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bell's palsy guideline

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181. Epilepsy Surgery (Follow-up)

– In this procedure, the cortex is disconnected from all subcortical structures, and the interhemispheric commissures are divided, but the brain remains in place Postoperative complications that may occur include the following: AMTR – Hemiparesis, visual field deficit, infections, cranial nerve palsy, fever, verbal deficits and memory problems Corpus callosotomy – Hydrocephalus, aseptic meningitis, bleeding from the superior sagittal sinus, frontal lobe edema, venous infarction, and air embolism Functional (...) of interictal abnormalities, in that ictal recordings are considered more accurate than interictal data. A possible exception to this general guideline might be when recording from a focal cortical dysplasia; distinctive interictal epileptiform patterns have been identified that may provide enough data to guide a resection based solely on interictal data. In monitoring a lesion with intracranial electrodes, seizure outcome is best when both the lesion and the ictal onset zone are completely resected

2014 eMedicine Surgery

182. Epilepsy Surgery (Diagnosis)

– In this procedure, the cortex is disconnected from all subcortical structures, and the interhemispheric commissures are divided, but the brain remains in place Postoperative complications that may occur include the following: AMTR – Hemiparesis, visual field deficit, infections, cranial nerve palsy, fever, verbal deficits and memory problems Corpus callosotomy – Hydrocephalus, aseptic meningitis, bleeding from the superior sagittal sinus, frontal lobe edema, venous infarction, and air embolism Functional (...) of interictal abnormalities, in that ictal recordings are considered more accurate than interictal data. A possible exception to this general guideline might be when recording from a focal cortical dysplasia; distinctive interictal epileptiform patterns have been identified that may provide enough data to guide a resection based solely on interictal data. In monitoring a lesion with intracranial electrodes, seizure outcome is best when both the lesion and the ictal onset zone are completely resected

2014 eMedicine Surgery

183. Wernicke-Korsakoff Syndrome (Overview)

horizontal nystagmus may persist indefinitely in as many as 60% of patients, but patients completely recover from sixth nerve palsies, ptosis, and vertical-gaze palsies. Ataxic complications Approximately 40% of patients recover completely from their ataxic symptoms. The remainder have varying degrees of incomplete recovery, with a residual slow, shuffling, wide-based gait and the inability to tandem walk. Vestibular dysfunction generally responds to a similar degree. Mental status complications (...) Encephalopathy and Korsakoff's Psychosis. Alcohol Alcohol . 2006 Mar-Apr. 41(2):151-8. . Wijnia JW, van de Wetering BJ, Zwart E, Nieuwenhuis KG, Goossensen MA. Evolution of Wernicke-Korsakoff syndrome in self-neglecting alcoholics: preliminary results of relation with Wernicke-delirium and diabetes mellitus. Am J Addict . 2012 Mar-Apr. 21(2):104-10. . Thomson AD, Marshall EJ, Bell D. Time to act on the inadequate management of Wernicke's encephalopathy in the UK. Alcohol Alcohol . 2013 Jan-Feb. 48(1):4-8

2014 eMedicine.com

184. Cancer and Rehabilitation (Overview)

for this adverse effect. Lymphedema can be seen immediately after surgery and results in a small increase in diameter in the upper arm only. Collateral circulation should resolve the edema within several weeks. Chronic lymphedema and its treatment are discussed elsewhere (see the section Management of Lymphedema, below). Injury to the long thoracic nerve results in winging of the scapula. About 30% of patients develop serratus anterior muscle palsy secondary to injury to the long thoracic nerve but appear

