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    Cranial Nerves BPT LEC

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    Akshara

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    Cranial Nerves BPT LEC

    Uploaded by

    Akshara
    12 views51 pages

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    © © All Rights Reserved

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    PPTX, PDF, TXT or read online from Scribd

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    Copyright:

    © All Rights Reserved
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    Download as pptx, pdf, or txt
    12 views51 pages

    Cranial Nerves BPT LEC

    Uploaded by

    Akshara

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 51

    CRANIAL NERVES

    THE OLFACTORY NERVE


    CRANIAL NERVE -2
    THE OPTIC NERVE
    • The peripheral receptors, retinal rods and
    cones
    • They send impulses to the inner nuclear or
    bipolar layer; cells there send axons to the
    ganglion cell layer
    • Axons of the ganglion cells make up the optic
    nerve
    OPTIC NERVE
    LESIONS
    MOTOR SUPPLY

    •MUSCLES OF MASTICATION :
    MASSETER,TEMPORALIS,PTERYGOID,
    •TENSOR TYMPANI
    •TENSOR VELI PALETINI
    •UPPER BELLY OF DIGASTRIC
    FACIAL PALSY
    Bell’s palsy
    • The most common form of facial paralysis
    Aetiology:

    • *The cause is still unclear, and its development isn't


    well understood.
    • *viral infection (most commonly by the herpes
    simplex virus), can cause the facial nerve to
    become swollen and injured.
    • Impairment of electrical impulses directed to your

    facial muscles by the damaged nerve results in the


    weakness or paralysis of these muscles
    Predisposing factors found in a minority
    of cases , include :

    • • Pregnancy
    • • Hypertension
    • • Diabetes
    • • Lymphoma
    • Also :
    • *Vascular ischemia
    • *Autoimmune inflammatory disorders
    • *Heredity
    Clinical Features:

    • Signs and symptoms of Bell's palsy may


    include:
    • *Sudden onset of paralysis or weakness
    on
    one side of your face, making it difficult to
    smile or close your eye on the affected
    side
    • *Facial droop and difficulty with facial
    expressions moves (Inability to smile,
    frown, or whistle)
    Clinical features :
    • Food collects between teeth and lips,and saliwa may
    dribble from
    the corner of the mouth.
    • *Facial stiffness or a feeling that your face is being pulled
    to one side
    • *Pain behind or in front of your ear on the affected side
    • *Sounds that seem louder on the affected side
    • *Headache
    • *Loss of taste on the front portion of the tongue
    • *Change in the amount of tears and salivary product
    • Bell's phenomenon—upward diversion of the eye
    on attempted closure of the lid—is seen when
    eye closure is incomplete.

    • Vesicles in the conchal bowl, soft palate, or


    tongue suggest Ramsay Hunt syndrome
    • The examination should exclude masses in the
    head and neck.
    • A deep lobe parotid tumour may only be
    identified clinically by careful examination of the
    oropharynx and ipsilateral tonsil to rule out
    asymmetry.
    Investigations
    MRI may reveal swelling and uniform enhancement of the
    geniculate ganglion and and facial nerve or in some cases
    entrapement of the swollen nerve in temporal bone.MRI has
    revolutionised the detection of tumours.

    • Salivary PCR for herpes simplex virus type 1 or herpes zoster


    virus is more likely to confirm virus during the replicating
    phase, but these tests remain research tools.
    • In some cases there is mild CSF lymphocytosis.
    Other investigations
    • ESR
    • Testing for diabetes
    • Lyme titre
    • ACE
    • Chest X-ray for possible sarcoidosis
    • L.P. for possible GBS
    • CBC
    Management
    • The main aims of treatment in the acute phase of Bell's palsy
    are to speed recovery and to prevent corneal complications.
    • Treatment should begin immediately to inhibit viral
    replication and the effect on subsequent pathophysiological
    processes that affect the facial nerve.
    • Psychological support is also essential, and for this reason
    patients may require regular follow up.
    • It focuses on protecting the cornea from drying and abrasion
    due to problems with lid closure and the tearing mechanism.

    • The most widely accepted treatment for Bell palsy is


    corticosteroid therapy.
    • Steroid. Usual regimen is 1mg/kg/day for 1 week.
    To be tapered in the 2nd week. significant improvement in
    outcomes when started within 72 hours of symptom onset.
    Management, Antivirals
    • It seems logical in Bell's palsy because of the probable
    involvement of herpes viruses.
    • Aciclovir, a nucleotide analogue, interferes with herpes virus
    DNA polymerase and inhibits DNA replication.
    • Dose: 400mg five times daily for 10days
    OR
    Valcyclovir 1000mg daily for 5-7 days.
    Management
    • Local Treatment
    * topical ocular lubrication
    • Facial Nerve Decompression
    Patients with a poor prognosis, identified by facial
    nerve testing or persistent paralysis, appear to benefit the
    most from surgical intervention.
    Bell palsy that has not responded to medical
    therapy and with greater than 90% axonal degeneration, as
    shown on facial nerve EMG within 3 weeks of the onset of
    paralysis
    Prognosis
    • Approximately 80-90% of patients with Bell
    palsy recover without noticeable disfigurement
    within 6 weeks to 3 months.
    • The risk factors thought to be associated with a
    poor outcome in patients with Bell palsy include
    (1) age greater than 60 years,
    (2) complete paralysis, and
    (3) decreased taste or salivary
    flow on the side
    of paralysis
    CN8:Vestibulocochlear Nerve

    SENSORY

    FOR HEARING (Cochlear) AND


    BALANCE (Vestibular)

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