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Facial Nerve Paralysis Causes


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121. Herpes Zoster - Diagnosis

rash. 54 Ramsey Hunt syndrome is de?ned as involvement of the facial or auditory nerves, with ipsilateral facial palsy, HZ lesions of the external ear, tympanic membrane and/or the anterior two- thirds of the tongue. 55–57 Complications are vertigo, tinnitus, otalgia, dysgeusia, osteonecrosis and deafness. 58 No speci?c recommendation for enhanced diagnostic means is proposed in the case of HZ oticus, but due to the risk of severe compli- cations, 58 it is recommended to seek advice of an otorhino (...) - laryngologist, especially in the case of involvement of the facial or auditory nerves (Table 5), in order to determine the treat- ment strategy and necessity for otorhinolaryngologist reassess- ment. Herpes zoster sine herpete is de?ned as the presence of uni- lateral dermatomal pain without cutaneous lesions in patients with virologic and/or serologic evidence of VZV infection. The most accurate method to con?rm the diagnosis is to demon- strate an increase in the blood of anti-VZV IgG and IgM. The identi

2017 European Dermatology Forum

122. CRACKCast E103 – Headache Disorders

on the IHSC (international headache society classification) Primary Secondary “Organic, identifiable, distinct pathologic process” Others: Migraine Cluster Tension H/A attributed to trauma or injury to the head or neck Cranial or cervical vascular disorder Nonvascular intracranial disorder A substance or its withdrawal Infection Disorder of homeostasis Headache or facial pain attributed to disorder of cranium, neck, Eyes, ears, nose, sinuses, teeth, mouth, or other facial or cranial structures PAINFUL (...) CRANIAL NEUROPATHIES, OTHER FACIAL PAINS, AND OTHER HEADACHES Other benign primary headaches Headache attributed to psychiatric disorder 2) What are the IHSC for migraine without aura (common migraine) and migraine with aura (classic migraine) 80% of migraines are without an aura. Migraine with aura is primarily characterized by the transient focal neurological symptoms that usually precede or sometimes accompany the headache. Some patients also experience a premonitory phase, occurring hours or days

2017 CandiEM

123. CRACKCast E134 – Tickborne Illnesses

for 21 days 25–40 mg/kg/day tid Alternative Cefuroxime axetil 500 mg PO bid for 21 days 250 mg bid or Erythromycin (less effective than doxycycline or amoxicillin) 500 mg PO qid for 14–21 days Neurologic disease ◦ Facial nerve paralysis With an isolated deficit, oral regimens for early disease, used for at least 28 days, may suffice. For a deficit associated with other neurologic manifestations, intravenous therapy is warranted (see below). ◦ Lyme meningitis c Ceftriaxone 2 g IV by single dose for 14 (...) understood, but… just like botulinum toxin: “Neurotoxins produced by I. holocyclus act on presynaptic motor nerve terminals and inhibit the release of acetylcholine The onset of symptoms of tick paralysis occurs only after a female tick has attached and begun feeding. Symptoms do not typically develop until the tick has fed for four to seven days. Toxin causes Slowing of motor nerve conduction velocity Lowering of the height of the nerve and muscle action potential Impaired propagation of afferent nerve

2017 CandiEM

124. SA-237 for neuromyelitis optica and neuromyelitis optica spectrum disorders

is in clinical development for children with neurofibromatosis type 1 (NF1), also called von Recklinghausen’s disease. NF1 is a rare genetic disorder characterized by the development of multiple benign tumours of nerves and skin and areas of abnormal skin colour. NF1 is caused by mutation in a gene that regulates the production of a … November 2018 Edaravone as an intravenous injection is in clinical development for people with amyotrophic lateral sclerosis (ALS). ALS is a neurological condition that affects (...) nerve cells in the brain and spinal cord. It results in gradual weakness and wasting of muscles of the body. Respiratory muscles are involved as the disease progresses, leading to shortness of breath and ultimately death. Little is known about the cause of the disease, and there is currently no cure. August 2018 Inebilizumab is a humanised monoclonal antibody that is in clinical development for reducing the risk of an attack in patients with Neuromyelitis Optica Spectrum Disorders (NMOSD). NMOSD