2014 eMedicine.com

185. Prematurity (Follow-up)

of an adaptive algorithm for automated control of inspired oxygen in the preterm infant. Arch Dis Child Fetal Neonatal Ed . 2017 Jan. 102 (1):F31-6. . Plottier GK, Wheeler KI, Ali SK, et al. Clinical evaluation of a novel adaptive algorithm for automated control of oxygen therapy in preterm infants on non-invasive respiratory support. Arch Dis Child Fetal Neonatal Ed . 2017 Jan. 102 (1):F37-F43. . [Guideline] Stark AR, for the American Academy of Pediatrics Committee on Fetus and Newborn. Levels of neonatal (...) , Committee on Fetus and Newborn. Respiratory support in preterm infants at birth. Pediatrics . 2014 Jan. 133 (1):171-4. . . Fox S. AAP backs CPAP plus selective surfactants in premies. Medscape Medical News. Available at . December 30, 2013; Accessed: January 5, 2014. DeMauro SB, Douglas E, Karp K, et al. Improving delivery room management for very preterm infants. Pediatrics . 2013 Oct. 132 (4):e1018-25. . Fox S. Delivery room guidelines improve outcomes for preemies. Medscape Medical News. Available

2014 eMedicine Pediatrics

186. Head Trauma (Diagnosis)

injury. Patients with severe head trauma are at increased risk of developing cerebral edema, respiratory failure, and herniation secondary to increased intracranial pressure (ICP). guidelines suggest that cardiopulmonary resuscitation should be the foundation upon which treatment of intracranial hypertension must be based and that in the absence of any obvious signs of increased ICP, no prophylactic treatment should be initiated; if instituted, prophylactic treatment has the potential to interfere (...) disruption of the dura mater. Cranial nerve injury may develop secondary to basilar skull fracture, mass effect, or herniation. Oculomotor palsy is due to injury of cranial nerves VI, III, or IV. Trauma to nerve VII leads to facial nerve palsy. Hearing loss may occur because of injury of cranial nerve VIII. Posttraumatic syndrome may develop after mild-to-moderate head trauma and consists of irritability, inability to concentrate, nervousness, and occasionally behavioral or cognitive impairment

2014 eMedicine Pediatrics

187. Extremely Low Birth Weight Infant (Diagnosis)

. First year survival was 15.5% for infants with a birth weight less than 500g. [ ] Infants with extremely low birth weight (ELBW) are more susceptible to all complications of premature birth, both in the immediate neonatal period and after discharge from the nursery. Although the mortality rate has greatly diminished with the use of surfactants, the proportion of surviving infants with severe sequelae, such as chronic lung disease, cognitive delays, cerebral palsy, and neurosensory deficits (ie (...) to the extracellular compartment following delivery. [ ] Normal potassium concentration is recovered in 4–5 days, with an eventual increase in glomerular filtration rate and increased diuresis. However, nonoliguric hyperkalemia has been associated with cardiac arrhythmias and death. [ ] There is no current guideline for the most effective treatment of hyperkalemia in ELBW infants; suggested therapies include insulin with glucose, albuterol inhalation, calcium, diuresis with furosemide, kayexalate and, rarely

2014 eMedicine Pediatrics

188. Acetabulum Fractures (Treatment)

or sciatic palsy develops after a closed reduction Nonoperative treatment should be considered in the following circumstances: Undisplaced fractures Displaced fractures if the following conditions are met: (1) A large portion of the acetabulum remains intact and the femoral head remains congruous with this portion of the acetabulum; (2) a secondary congruence is present after only moderate displacement of a both-column fracture and the patient presents late (>3 weeks after injury) Small posterosuperior (...) preference and experience of the operating surgeon (see and below). Guidelines for the choice of approach are as follows [ , , ] : Anterior fracture, cephalad to iliopectineal eminence - Iliofemoral Anterior fracture, patients with complex injuries requiring exposure of the symphysis or quadrilateral plate - Ilioinguinal Posterior wall/column - Kocher-Langenbeck [ ] Transverse with posterior lip - Kocher-Langenbeck or transtrochanteric Transverse without posterior lip - Depending on the rotation

2014 eMedicine Surgery

189. Skull Fracture (Overview)

Sabuncuoğlu (1385-1468) in his textbook "Cerrahiyyetu'l Haniyye" (Imperial Surgery). [ ] Charles Bell first described occipital condylar fracture in 1817 based on an autopsy finding. [ ] The same fracture was described for the first time as a radiograph finding in 1962 and by computed tomography (CT) in 1983. [ , ] Previous Next: Problem Skull fractures are classified in the image below. Classification of skull fractures Linear skull fracture Linear fracture results from low-energy blunt trauma over (...) deafness that resolves in less than 3 weeks is due to hemotympanum and mucosal edema in the middle ear fossa. Facial palsy, nystagmus, and facial numbness are secondary to involvement of the VII, VI, and V cranial nerves, respectively. Transverse temporal bone fractures involve the VIII cranial nerve and the labyrinth, resulting in nystagmus, ataxia, and permanent neural hearing loss. Occipital condylar fracture is a very rare and serious injury. [ ] Most of the patients with occipital condylar

