discomfort
  4. begins to fade within seconds and leaves a burning ache
  5. pain fully abates between attacks even if they are severe/frequent
  6. may cause grimace, wince, or aversive head movement
40
Q

Trigeminal Neuralgia

tx

A
  • AEDs (carbamazepine or oxcarbazepine)
  • Gabapentin
  • Lamotrigine
41
Q

Trigeminal Neuralgia

describe AEDs for tx

A
  • inhibit neuronal sodium channel activity, reducing excitability of neurons
42
Q

Trigeminal Neuralgia

describe gabapentin for tx

A
  • modulation of excitatory transmitters involved in pain
43
Q

Trigeminal Neuralgia

describe lamotrigine for tx

A
  • inhibits release of glutamate (excitatory amino acid) and inhibits neuronal sodium channel activity which stabilizes neuronal membranes, reducing excitability
44
Q

Trigeminal Neuralgia

surgical tx

A
  • microvascular decompression
  • Gamma knife tx
  • Radiofrequency
45
Q

Trigeminal Neuralgia

what does gamma knife tx do?

A

damages trigeminal nerve to stop transmission of pain signals

46
Q

Trigeminal Neuralgia

what does radiofrequency do?

A

damages trigeminal nerve to stop transmission of pain signals

47
Q

Trigeminal Neuralgia

complications of surgery

2

A
  1. permanent anesthesia over face
  2. disabling, spontaneous post-op pain (worse than original pain, untreatable)
48
Q

Trigeminal Neuralgia

prognosis

A
  • chronic
  • tx usually fail

CMT (72 decks)

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