2017 NIHR Innovation Observatory

125. CRACKCast E108 – Neuromuscular Disorders

with the choice dependent on which is available and preferred in the ICU. Botulism usually arises as a painless descending paralysis, often first affecting the cranial nerves and bulbar muscles, without sensory deficits or significant alteration of consciousness. The treatment is airway management and administration of antitoxin. Injection drug use remains an important cause of wound botulism outbreaks. Botulism must be considered in the evaluation of a weak and floppy infant. In hypokalemic periodic (...) Cholinesterase Inhibitors (pyridostigmine or neostigmine) Corticosteroids (caution in moderate to severe MG, can precipitate crisis) Intravenous immunoglobin (IVIG) Plasma exchange Thymectomy [9] What is the difference between myasthenia gravis and Lambert-Eaton myasthenic syndrome? Lambert-Eaton myasthenic syndrome = rare disorder. Almost 50% of cases are associated w/ small cell cancer of lung Autoantibodies cause inadequate release of ACh from nerve terminals Affects nicotinic (ie. peripheral

2017 CandiEM

126. CrackCAST E129 – Bacteria

support. Even with limited resources, mortality can be reduced to less than 50% with basic medication and experienced medical personnel. [7] List 5 differential diagnoses for Bell’s Palsy Common entities: CVA Trigeminal neuralgia Herpes zoster oticus (Ramsay Hunt syndrome) CNS tumour – acoustic neuroma; cerebellopontine angle lesions (meningioma); facial nerve schwanoma, parotid gland tumour, sarcoma Parotitis Malignant otitis externa Uncommon entities Cephalic tetanus Tick paralysis Botulism CN (...) in the CNS, causing generalized muscle spasm, whereas botulinum toxin targets peripheral neuromuscular junctions and autonomic synapses, causing flaccid paralysis. The toxin binds to the presynaptic nerve membrane, becomes internalized, and inhibits the release of acetylcholine predominantly at the cholinergic synapses of the cranial nerves, autonomic nerves, and neuromuscular junction. Clinically, this is manifested by cranial nerve palsies, parasympathetic blockade, and descending flaccid paralysis

2017 CandiEM

127. CRACKCast E120 – Dermatologic presentations

examination. Eye involvement may produce anterior uveitis, secondary glaucoma, and corneal scarring. There is a close correlation between eye involvement and vesicles located at the tip of the nose (Hutchinson’s sign). Ramsay Hunt syndrome: (Herpes zoster oticus) — The major otologic complication of VZV reactivation is the Ramsay Hunt syndrome, which typically includes the triad of ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle. The facial paralysis seen in Ramsay (...) are a useful alternative to older sedating ones to control pruritus and histamine-mediated rashes while allowing the patient to remain active. Scabies infestations should be diagnosed clinically and treated expeditiously even without definitive proof of the infestation. Medication reactions are common and may results from any medication, typically within 4 to 21 days after taking the medication. Rashes that are associated with mucosal lesions, blisters, or desquamating skin are often caused by significant

2017 CandiEM

128. Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

cause of morbidity and mortality. The management of cardiac disease in NMDs is made challenging by the broad clinical heterogeneity that exists among many NMDs and by limited knowledge about disease-specific cardiovascular pathogenesis and course-modifying interventions. The overlay of compromise in peripheral muscle function and other organ systems, such as the lungs, also makes the simple application of endorsed adult or pediatric heart failure guidelines to the NMD population problematic (...) phenotypes. Common to many NMDs is cardiac involvement. Although the past 3 decades have seen marked advances in our understanding of many NMDs, significant gaps in knowledge remain on how best to approach cardiac care in these patients. For example, survival in Duchenne muscular dystrophy (DMD) has been extended through the use of glucocorticoid use and respiratory support, yet cardiac complications remain a significant cause of morbidity and mortality. To achieve further gains in care, we will need

