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Facial Nerve Paralysis Causes

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121. Skull fractures

fragments. See also the corresponding sagittal CT image From the teaching collection of Demetrios Demetriades; used with permission [Citation ends]. History and exam presence of risk factors open fracture palpable discrepancy in bone contour Battle's sign periorbital ecchymosis bloody otorrhoea CSF rhinorrhoea facial paralysis, nystagmus, or paraesthesia evidence of trauma cranial pain or headache nausea altered mental state/loss of consciousness abnormal pupillary reflexes hearing loss male sex fall (...) Skull fractures Skull fractures - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Skull fractures Last reviewed: February 2019 Last updated: December 2017 Summary Most common causes include a fall, a traffic accident, or an assault. Skull fractures may be linear or comminuted with multiple fracture lines, may be located on the cranial vault or in the basilar skull, may have a varying degree of depression or elevation

2017 BMJ Best Practice

122. Guidelines for the Management of Genital Herpes in New Zealand

2017 Only available online at www.herpes.org.nz 2. Sexually Transmitted Infections – Summary of Guidelines 2017 Patient information pamphlets 1. The Facts: A guide for people with Herpes Simplex Includes – Genital Herpes – The Facts Herpes and Relationships Herpes and Pregnancy Facial Herpes 2. Herpes: Myth vs Facts Helpline Website Resources New Zealand Sexual Health Society (NZSHS) resources Comprehensive STI Management Guidelines and Patient Information handouts are available on www.nzshs.org (...) and reduce asymptomatic shedding. Suggest prescribing for 12 months, followed by a break of 3 months to see if recurrences are still frequent and/or bothersome. • Oral valaciclovir 500mg daily (increase to 500mg BD on individual basis of clinical presentation and/or having breakthrough recurrences on 500mg daily). • Alternative: oral aciclovir 400mg twice daily. GENITAL HERPES – COMMON MISCONCEPTIONS • MYTH: Most, if not all, genital herpes infections are due to HSV-2. FACT: Genital herpes is caused

2017 New Zealand Sexual Health Society

123. Appropriate Use Criteria: Imaging of the Head & Neck

bones, including detection of calvarial and facial bone fractures Common Diagnostic Indications This section begins with general 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 Acoustic neuroma Management of known acoustic neuroma when at least one of the following applies: ? Symptoms suggestive (...) of recurrence or progression ? Following conservative treatment or incomplete resection at 6, 18, 30, and 42 months ? Post resection, baseline imaging and follow up at 12 months after surgery Congenital or developmental anomaly Diagnosis or management (including perioperative evaluation) of a suspected or known congenital anomaly or developmental condition Examples include Chiari malformation, craniosynostosis, macrocephaly, and microcephaly. Dementia** ? Initial evaluation to exclude a secondary cause

2018 AIM Specialty Health

124. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

of Anesthesiology Critical Care and Pain Management, General University Hospital, Valencia, Spain; **Spine and Nerve Center of The Virginias, Charleston, WV; ††Carolinas Pain Institute, Winston-Salem, NC; and ‡‡Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA. Accepted for publication September 1, 2017. Address correspondence to: Samer Narouze, MD, PhD, Center for Pain Medicine, Western Reserve Hospital, 1900 23rd St, Cuyahoga Falls, OH 44223 (e-mail: ). Brian D. Sites, MD (...) broader than that for regional anesthesia, with diverse targets and objectives. Pain procedures vary from minimally invasive procedures with high-risk targets (eg, percutaneous SCS lead placement, vertebral augmentation, deep visceral blocks, and spine interventions) to low-risk peripheral nerve blocks ( ). The ASRA regional anesthesia and acute pain guidelines may be appropriate for the low- or intermediate-risk category, but the high-risk targets require a more intensive look at the issues specific

