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Flashcards in Cranial Nerves Deck (37)
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1
Q

List the effected nerves (in order) in a Cerebellopontine angle tumour

A

Corneal reflex lost first (V)
Then VII & VIII
Then rest of V
Sometimes IX & X

2
Q

What nerves are effected by Paget’s?

A

V, VII, VIII

3
Q

What nerves does Gradenigo’s syndrome effect?

A

V & VI

4
Q

Syringobulbia effects what nerves? What symptoms are each associated with?

A
Bulbar palsy (IX, X, & XII)
VIII - vertigo and nystagmus 
V - facial pain/sensory loss
VII - sparing
May have Horner's syndrome
May have syringomyelia
5
Q

Which nerves is a sinus thrombosis associated with?

A

III, IV, & VI (VI most common)
V - pain (especially ophthalmic division)
Corneal Reflex may be lost (V)

6
Q

What symptoms might you see with a cavernous sinus thrombosis?

A

Headache, periorbital oedema, proptosis

7
Q

Causes of any cranial nerve palsy

A
Diabetes
Stroke
MS
Tumour
Sarcoid
SLE
Vasculitis
8
Q

Ddx unilateral ptosis

A

CNIII palsy
Horners syndrome
Congenital

9
Q

Ddx bilateral ptosis

A

Myasthenia gravis
Myotonic dystrophy
Congenital

10
Q

Features of CNIII palsy

A

Eye deviated ‘down and out’
Ptosis
Dilated pupil of complete

11
Q

Ddx olfactory nerve palsy

A

Trauma
Frontal lobe tumour
Meningitis

12
Q

Ddx optic nerve palsy - optic blindness

A

MS, GCA

13
Q

Ddx optic nerve palsy - bitemporal hemaniopia

A

pituitary tumour

Internal carotid artery aneurysm

14
Q

Ddx optic nerve palsy - homonymous hemianopia

A

Anything behind chiasm

Stroke / tumour/ abscess

15
Q

Ddx partial occulomotor palsy

A

Pupil spared - diabetes

16
Q

Ddx complete occulomotor palsy

A

PCA aneurysm

Raised ICP with Tentorial herniation

17
Q

Ddx trochlear palsy

A

Single palsy rare - usually due to orbit palsy

18
Q

Ddx trigeminal palsy

A

Idiopathic (trigeminal neuralgia)
Acoustic neuroma
Herpes zoster

19
Q

Ddx abducens palsy

A

Skull # involving petrous temporal bone

Nasopharyngeal carcinoma

Raised ICP (false localising sign)

20
Q

Ddx facial nerve palsy

A

LMN:

  • Bell’s palsy
  • parotid tumour
  • herpes zoster (Ramsey Hunt)
  • Sarcoid (often bilateral)

UMN:
- stroke / tumour

21
Q

Ddx vestibulocochlear palsy

A

Excessive noise levels

Ménière’s disease

Furosemide

Amino glycoside antibiotics (gentamicin)

22
Q

Ddx IX, X, XII - lower motor lesion (bulbar palsy)

A
MND
diphtheria 
Polio
Guillain-Barré syndrome
Syringobulbia
23
Q

Ddx IX, X, XII - UMN lesion (pseudobulbar palsy)

A

Motor neurone disease
Bilateral strokes
MS

24
Q

Causes of groups cranial nerve palsies

A
  1. Cerebellopontine angle tumour (acoustic neuroma or meningioma)
  2. Paget’s disease of bone (bony impingement on nerves)
  3. Gradenigo’s syndrome (complication of otitis media)
  4. Syringobulbia
  5. Cavernous sinus thrombosis
25
Q

Ddx opthalmoplegia

A

Myaesthenia gravis

Cranial nerve palsy

26
Q

Rinne - bone>air (left ear)

Weber - lateralises to left ear

A

Conductive hearing loss in left ear

27
Q

Rinne - Air > bone (both ears)

Weber - lateralises to left ear

A

Sensorineural hearing loss in right ear

28
Q

Rinne - bone > air (right ear)

Webber - lateralises to right ear

A

Conductive loss is right ear

29
Q

Air > bone in both ears

Lateralises to right ear

A

Sensorineural hearing loss in left ear

30
Q

Describe the features and aetiology of a bulbar palsy

A

Lesion - LMN
Tongue appearance - flaccid, wasted, fasciculating
Other features - drooling, dysphonia, tremulous lips

Aetiology - MND, diphtheria, polio, Guillain-Barré syndrome, Syringobulbia

31
Q

Describe the features and aetiology of a pseudobulbar palsy

A

Lesion - UMN
Tongue appearance - spastic, contracted
Other features - drooling, dysphonia, emotional lability

Aetiology - MND, bilateral strokes (eg internal capsule), MS

32
Q

Describe Horner’s syndrome

A

Results from the interruption of sympathetic fibres to one eye –> unilateral pupillary constriction, slight ptosis (levator palpebrae suprioris), exophthalmos backward displacement of eye ball), loss of sweating on ipsilateral side of the face.

33
Q

Causes of Horner’s syndrome

A

Syringomyelia

Involvement of the T1 root by apical lung cancer (Pancoast tumour)

Lesions in the neck - trauma, surgical resection, or malignant lymph nodes

34
Q

Classic signs of cerebellar lesion?

A

DANISH

Dysdiadochokinesis
Ataxia (limb/trunk)
Nystagmus
Intention tremor
Speech (slurred, staccato)
Hypotonia
35
Q

Features of cerebellar limb ataxia?

A

Dysmetria
Past-pointing
Intention tremor
Dysdiadochokinesis

36
Q

Ddx nystagmus

A

Congenital

Brainstem or cerebellar problem - MS, stroke, tumour

Vestibular apparatus problem - labyrinthitis, Ménière’s disease, CN VIII lesion

37
Q

Ddx dysarthria

A

Facial nerve palsy - look for facial weakness
Bulbar palsy - look for flaccid wasted fasciculating tongue
Pseudobulbar palsy - look for spastic contracts tongue
Myasthenia gravis
Cerebellar disease