2017 American Heart Association

129. Management of Diabetes Mellitus in Primary Care

, the treatment methods to achieve the goals. • Reduce the risk of preventable complications while improving quality of life (QoL). II. Background A. Description of Diabetes Mellitus Diabetes mellitus is a disease caused by an absolute or relative insulin deficiency resulting in hyperglycemia. Type 1 DM (T1DM) is due to insulin secretion deficiency not resulting from insulin resistance, while type 2 DM (T2DM) is due to insulin resistance that can eventually also result in insulin secretion deficiency (...) are receiving care from the VA has DM. Veterans 65 years and older comprise 70% of those with diabetes, reflecting the older age distribution of this population.[12] 1 Associated with insulin resistance VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care April 2017 Page 8 of 160 DM can cause microvascular complications such as retinopathy, nephropathy, and neuropathy as well as macrovascular complications, including ischemic heart disease, stroke, and peripheral

2017 VA/DoD Clinical Practice Guidelines

130. Imaging Program Guidelines: Pediatric Imaging

lesions ? osseous assessment of the calvarium, skull base and maxillofacial bones, including detection of calvarial and facial bone fractures Common Diagnostic Indications This section begins with general pediatric indications for CT Head, followed by neurologic signs and symptoms and vascular indications. General Head/Brain Abnormal imaging findings Follow up of abnormal or indeterminate findings on a prior imaging study when required to direct treatment Ataxia, congenital or hereditary Examples (...) – Pediatrics | Copyright © 2017. AIM Specialty Health. All Rights Reserved. 8 Common Diagnostic Indications Developmental delay Evaluation of either of the following conditions: ? Cerebral palsy ? Global developmental delay, defined as significant delay or loss of milestones in at least two of the following domains: ? Activities of daily living ? Cognition ? Motor skills (gross/fine) ? Social/personal ? Speech/language Hearing loss Evaluation for a structural cause of conductive, sensorineural or mixed

2017 AIM Specialty Health

131. Orbits, Vision and Visual Loss

to detect pathology in patients presenting with vision loss. Variant 8: Ophthalmoplegia or diplopia. Initial imaging. Ophthalmoplegia is paralysis of one or more extraocular muscles. This may be caused by impaired motility of the muscles, disrupted nerve conduction along the neuromuscular junction, or from denervation of the affected cranial nerve or brainstem nucleus. Ophthalmoplegia may also be related to granulomatous, inflammatory, neoplastic, and traumatic abnormalities that primarily affect (...) nerve injury initially suspected on CT, or in patients with unexplained visual loss following facial trauma, MR of the orbits without contrast may be helpful in assessing the integrity of the optic nerve. MRI of the brain without contrast may also provide additional findings related to intracranial hemorrhage in the setting of traumatic brain injury and in assessment of traumatic cranial nerve injury. Please refer to the ACR Appropriateness Criteria ® “Head Trauma” [16] for additional

2017 American College of Radiology

132. Cranial Neuropathy

??? FDG-PET/CT whole body 2 ???? US neck 2 O Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level ACR Appropriateness Criteria ® 3 Cranial Neuropathy Variant 3: Weakness or paralysis of facial expression. Hemifacial spasm. Bell palsy. (Facial nerve, CN VII.) Radiologic Procedure Rating Comments RRL* MRI orbit face neck without and with IV contrast 9 This procedure is performed in conjunction with MRI of the head. O MRI head without (...) is vocal cord paralysis. Because lesions anywhere in the long course of the nerve may potentially cause paralysis, the imaging protocol must visualize the full extent of the nerve from the skull base to the mid chest [99]. MRI and CT With its rapid scanning time and availability, CT provides an excellent means of examining the lower course of the nerve [105]. Moreover, thoracic causes of paralysis, such as lung cancer, tuberculosis, and thoracic aortic aneurysm, are common [106]. Although chest

