cranial nerve palsy
Introduction
Introduction Because the lesions such as basal meningitis involve III, IV, V, VI, and VII from the cranial nerve, the corresponding nerve paralysis is caused. There are symptoms such as decreased vision, double vision, drooping eyelids, oblique eyeball position, facial numbness, mouth slanting, mouth drooling, hearing loss, difficulty swallowing, drinking water, cough, abnormal pronunciation. Mostly caused by brain stem, cranial nerve tumor and lesions in the vicinity of the skull base such as aneurysm, meningioma, chordoma, craniopharyngioma, pituitary tumor, schwannomas.
Cause
Cause
Mostly caused by brain stem, cranial nerve tumor and lesions in the vicinity of the skull base such as aneurysm, meningioma, chordoma, craniopharyngioma, pituitary tumor, schwannomas.
Symptoms of cranial nerve palsy: such as decreased vision, double vision, drooping eyelids, eccentricity of the eyeball, facial numbness, mouth and eye slanting, mouth drooling, hearing loss, difficulty swallowing, drinking water cough, abnormal pronunciation.
Cases of cranial nerve cranial nerve are common, although many abductor neural crests in the elderly and diabetic patients may be caused by small blood vessel lesions. In the case of special cases, other cranial nerve disorders do not occur, and the condition should be improved in 2 months. There is a clear cause, that is, the abductor nerve is compressed by the tumor originating from the nasopharynx in the cavernous sinus.
Typically, severe pain in the head and loss of sensation in the first branch of the trigeminal nerve also occur. Any lesion or factor that can cause brain displacement can cause traction on the sixth nerve because it enters the Dorello tube in an acute angle.
Therefore, a large brain tumor away from the abductor nerve, increased intracranial pressure or lumbar puncture may lead to the sixth neural crest. Diabetic infarction is one of the more common causes. Other causes include head trauma that is not sufficient to cause a skull base fracture, infection or tumor involving the meninges, Wernicke encephalopathy, aneurysm, and multiple sclerosis.
In children without signs of increased intracranial pressure, the sixth neural crest can be caused by a respiratory infection and can be recurrent. The diagnosis of complete sixth cranial nerve spasm is easy, but it is difficult to determine its etiology.
It is important to exclude intracranial hypertension and papilledema (with or without retinal vein pulsation during fundus examination). MRI or CT can help to exclude intracranial space-occupying lesions, hydrocephalus and intraorbital, cavernous sinus and skull base lesions. . Lumbar puncture can measure the initial pressure of cerebrospinal fluid, and can be found in clues of inflammation, infection, or infiltration of cancer.
Screening for connective tissue vasculopathy helps to rule out vascular disease processes. In many cases, the sixth nerve spasm is relieved once the primary disease has been treated.
Examine
an examination
Related inspection
Brain nerve examination, brain CT examination, brain MRI examination, electroencephalography, brain function imaging
(a) olfactory nerve.
(two) optic nerve:
1, vision.
2. Vision.
3, the fundus.
(three) eye movement, pulley, abduction nerve
1, eye cracks.
2, extraocular muscles:
(1) Extraocular muscle movement.
(2) Eye muscles move in the same direction.
(3) Radiating reflection.
3. Pupil:
(1) Shape.
(2) Reacting to light (simultaneous observation of reflex reflection).
(D) Trigeminal nerve.
1, face pain and touch.
2, corneal reflex.
3, masticatory muscle strength and volume.
(5) Facial nerves.
1. Upper and lower facial muscle movements.
2, 2/3 taste in front of the tongue (when needed).
(6) The auditory nerve.
1. Hearing: Rinne test, Weber test, Schwabach test.
2, nystagmus.
(7) Tongue and vagus nerves.
1. Pronunciation and swallowing.
2, soft turbulence and uvula position.
3, pharyngeal reflex.
(8) Paying nerves.
1. Turn the neck.
2. Shrug.
3, sternocleidomastoid muscle and trapezius muscle volume.
(9) Sublingual nerves.
Extend the tongue and tongue muscle volume.
Second, the sports system
(a) muscle volume
(two) muscle strength
(three) muscle tension
(4) Mutual aid movement
1. Limbs' mutual aid movement: refers to the nose test, the rotation test, and the knee test.
2, trunk tonic movement (balance test): wrong level test, Romberg test, walking and so on.
(5) Involuntary movements.
(6) Joint movement (when required)
Attachment: Gait
Third, the sensory system
(a) shallow feeling
(1) Pain.
(2) Touch.
(2) Deep feeling
(1) Tremor.
(2) Joint position sense.
(3) Cortical sense (when needed).
Graphic sense, two points of discrimination, solid sense, etc.
Fourth, reflection
(1) Deep reflex: biceps tendon reflex, triceps tendon reflex, periosteal reflex, knee reflex, and Achilles tendon reflex.
(B) shallow reflection: abdominal wall reflection, cremaster reflex.
(3) Pathological reflex: Babinski sign, Chaddock sign, Oppenheim sign, Gordon sign, Hoffmann sign, etc.
Fifth, the autonomic nervous system
(1) Skin color, temperature and nutrition.
(2) Sweating.
(c) Anal and bladder sphincter conditions.
Diagnosis
Differential diagnosis
Symptoms of cranial nerve palsy: such as decreased vision, double vision, drooping eyelids, eccentricity of the eyeball, facial numbness, mouth and eye slanting, mouth drooling, hearing loss, difficulty swallowing, drinking water cough, abnormal pronunciation.
In the 12 pairs of cranial nerves, except for the olfactory and hypoglossal nerves, the other 10 pairs of nerves can be damaged. The most common ones are optic nerve, oculomotor nerve and abductor nerve, which are generally bilateral symmetry and unilateral. It manifests as symptoms such as visual impairment and diplopia.
Fundus examination is papillitis or optic nerve head atrophy. When the third (eye-moving) nerves often affect the sympathetic nerves in time and the pupils are dysregulated, the sputum dilated and the light reflexes disappear, and even the Arroyo pupils, the upper eyelids often sag, and the eyeballs are oblique.
