Exam 15: Cranial Nerve & Peripheral Nerve D/O & Brain Tumors
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| Trigeminal Neuralgia | specific kind of peripheral nerve problem.
Caused by degeneration of or pressure on the trigeminal nerve (cranial nerve V). Also Known as Tic douloureux.
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| Trigeminal Neuralgia Clinical Manifestations | The pain radiates along one or more of the 3 divisions of the fifth cranial nerve. Sensory (afferent) branches are commonly affected. Pain typically extends only to the midline of the face and head because this is the extent of the tissue.
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| Trigeminal Neuralgia | one specific kind of peripheral nerve problem. Caused by degeneration of or pressure on the trigeminal nerve (cranial nerve V). Known as Tic douloureux.
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| Trigeminal Neuralgia Clinical Manifestations | pain radiates along one or more of the three divisions of the fifth cranial nerve. he sensory (afferent) branches are most commonly affected. Pain typically extends only to the midline of the face and head because this is the extent of the tissue.
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| Trigeminal Neuralgia characteristics are: | Excruciating, knifelike, or lightinglike shock in the lips, upper or lower gums, cheek, forehead, or side of nose.
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| Trigeminal Neuralgia Medical Management | 1) Tegretol (Carbamazepine).
2) Dilantin (Phenytoin).
3) Depakene (Valproate).
4) Neurontin (Gabapentin).
5) Trileptal (Oxcarbazepine).
6) Lamictal (Lamotrigine).
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| Absolute alcohol may be injected into the peripheral branches of the trigeminal nerve. Why? | This provides relief for weeks to months.
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| Within 24 hours after a fifth nerve resection, many patients develop | herpes simplex of the lips (cold sores).
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| Bell’s Palsy (Peripheral Facial Paralysis): | caused by an inflammatory process involving the facial nerve (VII), anywhere from the nucleus in the brain to the periphery. Evidence that reactivated herpes simplex virus (HSV) may be involved in the majority of cases.
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| The reactivation of the HSV causes inflammation, edema, ischemia, and eventual demyelination of the facial nerve VII. What does this cause? | This causes pain and disturbances in motor and sensory function.
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| Bell’s Palsy (Peripheral Facial Paralysis): Clinical Manifestations | Usually an abrupt onset of numbness or a feeling of stiffness or drawing sensation of the face.
Unilateral weakness of the facial muscles.
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| Bell’s Palsy (Peripheral Facial Paralysis): The face appears | asymmetric, with drooping of the mouth and cheek.
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| Bell’s Palsy (Peripheral Facial Paralysis): Medical Management | Corticosteroids.
Zovirax (Acyclovir).
Valtrex (Valacyclovir).
Famvir (Famciclovir).
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| Brain tumor. | Intracranial tumors include both benign and metastatic lesions.
All areas and structures of the brain can be affected.
Metastatic from a Primary site, or neoplasms arising from the cells of brain tissue and associated structures.
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| Brain Tumors include | 1) Gliomas.
2) Meningiomas.
3) Pituitary Tumors.
4) Neuromas.
Metastatic tumors also occur frequently.
Brain tumors are named for the tissues from which they arise.
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| Brain tumor: Assessment | Subjective data with a complete and thorough neurological exam.
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| Brain tumor: Objective data | Motor.
Gait.
LOA/LOC.
Orientation.
PERRLA.
Seizures.
Speech.
Cranial nerve Abnormalities.
S&S of ↑ICP.
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| Brain tumor: Dx Tests | Brain scan.
MRI.
PET scans.
EEG.
Arteriography.
Tissue Biopsy.
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| Brain tumor: Medical Management. | Surgical removal when feasible.
Radiation.
Chemotherapy.
Choice of therapy is determined by:
1) Tumor site.
2) Tumor type.
A combination of medical and surgical management is often used.
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| Brain tumor: Drugs to control ICP | Osmotic diuretics/hyperosmolar drugs to draw water from the edematous brain tissue. Examples: Manitol.
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| Corticosteriods- Usually given as Dexamethasone. What should you do? | Monitor blood glucose levels as carbohydrate metabolism and glucose utilization can be affected.
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| Brain tumor: Drugs given to prevent seizures | Anticonvulsants:
a) Dilantin is the most commonly used.
b) Cerebyx is a short term IV or IM. Toxic side effects include cardiac collapse and central venous system depression.
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