Nerve injuries

Question 1

Define Bell’s palsy

Answer 1

Acute, unilateral, idiopathic facial nerve paralysis

Question 2

What are the features of bell’s palsy?

Answer 2

Lower motor neurone facial nerve palsy - forehead affected
Post-auricular pain
Altered taste
Dry eyes

Question 3

What is the difference between upper and lower motor neurone facial lesions?

Answer 3

Upper = forehead sparing

Question 4

How is Bell’s palsy diagnosed?

Answer 4

Clinical diagnosis of exclusion

Question 5

What are some RFs for Bell’s Palsy?

Answer 5

Intranasal flu vaccine

Pregnancy

Question 6

What is the management for Bell’s palsy?

Answer 6

Corticosteroid
e.g. Prednisolone reduces time for full recovery
Usually within 3-4 months

Question 7

What are the features of third nerve palsy?

Answer 7

Down and out eye

Ptosis

Question 8

What is ptosis?

Answer 8

Drooping or downward displacement of the upper eyelid

Question 9

What are some differentials for ptosis?

Answer 9

Thyroid eye disease
Stroke
Orbital tumours
Involutional changes as a result of squinting

Uncommonly - MS, Myasthenia gravis, giant cell arteritis, horner’s, third nerve palsy

Question 10

What is multiple sclerosis?

Answer 10

Demyelinating CNS conditions

2 separate episodes of neuro dysfunction in different anatomy

Question 11

Who is a typical MS pt?

Answer 11

White women
20-40 years
Temporary visual and sensory weakness

Question 12

What are some presenting features of MS?

Answer 12

Visual disturbance in one eye
Peculiar sensory phenomena e.g. numbness, trigeminal neuralgia
Increased muscle tone
Increased reflexes 
Imbalance
Spastic weakness
Tremor

Question 13

What are the investigations for MS?

Answer 13

MRI brain - periventricular plaques

Visual evoked potentials

Question 14

What are the different forms of MS?

Answer 14

Relapsing-remitting
Secondary progressive disease
Primary progressive disease

Question 15

What is the treatment for an acute MS relapse?

Answer 15

High dose steroids e.g. methylprednisolone

Hastens recovery

Question 16

What are some disease modifying drugs used in MS?

Answer 16

Beta-interferon reduces relapse rate up-to 30%

Monoclonal ABs e.g. natalizumab

Question 17

What can be used to treat spasticity?

Answer 17

Gabapentin
Diazepam
Physio

Question 18

Define trigeminal neuralgia

Answer 18

Unilateral disorder characterised by brief electric shock-like pains, abrupt in onset and termination, limited to one or more divisions of the trigeminal nerve

Question 19

What evokes pain in trigeminal neuralgia?

Answer 19

Light touch e.g. washing, shaving, smoking, talking , brushing teeth

Question 20

What is first-line treatment for trigeminal neuralgia?

Answer 20

Carbamazepine

Question 21

What comprises the term paraesthesia?

Answer 21

Tingling
Prickling
Pins and needles
Burning

Question 22

What are some differentials for paraesthesia?

Answer 22

Carpal tunnel (3 digit weakness) 
Spinal cord compression
MS
DM
Peripheral vascular disease

Question 23

What are the main symptoms of peripheral neuropathy?

Answer 23

Pain
Tingling 
Loss of sensation
Loss of balance or weakness
Poor healing wounds/lcers

Question 24

What cases peripheral neuropathy?

Answer 24

Viral infection e.g. shingles
Alcohol excess
Medications
Diabetes

Question 25

What is the initial management for neuropathic pain?

Answer 25

``` Amitriptyline Duloxetine Gabapentin Pregabalin One at a time ```

Question 26

What conditions can case tremor?

Answer 26

``` Parkinsons Anxiety Essential tremor Thyrotoxicosis Hepatic encephalopathy CO2 retention Cerebellar disease ```

Question 27

Define tremor

Answer 27

involuntary rhythmic oscillation of ≥1 body parts, mediated by alternating contractions of reciprocally acting muscles

Question 28

Define essential tremor

Answer 28

progressive tremor of the upper extremities, present in posture and action, without other neurological signs or symptoms postural tremor: worse if arms outstretched improved by alcohol and rest most common cause of titubation (head tremor)

Question 29

How do you diagnose essential tremor?

Answer 29

Clinically bilateral tremor with normal muscle tone and speed of movement; negative history and examination for Parkinson's disease, hyperthyroidism, medications, and alcohol use

Question 30

When is medical treatment considered for essential tremor?

Answer 30

Dysfunction or embarrassment

Question 31

What are the treatment options for essential tremor?

Answer 31

Propanolol

Question 32

Define ALS

Answer 32

Amyotrophic lateral sclerosis Neurodegenerative disorder Progressive muscle weakness and disability Usually death from respiratory failure

Question 33

What are some presenting feature of ALS?

Answer 33

``` Upper extremity weakness Stiffness Poor coordination and balance Painful muscle spasms Foot drop Muscle atrophy Hyper-reflexia Dyspnoea Slow speech ```

Question 34

How is ALS diagnosed?

Answer 34

Clinically presence of upper and lower motor neuron signs, disease progression, and absence of any other explanation for the presentation

Question 35

What is the first line treatment for ALS?

Answer 35

``` Riluzole - Prolongs survival Supportive care NIV Counselling regarding prognosis Advance directives ```

Question 36

What are the types of motor neurone disease?

Answer 36

AML - 50% Primary lateral sclerosis - UMN signs only Progressive muscular atrophy - LMN signs only Progressive bulbar palsy

Question 37

What are the features of progressive bulbar palsy?

Answer 37

palsy of the tongue, muscles of chewing/swallowing and facial muscles due to loss of function of brainstem motor nuclei carries worst prognosis

Question 38

What can cause spinal cord compression?

Answer 38

``` Spine trauma Vertebral compression fracture Intervertebral disc herniation Primary or metastatic spinal tumour Infection ```

Question 39

What can be presenting features of spinal cord compression?

Answer 39

``` Back pain Numbness Weakness or paralysis Bladder/bowel dysfunction Hyper-relflexia ```

Question 40

What is the investigation for spinal cord decompression?

Answer 40

MRI Spine

Question 41

What is the management for acute spinal cord injury?

Answer 41

Immobilisation e.g. cervical collar, backboard Decompressive/stabilisation surgery

Question 42

What is the management for cauda equina syndrome?

Answer 42

Decompressive laminectomy

Question 43

What is the management for malignant spinal cord compression?

Answer 43

Corticosteroids - oral dexamethasone Surgery - decompression laminectomy Radiation therapy