2017 American College of Radiology

133. CRACKCast E022 – Red and Painful Eye

Afferent or efferent nerve dysfunction Ciliaris or iris paralysis Previous eye surgery (iridotomy) Synechiae from prior iritis Physiologic (up to 10% of the population) Medication related (drugs) Serious causes: Uveitis AACG This post was copyedited and uploaded by Michael Bravo ( ). 1. Marx J. Rosen’s Emergency Medicine – Concepts and Clinical Practice . Mosby; 2015. (Visited 2,356 times, 3 visits today) Adam Thomas CRACKCast Co-founder and newly minted FRCPC emergency physician from the University (...) penetration Leaking aqueous fluid is detected by diluted fluorescein. The fluorescein strip MUST BE HELD DIRECTLY OVER THE SUSPECTED AREA OF CORNEAL DISRUPTION Ancillary testing: ESR and CRP – may help in cases where temporal arteritis is suspected ○ **however TA can occur with NORMAL levels of ESR and CRP** CT orbits and facial bones to rule out free air, FB’s, fractures, Ultrasound – good at detecting foreign bodies, but CT is better at delineating the damage caused by intraocular foreign bodies 1

2017 CandiEM

134. CRACKCast E070 – Oral Medicine

syndromes Symptomatic analgesia (Tylenol, NSAIDS) Refer to Dentist Maxillary Sinusitis Masquerades as tooth pain – NSAIDS and Tylenol CT +/- Antibiotics f/u with ENT More on this in future chapters Atypical Odontalgia Make sure you’re not missing an MI, temporal arteritis or other major referred pain cause Refer to Dentist Post extraction pain NSAIDS Look for dry socket aka acute alveolar osteitis If present, nerve block, irrigation, daily packing changes Antibiotic use is controversial (Most dentists (...) CRACKCast E070 – Oral Medicine CRACKCast E070 - Oral Medicine - CanadiEM CRACKCast E070 – Oral Medicine In , by Adam Thomas April 10, 2017 This episode of CRACKCast covers Rosen’s Chapter 70, Oral Medicine. This chapter covers common tooth and mouth complaints that present to the ED and provides treatment and management tips to help with your next patient. Shownotes – Rosen’s in Perspective The oral cavity and associated facial structures, AKA stomatognathic system, is made up of the: Mandible

2017 CandiEM

135. Clinical Practice Guideline for the Management of Communication and Swallowing Disorders following Paediatric Traumatic Brain Injury

of TBI • Cranial nerve involvement/palsy (speech and swallowing only) • Presence of seizures or other co-morbid medical conditions (e.g., loss of hearing or smell) • Extent of broader motor system involvement • Additional physical/facial injuries (speech and swallowing only) • Trajectory of recovery post-injury (i.e., rapid vs. slow recovery in early phases) • Cognition (including visual and auditory system integrity, memory, attention, initiation, level of insight) • Compliance to recommendations (...) , symbols, communication books) Bulbar Cranial nerves that arise from the brain Cognitive therapy Defined here as therapy that targets the underlying cognitive processes that support language (e.g., memory, information processing) Confrontation naming Naming an object or action when provided with a stimulus (e.g., picture of the object/action) Communication Ability to receive and send verbal and non- verbal messages, encompassing all aspects of speech and language Community rehabilitation Rehabilitation

