Cranial Nerve Injury

NOTES
NOTES
CRANIAL NERVE INJURY
GENERALLY, WHAT IS IT?

PATHOLOGY & CAUSES DIAGNOSIS
▪ Brain/cranial nerves injury → neurological DIAGNOSTIC IMAGING
dysfunction
CT scan/MRI
▪ Specific, focused neurological functioning
CAUSES tests
▪ Trauma (accidental, inflicted), autoimmune,
infectious, idiopathic
SIGNS & SYMPTOMS TREATMENT

▪ Varies widely ▪ Symptomatic complications, treat
▫ Area-dependent underlying causes
BELL'S PALSY
osms.it/bells-palsy
RISK FACTORS
PATHOLOGY & CAUSES ▪ Age (peak incidence > 50), diabetes
mellitus, pregnancy (third trimester), early
▪ Lower motor neuron weakness of cranial postpartum
nerve VII (facial nerve) → acute, peripheral
facial palsy
▪ Adversely affects facial motor activity; COMPLICATIONS
lacrimal, salivary glands (parasympathetic ▪ Corneal exposure → keratitis, motor
fibers); taste (afferent fibers on anterior regeneration → oral incompetence,
two-thirds of tongue); external auditory reinnervation “miswiring” → synkinesis
canal, pinna (somatic afferents) (involuntary muscle movement)
▪ Etiology unknown ▪ Incomplete sensory regeneration
▫ Potentially viral-associated ischemia, ▫ Dysesthesia (unpleasant/abnormal
demyelination (e.g. herpes zoster, touch), dysgeusia (distorted taste),
herpes simplex (HSV), Epstein–Barr ageusia (decreased taste)
virus, Lyme disease)
552 OSMOSIS.ORG
Chapter 71 Cranial Nerve Injury
SIGNS & SYMPTOMS DIAGNOSIS

▪ Unilateral facial weakness evolves rapidly LAB RESULTS
over 48 hours ▪ Serologic testing if viral infection suspected
▫ Eyebrow sags, eye won’t close, mouth
corner droops (drooling, difficulty eating/
OTHER DIAGNOSTICS
drinking), decreased tear production →
ocular dryness, hyperacusis (↓ everyday ▪ House–Brackmann facial nerve dysfunction
sound tolerance), ageusia (decreased classification
taste sensation) ▫ Grades facial muscle impairment degree
▪ Prodromal symptoms (pre-onset) ▫ Normal, mild, moderate, moderately-
▫ Ear pain, dysacusis (sound distortion) severe, severe, total paralysis
▪ See mnemonic: BELL’S Palsy ▪ Palpebral-oculogyric reflex (Bell
phenomenon)
▫ Attempted eyelid closure → upward eye
MNEMONIC: BELL'S Palsy deviation
Symptoms of Bell’s palsy ▪ Stethoscope loudness test
Blink reflex abnormal ▫ Individual listens to tuning fork through
Ear sensitivity stethoscope
Lacrimation: deficient, excess ▫ Hyperacusis indicates paralyzed
stapedius muscle on affected side
Loss of taste
▪ ↓ pinprick sensation in posterior auricular
Sudden onset
area
Palsy: CN VII nerve muscles
▪ ↓ taste
(All symptoms are unilateral)
▫ Sweetness, saltiness, acidity
▪ Motor nerve conduction studies (NCS)
▫ Estimates axonal loss degree
TREATMENT
MEDICATIONS
▪ Corticosteroids
▫ Symptom onset → begin within 3–4
days
OTHER INTERVENTIONS
▪ Artificial tears, eye patching
▫ Reduce corneal damage risk
▪ Physical therapy (e.g. facial exercise,
neuromuscular retraining)
▪ May resolve spontaneously within three
weeks
Figure 71.1 An individual with Bell’s palsy

affecting the right side of the face.
OSMOSIS.ORG 553
TRIGEMINAL NEURALGIA
osms.it/trigeminal-neuralgia
PATHOLOGY & CAUSES DIAGNOSIS

▪ AKA tic douloureux; stimulating facial DIAGNOSTIC IMAGING
trigger zone → intense, stabbing,
paroxysmal pain in trigeminal nerve (cranial CT scan/MRI
nerve V—usually V2/V3 subdivisions) ▪ May identify lesion/vascular compression
▫ Triggers: touching/moving tongue, lips, ▪ Electromyographyrigeminal reflex testing
face; chewing; shaving; brushing teeth; ▫ Measures muscles’, controlling nerves’
blowing nose; hot/cold drinks electrical activity
TYPES OTHER DIAGNOSTICS

▪ Classic ▪ Classic trigeminal neuralgia
▫ Most common; unknown etiology, ▫ No clinically evident neurologic deficit,
artery/vein compressing cranial nerve no better explanation via another
(CN) V root may → pain diagnosis, ≥ three attacks of unilateral
▪ Secondary facial pain fulfilling criteria A and B
▫ Nonvascular lesion compressing nerve ▫ A: Occurs in ≥ one trigeminal nerve
→ pain divisions, no radiation beyond trigeminal
distribution
▫ B: Pain has three or more of the
RISK FACTORS
following four characteristics: recurring
▪ Biological sex (female > male) paroxysmal attacks (< two minutes);
▪ Age (peak incidence 50–60) severe intensity; shock-like, shooting,
▪ Demyelinating disorders (e.g. multiple stabbing, sharp pain; stimulating
sclerosis) affected facial side → > two attacks
▪ Postherpetic trigeminal neuropathy (other attacked may be spontaneous)
▪ Acoustic neuroma
▪ Saccular aneurysm
TREATMENT
▪ Vestibular schwannoma
MEDICATIONS
SIGNS & SYMPTOMS ▪ Pain management
▪ Pain paroxysms SURGERY

▫ Last one–several seconds; may repeat; ▪ Microvascular decompression
usually unilateral ▪ Neuroablation
▪ Dull pain between paroxysms ▫ Rhizotomy with radiofrequency
▪ Facial muscle spasms/autonomic symptoms thermocoagulation/mechanical balloon
(e.g. lacrimation, diffuse conjunctival compression/chemical (glycerol) injection
injection, rhinorrhea) ▫ Radiosurgery
▫ Peripheral neurectomy, nerve block
554 OSMOSIS.ORG

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NOTES

GENERALLY, WHAT IS IT?

SIGNS & SYMPTOMS TREATMENT

SIGNS & SYMPTOMS DIAGNOSIS

Figure 71.1 An individual with Bell’s palsy

PATHOLOGY & CAUSES DIAGNOSIS

TYPES OTHER DIAGNOSTICS

▪ Pain paroxysms SURGERY

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