2014 eMedicine Surgery

190. Acetabulum Fractures (Follow-up)

or sciatic palsy develops after a closed reduction Nonoperative treatment should be considered in the following circumstances: Undisplaced fractures Displaced fractures if the following conditions are met: (1) A large portion of the acetabulum remains intact and the femoral head remains congruous with this portion of the acetabulum; (2) a secondary congruence is present after only moderate displacement of a both-column fracture and the patient presents late (>3 weeks after injury) Small posterosuperior (...) preference and experience of the operating surgeon (see and below). Guidelines for the choice of approach are as follows [ , , ] : Anterior fracture, cephalad to iliopectineal eminence - Iliofemoral Anterior fracture, patients with complex injuries requiring exposure of the symphysis or quadrilateral plate - Ilioinguinal Posterior wall/column - Kocher-Langenbeck [ ] Transverse with posterior lip - Kocher-Langenbeck or transtrochanteric Transverse without posterior lip - Depending on the rotation

2014 eMedicine Surgery

191. Skull Fracture (Diagnosis)

Sabuncuoğlu (1385-1468) in his textbook "Cerrahiyyetu'l Haniyye" (Imperial Surgery). [ ] Charles Bell first described occipital condylar fracture in 1817 based on an autopsy finding. [ ] The same fracture was described for the first time as a radiograph finding in 1962 and by computed tomography (CT) in 1983. [ , ] Previous Next: Problem Skull fractures are classified in the image below. Classification of skull fractures Linear skull fracture Linear fracture results from low-energy blunt trauma over (...) deafness that resolves in less than 3 weeks is due to hemotympanum and mucosal edema in the middle ear fossa. Facial palsy, nystagmus, and facial numbness are secondary to involvement of the VII, VI, and V cranial nerves, respectively. Transverse temporal bone fractures involve the VIII cranial nerve and the labyrinth, resulting in nystagmus, ataxia, and permanent neural hearing loss. Occipital condylar fracture is a very rare and serious injury. [ ] Most of the patients with occipital condylar

2014 eMedicine Surgery

192. Microcystic Adnexal Carcinoma (Diagnosis)

A. High (nuclear) grade adnexal carcinoma with microcystic adnexal carcinoma-like structural features. Am J Dermatopathol . 2006 Aug. 28(4):346-51. . Mueller SK, Iro H, Lell M, Seifert F, Bohr C, Scherl C, et al. Microcystic adnexal carcinoma (MAC)-like squamous cell carcinoma as a differential diagnosis to Bell´s palsy: review of guidelines for refractory facial nerve palsy. J Otolaryngol Head Neck Surg . 2017 Jan 5. 46 (1):1. . Wong LK, Kereke AR, Wright AE, Vyas KS. Microcystic Adnexal Carcinoma

2014 eMedicine.com

193. Ectropion (Diagnosis)

. 1985 Nov. 103(11):1750-3. . Oh SR, Korn BS, Kikkawa DO. Orbitomalar suspension wth combined single drill hole canthoplasty. Ophthal Plast Reconstr Surg . Sept 2013. 29:357-60. Perez-Dieste JM, Catroviejo-Bolbar M. Eyelid ectropion caused by glasses. Mechanical centurion syndrome. Arch Soc Esp Oftalmol . February 2013. 88:80-2. [Guideline] Salinas RA, Alvarez G, Daly F, Ferreira J. Corticosteroids for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev . 2010. (3):CD001942 (...) -Dec/2013. 12:193-6. Fezza JP. Nonsurgical treatment of cicatricial ectropion with hyaluronic acid filler. Plast Reconstr Surg . 2008 Mar. 121(3):1009-14. . Schrom T, Habermann A. Temporary ectropion therapy by adhesive taping: a case study. Head Face Med . 2008 Jul 21. 4:12. . . Dobson R. Antiviral drugs should not be used to treat Bell's palsy, Cochrane analysis concludes. BMJ . 2009 Oct 7. 339:b4086. . Criglow BG, Choate KA, Milstone LM. Topical tazarotene for the treatment of ectropion