2017 Clinical Practice Guidelines Portal

136. CRACKCast E072 – Otolaryngology

osteomyelitis . Think OE with Cranial Nerve/intracranial involvement or an ill appearing patient! Need to image (CT/MRI) Oral or IV cipro is the way to go: great penetration into bone. Treatment duration for 6-8weeks. Little evidence for hyperbaric treatment, but sometimes recommended as adjuvant. [5] What is Ramsay Hunt Syndrome? How is it treated? Triad: Ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle This is Herpes zoster oticus . Think viral infection (...) of the auricle. Classic reactivation of VZV in 8th cranial nerve, can lead to hearing and vestibular problems. Can involve the facial nerve (CN 7) leading to facial paralysis. Thought to be worse than Bell’s palsy from HSV. Look for pain, swelling and vesicles. Note: vesicles can form 7-10 days after primary infection. Ramsay-Hunt Syndrome Image: Labelled for reuse from Wikipedia Treatment: analgesia and antivirals (little evidence to support): Acyclovir 800 mg five times a day Valacyclovir 1000 mg three

2017 CandiEM

137. Safety and effectiveness of the herpes zoster vaccine to prevent postherpetic neuralgia: 2014 update and consensus statement from the Canadian Pain Society

is approximately $68 million. However, with an aging population, the incidence of HZ and the related costs are expected to increase. Shingles typically begins as a painful skin rash, usually on one side of the body. Pain may also be present without a rash. Repeat episodes are rare. Complications can include nerve damage, facial paralysis, serious eye infections and other secondary infections. However, the most common and serious complication of HZ is PHN, defined as pain lasting >3 months after the onset (...) management and research (listed below). The aim was to review the National Advisory Committee on Immunization guidelines and to prepare a CPS position statement concerning the use of the zoster vaccine in Canada. POSITION 1 The Canadian Pain Society strongly encourages health care practitioners to discuss herpes zoster vaccination with immunocompetent patients ≥60 years of age Rationale: Before 1996, when a vaccine was introduced, almost all Canadian children (>90%) developed chickenpox, caused

2015 CPG Infobase

139. Gardasil 9 - human papillomavirus 9-valent vaccine (recombinant, adsorbed)

and cancers affecting the cervix, vulva, vagina and anus caused by vaccine HPV types ? Genital warts (Condyloma acuminata) caused by specific HPV types. Pharmaceutical form(s): Suspension for injection Per 0.5 ml dose: Human Papillomavirus Type 6 L1 EMA/CHMP/76591/2015 Page 3/128 Strength(s): protein 30 micrograms Human Papillomavirus Type 11 L1 protein 40 micrograms Human Papillomavirus Type 16 L1 protein 60 micrograms Human Papillomavirus Type 18 L1 protein 40 micrograms Human Papillomavirus Type 31 L1 (...) caused by HPV types (6, 11, 16, 18, 31, 33, 45, 52, 58). The legal basis for this application refers to: Article 8.3 of Directive 2001/83/EC - complete and independent application. The applicant indicated that Human Papillomavirus Type 31 L1 protein, Human Papillomavirus Type 33 L1 protein, Human Papillomavirus Type 45 L1 protein, Human Papillomavirus Type 52 L1 protein and Human Papillomavirus Type 58 L1 protein were considered to be new active substances. The application submitted is composed

2015 European Medicines Agency - EPARs

140. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death Full Text available with Trip Pro

year. 24 3.1.1 Causes of sudden cardiac death in different age groups Cardiac diseases associated with SCD differ in young vs. older individuals. In the young there is a predominance of channelopathies and cardiomyopathies ( Web Table 2 ), 21,25–48 myocarditis and substance abuse, 49 while in older populations, chronic degenerative diseases predominate (CAD, valvular heart diseases and HF). Several challenges undermine identification of the cause of SCD in both age groups: older victims (...) , for instance, may suffer from multiple chronic cardiovascular conditions so that it becomes difficult to determine which contributed most to SCD. In younger persons, the cause of SCD may be elusive even after autopsy, because conditions such as inherited channelopathies or drug-induced arrhythmias that are devoid of structural abnormalities are epidemiologically relevant in this age group. Table 2 Levels of evidence Table 2 Levels of evidence 3.2 Autopsy and molecular autopsy in sudden death victims

2015 European Society of Cardiology

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