Other Facial Nerve Disorders

Herpes zoster infection of the geniculate (facial) ganglion causes sudden severe facial weakness with a typical zoster vesicular eruption within the external auditory meatus. Pain is a major feature and may precede the facial weakness. Serosanguinous fluid may discharge from the ear. Deafness may result from VIII involvement. Occasionally, other cranial nerves from V-XII are affected. Antiviral agents (acyclovir) may help. HEMIFACIAL SPASM This condition is characterised by unilateral clonic...

Specific syndromes of drugs and toxins

A rare life-threatening disorder induced by initiation, increase or reintroduction of neuroleptic drugs (e.g. chlorpromazine, haloperidol). The condition appears to result from acute dopamine receptor blockade and is characterised by hyperpyrexia, bradykinesia, rigidity, autonomic disturbance, alteration of consciousness and high serum muscle enzymes (creatine kinase). The causal drug should be withdrawn and the patient cooled. Give dopamine agonists with dantrolene sodium to control...

Deafness tinnitus and vertigo

Auditory From the cochlear nucleus, second order neurons either pass upwards in the lateral lemniscus to the ipsilateral inferior colliculus or decussate in the trapezoid body and pass up in the lateral lemniscus to the contralateral inferior colliculus. Third order neurons from the inferior colliculus on each side run to the medial geniculate body on both sides. Fourth order neurons pass through the internal capsule and auditory radiation to the auditory cortex. The bilateral nature of the...

Epilepsy Differential Diagnosis

The following should be considered in the differential diagnosis of epilepsy -SYNCOPE (VASOVAGAL) ATTACKS These attacks occur usually when the patient is standing and result from a global reduction of cerebral blood flow. Prodromal pallor, nausea and sweating occur if the patient sits down, the attack may pass off or proceed to a brief loss of consciousness. Tonic and clonic movements may develop if impaired cerebral blood flow is prolonged ('anoxic' seizures). Mechanism Peripheral...

Other movement disorders

A rare condition associated with prescribing dopamine antagonist and long-acting depot neuroleptic preparations. Drowsiness, fever, tremor and rigidity occur suddenly. Muscle necrosis (rhabdomyolysis) results in myoglobinuria and occasionally renal failure. Early identification and treatment with dopamine receptor agonists (bromocriptine) and muscle relaxants (sodium dantrolene) may be life saving. WILSON'S DISEASE (hepatolenticular degeneration) A rare autosomal recessive disorder of copper...

Movement disorders extrapyramidal diseases

The effects of disease of the extrapyramidal system on movement can be regarded as negative (primary functional deficit) and positive (secondary effect due to release or disinhibition in undamaged regions). 1. Bradykinesia - a loss or slowness of voluntary movement. This is a major feature of Parkinson's disease and produces - reduced facial expression (mask-like) - reduced adjustments of posture when seated. When agitated the patient will move swiftly - 'kinesia paradoxica'. 2. Postural...

Causes Of Lower Cranial Nerve Palsies

Lower cranial nerve palsies seldom occur in isolation. Investigations include CT or MR imaging of the skull base. If negative, specific tests for systemic causes and EMG (for nerve and muscle disease) may be required. meningioma, neurofibroma, metastasis, epidermoid, nasopharyngeal carcinoma Bone lesions - osteomyelitis (in diabetics, consider pseudomonas), chordoma Basal meningitis (especially tuberculous) Carcinomatous meningitis Glomous jugulare tumour (chemodectoma) Brain stem Infarction...

Dementias History And Clinical Examination

When obtaining a history from a demented person and relative, establish - Rate of intellectual decline - Nutrition status - Impairment of social function - Drug history - General health and relevant disorders, - Family history of dementia. Tests to assess intellectual function are designed to check - Specific higher cortical functions A simple bedside battery of tests includes assessment from a clinical psychologist is advisable. Tap lips with tendon hammer - a pout response is observed Patient...

Facial Pain Trigeminal Neuralgia

MANAGEMENT (contd) Operative therapy Peripheral nerve techniques Nerve block with alcohol or phenol provides temporary relief (up to two years). Avulsion of the supra- or infraorbital nerves gives more prolonged pain relief. Trigeminal ganglion root injection Alcohol or phenol injection into the trigeminal ganglion effectively produces pain relief, but area control is limited and the risk of corneal anaesthesia, ulceration and scarring is high. Now rarely used. Glycerol injection into Meckel's...

Autonomic nervous system specific diseases

Symptoms of autonomic dysfunction occur in many common conditions which affect both the parasympathetic and sympathetic pathways e.g. cerebrovascular disease. The following arc less common disorders which primarily may affect the autonomic nervous system - Two types of this condition are recognised 1. Due to degeneration of sympathetic postganglionic neurons. 2. Due to degeneration of sympathetic preganglionic neurons of the intermediolateral column T1-T12 -SHY-DRAGER SYNDROME. In the latter...