2018 American Society of Regional Anesthesia and Pain Medicine

125. CRACKCast E175 – Neurologic Disorders

incontinence. Management: Based on the underlying process – surgery vs antibiotics vs steroids. [2] Guillain- Barré Syndrome Definition: An acute, demyelinating polyneuropathy that typically presents as transient, symmetric, ascending paralysis in the setting of a recent infection. It is thought to be autoimmune-mediated and classically causes demyelination of motor and sensory nerves. Children of all ages may be affected; however, it is uncommon in young toddlers and infants. Often, there is a history (...) of vertigo in children? REMEMBER: Vertigo = illusion of movement . Disease processes that effect the balance of the vestibular, visual, and proprioceptive systems can cause vertigo by impairing the neural activity of the vestibular nucleus. Diseases of the ear, eighth cranial nerve, neck, brainstem, or eye can lead to vertiginous symptoms. Vertigo is characterized as central or peripheral, depending on whether the cause is in the CNS. NOTE: Key things to ask about on history: Ear symptoms

2018 CandiEM

126. Imaging Guidelines

treatment 9delay and definitively identifying presence or absence of ongoing bleeding that warrants intervention. Part 3: Sedation Key Points z Agitated adult trauma patients may require intubation with sedation and chemical paralysis to expedite radiographic work- up and ensure adequate quality. Short acting drugs are preferred along with careful monitoring of cardiac and respiratory status. z Consider physiologic parameters (heart rate, blood pressure, and other existing injuries) and the child’s age (...) , size, and cognitive level to provide safe sedation administration. z Patient age and cognitive developmental stage can significantly affect the amount and type of sedation administered. z A dedicated provider and resuscitation equipment must be with the sedated patient at all times. Sedation for Adult Patient Imaging Adult trauma patients may require light to moderate sedation to obtain adequate CT and MRI images. Agitated patients may require intubation with sedation and chemical paralysis

2018 American College of Surgeons

127. Shingles

onset: 40% 3 months after rash onset: 13% 1 year after rash onset: 7% Risk factors for developing PHN: Older age More severe pain during prodrome and onset of rash Larger rash surface area Skin changes, such as secondary bacterial infection, scarring or pigmentation changes Ophthalmic complications (herpes zoster ophthalmicus) such as periorbital rash, conjunctivitis, keratitis or uveitis, which can lead to vision loss and debilitating pain. May occur in 25% of herpes zoster cases Facial paralysis (...) Shingles Shingles - medSask Home - College of Pharmacy and Nutrition - University of Saskatchewan Toggle Menu Search the U of S Search Shingles Neuralgic pain and blistering skin eruptions that occur due to reactivation of the chicken pox virus - varicella zoster virus (VZV). Incidence of herpes zoster (shingles) increases with decline in T-cell-mediated immunity, which may occur with age or immunosuppression. Rash typically resolves in 2 to 4 weeks, but nerve pain may continue for months

2018 medSask

128. 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

129. 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

130. 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

131. Corticosteroids improve recovery rates after Bell’s palsy

are supported by NIHR infrastructure funding. Bibliography Clinical Knowledge Summaries. . London: National Institute for Health and Care Excellence; 2012. NHS Choices. . London. Department of Health; 2014. Corticosteroids for Bell's palsy (idiopathic facial paralysis) Published on 19 July 2016 Madhok, V. B.,Gagyor, I.,Daly, F.,Somasundara, D.,Sullivan, M.,Gammie, F.,Sullivan, F. Cochrane Database Syst Rev Volume 7 , 2016 BACKGROUND: Inflammation and oedema of the facial nerve are implicated in causing (...) different corticosteroids against each other, rather than placebo, to find the best options in terms of timing, drug and dose. Share your views on the research. Why was this study needed? Bell’s palsy affects about 12,000 people in the UK each year. It is most common in people aged 15 to 60 years. Bell’s palsy is caused by inflammation or compression of the facial nerve, which controls the facial muscles. The cause is unknown, but it has been associated with viral infections such as the herpes virus

2019 NIHR Dissemination Centre

132. 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

133. 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

134. 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

135. 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

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. 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

138. 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

139. 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

140. 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

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