Cranial nerves
Ian Mann, Alastair Noyce in The Finalist’s Guide to Passing the OSCE, 2021
An accomplished examination necessitates a basic understanding of the neurological anatomy and a good deal of practice. Examining the cranial nerves is a simple but strangely daunting task for students. It is not exhaustive and represents the bare minimum knowledge that one should be equipped with for a cranial nerves examination. A handful of candidates will test cranial nerves according to the anatomy and modify their examination as they build a picture of the diagnosis. When examining the cranial nerves, the patient can be lying semi-recumbent on the couch or sat on the edge. Drooping of the corner of the mouth, loss of the nasolabial fold and absence of forehead wrinkling may indicate facial nerve damage. In sensorineural deafness, air conduction often exceeds bone conduction, and so is Rinne positive, but may give false negatives.
Cranial nerves
E Glucksman in MCQs in Neurology and Neurosurgery for Medical Students, 2022
This chapter explores that the themed presentation encourages quick, focused study and detailed answers aid comprehension and encourages familiarity with cranial nerves with essential diagrams, colour images and sample MRIs. Pituitary adenomas compress the optic chiasm from below and so even though the deficit is a bitemporal hemianopia, the superior temporal quadrants are actually slightly worse than the inferior temporal quadrants. Craniopharyngiomas often compress the chiasm from above and hence the opposite is true, the deficit is slightly greater in the inferior temporal quadrants. Bell’s palsy is ipsilateral paralysis of the upper and lower face, with inability to close the eye on the involved side. It is the complete destruction of the facial nucleus or its efferent fibres.
Fifi
Walter J. Hendelman, Peter Humphreys, Christopher R. Skinner in The Integrated Nervous System, 2017
The essential elements of Fifi's medical history and neurological examination includes: a respiratory illness two weeks prior to the onset of symptoms, the development of severe muscle weakness and mild sensory symptoms over a period of two days. On examination, the presence of diffuse, symmetrical muscle weakness involving the face, swallowing musculature and all four limbs, the legs more than the arms. Having briefly surveyed the system presumably involved in the pathogenesis of Fifi's muscle weakness, we must now return to the clinical information provided and attempt to localize the lesion. Clearly, this is a very different disease process from the one we encountered in dying-back neuropathy and accounts for the significantly different clinical picture. Clinically, these two disorders are quite different, although there is some overlap in presentation. With AIDP, there are mixed motor and sensory deficits; cranial nerve involvement is common as is autonomic dysfunction.
Familial amyloid polyneuropathy (Finnish type) presenting multiple cranial nerve deficits with carpal tunnel syndrome and orthostatic hypotension
Published in Neurological Research, 2010
Kouki Makioka, Masaki Ikeda, Yoshio Ikeda, Ai Nakasone, Tenshi Osawa, Atsushi Sasaki, Tomohiro Otani, Masashi Arai, Koichi Okamoto
Familial amyloid polyneuropathy, Finnish type (FAF), is a dominantly inherited disorder caused by mutations in the gelsolin gene and rarely reported in several countries. We report a Japanese FAF patient with a missense mutation (G654A), presenting multiple cranial nerve symptoms, corneal lattice dystrophy, carpal tunnel syndrome and orthostatic hypotension. It is notable that this patient showed very wide range of cranial nerve involvement (III, IV, VI, VII, VIII, IX, X and XII), which have gradually deteriorated for 6 years. The patient also has carpal tunnel syndrome, which is not commonly found in FAF cases. Even if not for certain familial inheritance, it is preferable to take consideration of FAF as one of differential diagnoses of a case presenting multiple cranial nerves symptoms.
Multiple cranial nerve palsies in immunodeficiency subtype of Burkitt lymphoma
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Burkitt lymphoma is a late complication of HIV, and bilateral cranial nerve palsies are extremely rare in patients with AIDS. A twenty year old Caucasian male with known congenital HIV who had been non-adherent with anti-retroviral therapy presented with multiple cranial nerve palsies and was eventually diagnosed with Burkitt lymphoma. Before chemotherapy, he was started on radiation therapy to the brain, meninges, and base of skull with the intent of improving cranial nerve palsies and preventing further neurological sequelae since the cranial nerve palsies were dense and there was concern that intrathecal chemotherapy would have less penetration than radiation. He eventually died due to overall disease burden. We hereby present what we believe is the first reported case of Burkitt lymphoma presenting with bilateral facial, vestibulocochlear, left abducens, and mandibular nerve palsies. Recognition of different presentations of Burkitt lymphoma is extremely important as it would aid in early diagnosis and initiation of both chemotherapy and anti-retroviral therapy potentially leading to improved outcomes.
Unique Presentation of 3rd and 6th Cranial Nerve Palsies, Nodular Scleritis and Nummular Keratouveitis in an Immunocompetent Patient following an Attack of Herpes Zoster Ophthalmicus
Published in Ocular Immunology and Inflammation, 2012
Kalpana Babu, Raghuvir Kini, Krishna R. Murthy
Aim: To report a unique presentation of 3rd and 6th cranial nerve palsies with nodular scleritis and nummular keratouveitis following an attack of herpes zoster ophthalmicus (HZO). Methods: Case report. Case Report and Results: A 56-year-old woman with a 1-month history of HZO presented with drooping of the right upper eyelid, diplopia, and pain around the right eye. She was noted to have right 3rd and 6th cranial nerve palsies. She developed nodular scleritis and nummular keratouveitis at 2 and 4 months follow-up, respectively, which were treated with antivirals and steroids. At 10 months follow-up, although the diplopia in right lateral gaze persisted, there was no recurrence of ocular inflammation with complete recovery of ptosis. Conclusions: A unique presentation of multiple cranial nerve palsies with nodular scleritis and nummular keratouveitis in an immunocompetent patient following an attack of HZO is highlighted in this report.
Related Knowledge Centers
- External Ear
- Olfactory Bulb
- Pons
- Retina
- Taste
- Optic Chiasm
- Chemoreceptor Cells