Viral infections myelitis and poliomyelitis

Acute viral transverse myelitis is rare. It can occur in association with measles, mumps, Epstein-Barr, herpes zoster simplex, enterovirus infections or small pox. Fever, back and limb pain precede paralysis, sensory loss and bladder disturbance. Initially paralysed limbs are flaccid, but over 1-2 weeks spasticity and extensor plantar responses develop. Good recovery occurs in 30 . Death from respiratory failure is rare (5 ). Myelography when performed is normal. MRI may demonstrate focal cord...

Movement disorders extrapyramidal system

The observation that drugs such as reserpine and phenothiazines regularly produce extrapyramidal syndromes has clarified the neurochemical basis of movement disorders and delineated the role of neurotransmitters. Neurotransmitter substances are synthesised and stored presynaptically. When released by an appropriate stimulus they cross the synaptic gap and combine with specific receptors of the postsynaptic cell, e.g. - acetylcholine - serotonin - Synthesised by small striatal cells -...

Parkinsons disease

Initial symptoms are vague, the patient often complains of aches and pains. 1. A coarse TREMOR at a rate of 4 per second usually develops early in the disease. It begins unilaterally in the upper limbs and eventually spreads to all four limbs. The tremor is often 'pill rolling', the thumb moving rhythmically backwards and forwards on the palm of the hand. It occurs at rest, improves with movement and disappears during sleep. 2. RIGIDITY is detected by examination. It predominates in the flexor...

Sellarsuprasellar tumours pituitary adenoma

Occurs in most patients with enlargement of the pituitary fossa. It is not specific in site or nature. Pressure on the inferior aspect of the optic chiasma usually causes superior temporal quadrantanopia initially, with progression to bitemporal hemianopia, but any pattern can occur. The clinical syndrome produced is dependent on the hormone secreted. Stimulates growth and plays a part in control of protein, fat and carbohydrate metabolism. Excess GH In childhood, prior to fusion of bone...

Dementias

Progressive deterioration of intellect, behaviour and personality as a consequence of diffuse disease of the cerebral hemispheres, maximally affecting the cerebral cortex and hippocampus. Distinguish from delirium which is an acute disturbance of cerebral function with impaired conscious level, hallucinations and autonomic overactivity as a consequence of toxic, metabolic or infective conditions. Dementia may occur at any age but is more common in the elderly, accounting for 40 of long-term...

Parkinson s disease

Described by James Parkinson (1817) in 'An essay on the shaking palsy'. Recognised as an extrapyramidal disorder by Kinnier Wilson (1912). Annual incidence 20 per 100 000. Prevalence 190 per 100000. Sex incidence male female - 3 2 Age of onset 50 years upwards. Incidence peaks in mid-70s then declines. Familial incidence occurs in 5 . The cause of Parkinson's disease is unknown. Discordance in identical twins suggests that genetic factors are not important and environmental mechanisms appear to...

Headache Specific Causes

HEADACHE FROM RAISED INTRACRANIAL PRESSURE - aggravated by bending or coughing. - worse in the morning on awakening may awaken patient from sleep. - the severity of the headache gradually progresses. Associated features - transient loss of vision (obscuration) with sudden change in posture. - eventual impairment of conscious level. Management further investigations are essential - CT or MRI HEADACHE DUE TO INTRACRANIAL HAEMORRHAGE - severe pain, spreading over the vertex to the occiput, or...

Dementias Specific Diseases

Numerous tests have been assessed to predict those most likely to benefit from operation. The most reliable are - Other tests include the presence of periventricular lucency or disproportionate sulcal width on CT scan, isotope cisternography and CSF infusion studies but none appear to produce a reliable guide. Operation Ventriculo-peritoneal shunting (see page 363). Results Improvement occurs in 50-70 of those patients with a known preceding cause e.g. subarachnoid haemorrhage. Only 30 of the...

Tumours of the cerebral hemispheres extrinsic

Approximately a quarter of patients with meningioma present with epilepsy - often with a focal component. In the remainder, the onset is insidious with pressure effects (headache, vomiting, papilledema) often developing before focal neurological signs become evident. Notable characteristic features occur, dependent on the tumour site - PARASAGITTAL PARAFALCINE tumours lying near the vertex affect the 'foot' and 'leg' area of the motor or sensory strip. Partial seizures or a 'pyramidal' weakness...

The Neurological Observation Chart

Despite major advances in intracranial investigative techniques, none has replaced clinical assessment for monitoring the patient's neurological state. The neurological observation chart produced by Jennett and Teasdale incorporates the most relevant clinical features, i.e. coma scale eye opening, verbal and motor response , pupil size and reaction to light, limb responses and vital signs. The frequency of observation normally 2-hourly depends on the individual patient's needs. The chart...