Documentos de Académico
Documentos de Profesional
Documentos de Cultura
CN 7 assessment
Facial expression
Ask about crocodile tears
Ask about noise intolerance
Ask about taste
Conservative educate the patient and reassure them that they have
not had a stroke! Monitor the patient to ensure this is Bells palsy and
there is no sinister underlying cause.
Medical If quickly diagnosed within 2-3 days, high dose steroids with
or without antivirals can be used. Steroids improve the rate of
complete recovery . Regardless of this, eye care is important this can
include artificial tears for dry eyes and taping the eyes shut at night to
prevent exposure keratitis.
Complications:
Failure to recover: prognosis depends on the degree of initial weakness
- the less the better.
Synkinesis this is where the regenerating facial nerve fibres are
thought to erroneously innervate different targets. Examples include
eyes closing whilst muscles of the mouth contract, lacrimation during
eating (crocodile tears) or smiling causing eye closure.
Recurrence this is uncommon, and occurs in around 1 in 10 people.
Ramsey Hunt syndrome
Varicella Zoster reactivation
in geniculate ganglion
Pain pre-auricular pain
Vesicles in external auditory
meatus
Clinical presentation
Ear pain, rash, facial paralysis,
loss of taste, vertigo, hearing loss
Treatment
Steroids and antivirals
Complications
Cerebellopontine angle tumour
Most common is vestibular schwannoma
Assoc Neurofibromatosis type 2( if bilateral)
Clinical
Pressure on adjoining structures CN5, 6,7,&8
Pressure develops over months
Eventual BSt infiltration and raised ICP
Also meningiomas, astrocytomas
Cerebellopontine angle tumors :Vestibular schwannoma
Clinical
5th-6th decadeCN8 deafness,
tinnitus, vertigo
CN7 LMN paralysis in face
CN6 Diplopia
CN5 parasthesias of face and
inside mouth
B st compression
Raised ICP
Vestibulocochlear nerve
Composed of vestibular nerve and
Cochlear nerve
Symptoms of nerve deficit include
sensorineural deafness, vertigo, nausea
and vomiting
CAUSES of
VERTIGO
Causes
Presbyacussis, drugs (gentamicin,
neomycin)Menieres disease, acoustic neuroma,
Congenital Rubella
SUMMARY:
Cranial nerves 7 & 8 originate in the pons and pass out at the
cerebellar pontine angle.
8th nerve assessment is by Webbers and Rinnes test
7 & 8 are compressed by cerebellar pontine angle tumours
Vertigo is an important symptom and has several causes