PAEA Neurology 2
What is Bell Palsy? - ✔️✔️Unilateral facial muscle weakness without evidence of other
neurologic disease and without apparent cause. More than 60% of cases occur on the
right side.
Thought to be caused by herpes simplex virus activation. End result is damage to the
myelin layer facial nerve
More frequently seen in pregnant women and diabetics
There can be a paralysis of all muscles supplied by cranial nerve 7 (complete palsy) or
variable weakness to different muscles (incomplete palsy)
What is cerebral palsy? - ✔️✔️Chronic impairment of muscle tone, strength,
coordination, or movements. It is believed to result from cerebral injury before birth,
during delivery or in the perinatal period
PE of cerebral palsy - ✔️✔️hyperreflexia, hypotonia, microcephaly, limb length
discrepancies, cataracts, retinopathy, and congenital heart defects
Treatment for cerebral palsy - ✔️✔️Supportive
Restless leg syndrome - ✔️✔️subjective need to move the legs and abnormal
sensations, including tingling, creeping or crawling sensation, itching, heaviness,
burning, coldness or tension. Sxs occur most commonly during periods of prolonged
inactivity or rest.
Sleep disturbance is most common
Women more affected
May occur secondary to peripheral neuropathy, uremia, pregnancy or iron deficiency
Although most cases of RLS are primary, what are some secondary causes? -
✔️✔️peripheral neuropathy, uremia, pregnancy, or Fe deficiency
Treatment for RLS - ✔️✔️Dopamine agonists (pramipexole, ropinirole)*DOC
Benzos - (clonazepam)
Opiate agonists are last choice
A trial of iron therapy is now recommended in all pts w RLS
, Clinical features of cerebral palsy - ✔️✔️spasticity, lack of coordination, fine motor
difficulties, ataxia, lethargy, hypotonia, or dystonia.
Seizures, mental retardation, speech disorders, hearing, vision, and sensory often
accompany
Clinical features of Bell palsy - ✔️✔️facial muscle weakness typically begins abruptly
but may progress over a matter of hours to 2 days. Paralysis involves the forehead and
lower face; patients cannot close the eye, raise the brow or smile on the affected side.
Pain about the ipsilateral ear often precedes the facial weakness or is noted
concurrently
Depending on the site of the nerve lesion, pts may demonstrate impairment of taste,
lacrimation, or hyperacusis
Recovery occurs within 6 months
Diagnostic studies for Bell Palsy - ✔️✔️clinically diagnosed
EMG - only for pts w atypical or prolonged Bell Palsy
Tx for Bell Palsy - ✔️✔️60% of cases resolve spontaneously and require no tx.
Supportive - lubricating eye drops for corneal drying
Course of oral prednisone, if begun soon after the onset of sxs, has been shown to
increase the percentage of pts who completely recover
Surgery - severe or recalcitrant cases
Diabetic peripheral neuropathy - ✔️✔️MC type of neuropathy
Neuropathy generally is related to the duration and severity of hyperglycemia, but it may
be the presenting sxs in occult diabetes. Neuropathy is teh result of vascular
insufficiency or nerve infarction
Clinical features of diabetic peripheral neuropathy - ✔️✔️sxs MC in the lower
extremities than in the upper extremities and consist of numbness, pain, dyesthesias
(burning), or paresthesias
reduced DTR or impaired vibratory sensation
Tx for diabetic peripheral neuropathy - ✔️✔️Tight control of hyperglycemia
Amitriptyline, nortriptyline, desipramine, gabapentin or pregabalin - controls deep,
constant, aching pain
Duloxetine - serotonin and norepi reuptake inhibtor
Postural hypotension may respond to salt suppplementation, lower extremity pressure
stockings, or medications such as fludrocortisone or midodrine
What is Bell Palsy? - ✔️✔️Unilateral facial muscle weakness without evidence of other
neurologic disease and without apparent cause. More than 60% of cases occur on the
right side.
Thought to be caused by herpes simplex virus activation. End result is damage to the
myelin layer facial nerve
More frequently seen in pregnant women and diabetics
There can be a paralysis of all muscles supplied by cranial nerve 7 (complete palsy) or
variable weakness to different muscles (incomplete palsy)
What is cerebral palsy? - ✔️✔️Chronic impairment of muscle tone, strength,
coordination, or movements. It is believed to result from cerebral injury before birth,
during delivery or in the perinatal period
PE of cerebral palsy - ✔️✔️hyperreflexia, hypotonia, microcephaly, limb length
discrepancies, cataracts, retinopathy, and congenital heart defects
Treatment for cerebral palsy - ✔️✔️Supportive
Restless leg syndrome - ✔️✔️subjective need to move the legs and abnormal
sensations, including tingling, creeping or crawling sensation, itching, heaviness,
burning, coldness or tension. Sxs occur most commonly during periods of prolonged
inactivity or rest.
Sleep disturbance is most common
Women more affected
May occur secondary to peripheral neuropathy, uremia, pregnancy or iron deficiency
Although most cases of RLS are primary, what are some secondary causes? -
✔️✔️peripheral neuropathy, uremia, pregnancy, or Fe deficiency
Treatment for RLS - ✔️✔️Dopamine agonists (pramipexole, ropinirole)*DOC
Benzos - (clonazepam)
Opiate agonists are last choice
A trial of iron therapy is now recommended in all pts w RLS
, Clinical features of cerebral palsy - ✔️✔️spasticity, lack of coordination, fine motor
difficulties, ataxia, lethargy, hypotonia, or dystonia.
Seizures, mental retardation, speech disorders, hearing, vision, and sensory often
accompany
Clinical features of Bell palsy - ✔️✔️facial muscle weakness typically begins abruptly
but may progress over a matter of hours to 2 days. Paralysis involves the forehead and
lower face; patients cannot close the eye, raise the brow or smile on the affected side.
Pain about the ipsilateral ear often precedes the facial weakness or is noted
concurrently
Depending on the site of the nerve lesion, pts may demonstrate impairment of taste,
lacrimation, or hyperacusis
Recovery occurs within 6 months
Diagnostic studies for Bell Palsy - ✔️✔️clinically diagnosed
EMG - only for pts w atypical or prolonged Bell Palsy
Tx for Bell Palsy - ✔️✔️60% of cases resolve spontaneously and require no tx.
Supportive - lubricating eye drops for corneal drying
Course of oral prednisone, if begun soon after the onset of sxs, has been shown to
increase the percentage of pts who completely recover
Surgery - severe or recalcitrant cases
Diabetic peripheral neuropathy - ✔️✔️MC type of neuropathy
Neuropathy generally is related to the duration and severity of hyperglycemia, but it may
be the presenting sxs in occult diabetes. Neuropathy is teh result of vascular
insufficiency or nerve infarction
Clinical features of diabetic peripheral neuropathy - ✔️✔️sxs MC in the lower
extremities than in the upper extremities and consist of numbness, pain, dyesthesias
(burning), or paresthesias
reduced DTR or impaired vibratory sensation
Tx for diabetic peripheral neuropathy - ✔️✔️Tight control of hyperglycemia
Amitriptyline, nortriptyline, desipramine, gabapentin or pregabalin - controls deep,
constant, aching pain
Duloxetine - serotonin and norepi reuptake inhibtor
Postural hypotension may respond to salt suppplementation, lower extremity pressure
stockings, or medications such as fludrocortisone or midodrine