2014 eMedicine.com

194. Herpes Zoster (Diagnosis)

impairment, nystagmus, vertigo, or a facial nerve palsy mimicking Bell palsy. [ ] Patients may lose taste sensation in the anterior two thirds of the tongue. [ ] Clinical phases of disease The clinical manifestations can be divided into the following three phases: Preeruptive phase (preherpetic neuralgia) Acute eruptive phase Chronic phase (PHN) The preeruptive phase is characterized by unusual skin sensations or pain within the affected dermatome that heralds the onset of lesions by 48-72 hours. During (...) include hyperesthesia or, more rarely, hypoesthesia or anesthesia in the area of involvement Common features of herpes zoster ophthalmicus are as follows: Classic symptoms and lesions of herpes zoster Ophthalmic manifestations including conjunctivitis, scleritis, episcleritis, keratitis iridocyclitis, Argyll-Robertson pupil, glaucoma, retinitis, choroiditis, optic neuritis, optic atrophy, retrobulbar neuritis, exophthalmos, lid retraction, ptosis, and extraocular muscle palsies Other forms include

2014 eMedicine.com

195. Herpes Zoster (Diagnosis)

impairment, nystagmus, vertigo, or a facial nerve palsy mimicking Bell palsy. [ ] Patients may lose taste sensation in the anterior two thirds of the tongue. [ ] Clinical phases of disease The clinical manifestations can be divided into the following three phases: Preeruptive phase (preherpetic neuralgia) Acute eruptive phase Chronic phase (PHN) The preeruptive phase is characterized by unusual skin sensations or pain within the affected dermatome that heralds the onset of lesions by 48-72 hours. During (...) include hyperesthesia or, more rarely, hypoesthesia or anesthesia in the area of involvement Common features of herpes zoster ophthalmicus are as follows: Classic symptoms and lesions of herpes zoster Ophthalmic manifestations including conjunctivitis, scleritis, episcleritis, keratitis iridocyclitis, Argyll-Robertson pupil, glaucoma, retinitis, choroiditis, optic neuritis, optic atrophy, retrobulbar neuritis, exophthalmos, lid retraction, ptosis, and extraocular muscle palsies Other forms include

2014 eMedicine.com

196. Bowel Management (Diagnosis)

bifida is also associated with significant bowel issues. Parkinson disease The pathophysiology of bowel dysfunction in PD is characterized by dystonia of striated muscles of the pelvic floor and the external anal sphincter. Colonic transit time is prolonged as a consequence of loss of dopamine within the CNS and the enteric nervous system. [ ] Brain lesions Patients with brain lesions and survivors of stroke have bowel dysfunction caused by loss of inhibition of the sacral reflex. [ ] Cerebral palsy (...) : Elsevier; 2006. 345-58. Krogh K, Christensen P. Neurogenic colorectal and pelvic floor dysfunction. Best Pract Res Clin Gastroenterol . 2009. 23 (4):531-43. . Coggrave M, Norton C. Neurogenic bowel. Handb Clin Neurol . 2013. 110:221-8. . Pellat GC. Neurogenic continence. Part 1: pathophysiology and quality of ilfe. Br J Nurs . 2008 Jul 10-23. 17 (13):836-41. . Wiesel P, Bell S. Bowel dysfunction: assessment and management in the neurological patient. Bowel Continence Nursing . 2004. 181-203. Johanson

