Download NEURO CONDITIONS I

Cranial Nerve Disorders:
BELL’S PALSY AND TRIGEMINAL NEURALGIA
JANE E BINETTI RN MSN
Bell’s Palsy
 Acute Benign facial paralysis
 Cranial nerve VII
 Cause unknown ? HSV-1?
 Reactivation causes inflammation, edema, ischemia
 Demyelination causes pain, loss of function
 20-60 most common
 20 /100,000 will have it;
 8,000 permanent facial weakness
What do you see?
 Often Herpes break around face or ear
 Pt complains of pain, tinnitus, loss of hearing
 Drooping/ptosis on one side of the face :
 Drooling , cannot purse lips
 Inability to smile/frown
 Diminished hearing
 Nasolabial fold is flattened
 Often cannot close the eye, dry eye/tearing
 Loss of taste
Diagnostics
 Diagnosed by exclusion
 H and P
 Review of systems
 EMG
Collaborative Care
 Comfort:
 Moist heat
 Massage
 Electrical stimulation
 Protection of eye
 Medication
 Corticosteroids
 Analgesics
 Antivirals: Acyclovir, Valacyclovir
What do you do?
 Assess your patient to get baseline functioning
 Infection control for active HSV-1
 Protection of eye
 Sunglasses, moisture drops
 Ensure oral care especially to affected side
 Provide emotional support
 Can last about 6 weeks
 Compliance with tx
Trigeminal Neuralgia
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Also called “Tic Douloureux”
Uncommon nerve disorder of Cranial nerve V
Sudden unilateral stabbing pain
Cause:
 Vascular compression?
 Herpes virus
 Infection of teeth/jaw
 Risk factors:
 MS, HTN
 15,000 cases in US/yr
 More women than men
What do you see?
 Patients present with complaints of stabbing, shock
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like pain on any or all of the branches
Twitching, grimacing, blinking (Tic)
May be sporadic or recurring
Refractory period, then clusters
Triggers reported by patients:
 Touch, chewing, yawning, cold/heat
 Physical and psychological effects
Diagnostics
 History and Physical
 CT
 MRI
Collaborative Care
 Goal is relief of pain
 Medications:
 Carbamazepine (Tegretol)
 Oxcarbazepine (Trileptal)
 Conservative Treatment
 Nerve blocks
 Biofeedback
Surgical Therapy
 Glycerol Rhizotomy
 Inject glycerol into trigeminal root
 Percutaneous Radiofrequency Rhizotomy
 Radiofrequency to roots next to Pons
 Microvascular Decompression
 Moving vasculature away from nerve root
 Gamma Knife Radiosurgery
 Image guided radiation to proximal trigeminal nerve
What do you do?
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Pts need emotional support – chronic pain
Monitor pain med use
Oral care
Avoidance of triggers
Procedural Care:
 Pt will be awake
 Post Procedural Care:
 Craniotomy care if surgical
 Assessment of VS
 Neuro assessment of outcomes