Neurological Disorders: Bell's Palsy, Vertigo, and Trigeminal Neuralgia

Bell's Palsy

• Definition: Acute unilateral weakness or paralysis of the facial nerve (Cranial Nerve VII).
• Onset: Acute and typically progresses to full paralysis within 72 hours.
• Etiology: Unknown, but commonly thought to be related to viral infections.
• Demographics: Affects all age groups, most common in young and middle-aged adults, evenly distributed between men and women.
• **Symptoms:
  • Pain behind ear preceding facial paralysis.
  • Flattened forehead, inability to close eye, asymmetric smile.
  • Tearing, drooling, post-auricular pain, tinnitus, mild hearing deficits.
• **Diagnosis:
  • Rule out other conditions (stroke, tumors, MS).
  • Rarely uses lab tests or imaging unless presentation is atypical.
• **Management:
  • Non-pharmacologic: Eye protection (glasses, moisturizing drops, taping eyelids), surgical decompression if recurrent and painful.
  • Pharmacologic: Corticosteroids within 72 hours of symptom onset, possibly coupled with antivirals, pain management with acetaminophen or NSAIDs.
• Complications: Exposure keratitis leading to possible blindness, corneal ulceration, hearing loss, permanent tinnitus, poor facial symmetry recovery.

Vertigo

• Definition: Illusion of environmental or self-motion (spinning, tilting, falling).
• Types: Central or Peripheral.
• Prevalence: Affects 5-10% of the population, more common in those over 40.
• Symptoms: Dizziness, nausea, vomiting, tinnitus, ear fullness, hearing loss.
• Differentials: Vascular insufficiency, stroke, neoplasm, migraines, MS, seizures, Meniere's disease, labyrinthitis, BPPV.
• **History & Exam:
  • Determine onset (acute or recurrent).
  • Note triggers and alleviating factors.
  • Evaluate gait and cranial nerves, consider previous testing (audiometric, CT, MRI).
• Diagnostics: Based on history and physical exam findings, may include CT, MRI, audiogram, lumbar puncture.
• **Management:
  • Non-pharmacologic: Bed rest, vestibular rehab (PT), dietary restrictions in Meniere's disease (sodium, caffeine, alcohol, tobacco).
  • Pharmacologic: Antihistamines, benzodiazepines, beta-adrenergic antagonists, anticholinergic agents, diuretics for Meniere's disease.
• Special Populations: Pediatric (otitis media, migraines, BPPV), Geriatric (vestibular disorders, disequilibrium).
• Consultation/Referral: Consider if no improvement in 2-4 weeks, referral to otolaryngologist for specialized testing.

Trigeminal Neuralgia

• Definition: Pain disorder affecting the trigeminal nerve, characterized by sharp, burning, stabbing pain.
• Symptoms: Unilateral facial pain, described as electric shocks, occurring in seconds to minutes, triggered by specific zones.
• Diagnosis: Based on history and physical findings, no essential diagnostic procedures unless ruling out differentials.
• Differentials: Headache, migraine, tumor, aneurysm, chronic meningitis, dental abnormalities, MS.
• **Management:
  • Pharmacologic: First-line anticonvulsants, stepwise addition of second-line drugs if needed, consider gabapentin for MS, sumatriptan for acute episodes.
  • Non-pharmacologic: Potential use of acupuncture, nutritional therapy, or Botox for relief.
  • Surgical: Referral to neurosurgeon if medications are ineffective.
• Complications: Usually related to medication side effects, caution in prescribing based on age and comorbidities.
• Client Education: Importance of medication adherence, managing sedative effects of medications.

Contact for Questions

• Discussion board or email for further assistance.