2014 eMedicine.com

197. Varicella Zoster (Diagnosis)

impairment, nystagmus, vertigo, or a facial nerve palsy mimicking Bell palsy. [ ] Patients may lose taste sensation in the anterior two thirds of the tongue. [ ] Clinical phases of disease The clinical manifestations can be divided into the following three phases: Preeruptive phase (preherpetic neuralgia) Acute eruptive phase Chronic phase (PHN) The preeruptive phase is characterized by unusual skin sensations or pain within the affected dermatome that heralds the onset of lesions by 48-72 hours. During (...) include hyperesthesia or, more rarely, hypoesthesia or anesthesia in the area of involvement Common features of herpes zoster ophthalmicus are as follows: Classic symptoms and lesions of herpes zoster Ophthalmic manifestations including conjunctivitis, scleritis, episcleritis, keratitis iridocyclitis, Argyll-Robertson pupil, glaucoma, retinitis, choroiditis, optic neuritis, optic atrophy, retrobulbar neuritis, exophthalmos, lid retraction, ptosis, and extraocular muscle palsies Other forms include

2014 eMedicine.com

198. Wernicke-Korsakoff Syndrome (Diagnosis)

horizontal nystagmus may persist indefinitely in as many as 60% of patients, but patients completely recover from sixth nerve palsies, ptosis, and vertical-gaze palsies. Ataxic complications Approximately 40% of patients recover completely from their ataxic symptoms. The remainder have varying degrees of incomplete recovery, with a residual slow, shuffling, wide-based gait and the inability to tandem walk. Vestibular dysfunction generally responds to a similar degree. Mental status complications (...) Encephalopathy and Korsakoff's Psychosis. Alcohol Alcohol . 2006 Mar-Apr. 41(2):151-8. . Wijnia JW, van de Wetering BJ, Zwart E, Nieuwenhuis KG, Goossensen MA. Evolution of Wernicke-Korsakoff syndrome in self-neglecting alcoholics: preliminary results of relation with Wernicke-delirium and diabetes mellitus. Am J Addict . 2012 Mar-Apr. 21(2):104-10. . Thomson AD, Marshall EJ, Bell D. Time to act on the inadequate management of Wernicke's encephalopathy in the UK. Alcohol Alcohol . 2013 Jan-Feb. 48(1):4-8

2014 eMedicine.com

199. Lyme Disease (Diagnosis)

findings in patients with early disseminated disease are as follows: EM (single or multiple lesions) Headache Fever Tender adenopathy (regional or generalized) Conjunctivitis (uncommon, never prominent) Carditis (usually manifests as heart block) Meningismus as a sign of aseptic meningitis Cranioneuropathy, especially cranial nerve VII and Bell palsy (peripheral seventh nerve palsy with decreased unilateral function, including the forehead) In patients with late disease, the typical physical finding (...) or nursing women with early localized or early disseminated Lyme disease: Amoxicillin or cefuroxime axetil Neurologic Lyme disease: IV penicillin, ceftriaxone, or cefotaxime; oral doxycycline, when not contraindicated, in patients with Lyme-associated meningitis, facial nerve palsy, or radiculitis Treatment of Lyme arthritis is as follows: Oral antibiotics for 28 days Re-treatment with oral antibiotics for mild residual joint swelling Re-treatment with IV antibiotics for refractory cases Oral antibiotics

2014 eMedicine.com

200. Lyme Disease (Diagnosis)

findings in patients with early disseminated disease are as follows: EM (single or multiple lesions) Headache Fever Tender adenopathy (regional or generalized) Conjunctivitis (uncommon, never prominent) Carditis (usually manifests as heart block) Meningismus as a sign of aseptic meningitis Cranioneuropathy, especially cranial nerve VII and Bell palsy (peripheral seventh nerve palsy with decreased unilateral function, including the forehead) In patients with late disease, the typical physical finding (...) or nursing women with early localized or early disseminated Lyme disease: Amoxicillin or cefuroxime axetil Neurologic Lyme disease: IV penicillin, ceftriaxone, or cefotaxime; oral doxycycline, when not contraindicated, in patients with Lyme-associated meningitis, facial nerve palsy, or radiculitis Treatment of Lyme arthritis is as follows: Oral antibiotics for 28 days Re-treatment with oral antibiotics for mild residual joint swelling Re-treatment with IV antibiotics for refractory cases Oral antibiotics

2014 eMedicine.com

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