Cranial nerve disorders

1. CRANIAL NERVE DISORDERS

2. • Cranial nerve disorders are often classified as
peripheral neuropathies.
• The 12 pairs of cranial nerves are considered the
peripheral nerves of the brain. The disorders usually
involve the motor and/or sensory branches of a
single nerve (mononeuropathies). Causes of cranial
nerve problems include tumors, trauma, infection,
inflammatory processes, and idiopathic (unknown)
causes. The 2 cranial nerve disorders discussed here
are trigeminal neuralgia and Bell’s palsy.

3. TRIGEMINAL NEURALGIA

4. • Trigeminal neuralgia
(TN) (tic douloureux)
is characterized by
sudden, usually
unilateral, severe,
brief, stabbing,
recurrent episodes of
pain in the distribution
of the trigeminal
nerve.

5. Etiology
• Tumors
• Trauma
• Infection and inflammatory processes
• Multiple sclerosis
• Shingles, or masses in the cerebellum or
brainstem.

6. Pathophysiology
Damage to the myelin sheath
Flattening and atrophy of the nerve
Constant compression appears to lead to chronic injury
Artery compresses the nerve as it exits the brainstem
Vascular compression of the trigeminal nerve root by an
abnormal loop of the superior cerebellar artery.

7. Clinical Manifestations
• Excruciating pain - Precipitating stimuli
include chewing, brushing the teeth, feeling a
hot or cold blast of air on the face, washing the
face, yawning, or even talking.
• Lightning-like shock in the lips, upper or lower
gums, cheek, forehead, or side of the nose.
• Facial twitching, grimacing, and frequent
blinking and tearing of the eye
• Facial sensory loss

8. Diagnostic Studies
• History
• Physical and neurologic examinations
• MRI may be used to assess for sinusitis,
cancer, multiple sclerosis, or masses in the
cerebellopontine angle.
• 3D reconstruction and angiography MRI are
helpful with seeing the specific brain
anatomy, nerve roots, and vasculature
involved.

9. Management
• Drug therapy
– Antiseizure drugs (e.g., carbamazepine, oxcarbazepine ,
gabapentin)
– Tricyclic antidepressants (e.g., amitriptyline)
• Local nerve block
• Percuteaneous methods
– Balloon surgery
– Thermal lesioning
• Surgical therapy
– Micro vascular decompression with or without neurectomy
– Steriostatic radiosurgeory
– Glycerol rhizotomy

10. Nursing managements
• Plan for regular follow-up care.
• Teach the patient about any
medications.
• Although pain may be relieved,
encourage the patient to keep
environmental stimuli to a
moderate level and to use stress
management techniques.
• Long-term management after
surgical intervention depends
on residual effects of the
procedure.
• If anesthesia is present or the
corneal reflex is altered
• Teach the patient to
– chew on the unaffected side
– avoid hot foods or beverages, which
can burn the mucous membranes
– check the oral cavity after meals to
remove food particles
– practice meticulous oral hygiene
and continue with semiannual
dental visits
– protect the face against extremes of
temperature
– use an electric razor
– wear a protective eye shield and
avoid rubbing eyes
– examine eye regularly for
symptoms of infection or irritation

11. BELL’S PALSY

12. • Bell’s palsy is an acute, usually temporary,
facial paresis (or palsy) resulting from
damage or trauma of the facial nerve (CN
VII). It usually affects only 1 side of the face,
but both sides can be affected

13. ETIOLOGY
• Vascular ischemia
• A type of herpes infection called herpes zoster (herpes
zoster) is a painful, blistering skin rash due to the
varicella-zoster virus.
• HIV infection
• Lyme disease- Is an infectious disease caused by the
Borrelia bacterium which is spread by ticks
• Middle ear infection
• Sarcoidosis

14. CLINICAL FEATURES
• Symptoms are present on one side of
the face.
• Pain around and behind the ear.
• The face will feel stiff or pulled to one
side
• Increased sensitivity to loud noise.
• Difficulty in closing one eye
• Difficulty in eating and drinking; food
falls out of one side of the mouth
• Drooling due to lack of control over the
muscles of the face.
• Drooping of the face, such as the eyelid
or corner of the mouth
• Problems in smiling, or making facial
expressions
• Twitching or weakness of the muscles
in the face

15. Diagnosis
• Observation of typical pattern of onset of symptoms .
• CT scan of the head
• Magnetic resonance imaging (MRI) of the head-
helps to rule out any evidence of brain tumor.
• Electromyography

16. Management
• Nerve stimulation and exercises – helps to maintain
muscle tone and prevent atrophy.
• Moist heat- promote comfort and blood flow
• Gentle massage
• Corticosteroid – reduce inflammation and edema.
• Lubricating eye drops or eye ointments to keep the
surface of the eye moist.
• Advice to wear an eye patch while sleep.
• Antivirals (such as acyclovir)
• Mild analgesics to relieve pain .

17. Nursing management
• Early identification is important .
• Assess facial muscle for any weakness
• Mild analgesics can given to relieve pain
• Hot wet packs reduces discomfort
• Face should be protected from cold.
• Maintain good nutrition
• Good oral hygiene
• The patient is taught to report any ocular pain.
• Impermeable eye shield can use at night.

18. THANK YOU