cranial nerve disorders

1. SISTER NIVEDITA GOVT. NURSING COLLEGE
TOPIC ON
CRANIAL NERVE DISORDERS
Submitted to:- Submitted by
Miss Sunita Verma Vandana Rani
Lect. Med. Sur. Nsg. Pbs. Nsg. 1st Yrs.
Roll No 29
Submitted On
15/12/2017

2. CONTENT
• Introduction of cranial nerve disorders
• Definition of cranial nerve disorder
• Third cranial nerve disorder
• Cause and investigation
• Management
• Bell’s Palsy
• cause and investigation
• Clinical manifestation

3. Cont…..
•Management
•Trigeminal neuralgia
•Cause and clinical manifestation
•Investigation and management
•Prognosis
•Bibliography
•summary

4. CRANIAL NERVE
DISORDERS
Brain stem and cranial nerve vital
motor,sensory,and automatic function of the
body, these nerve may be affected by
conditions arising primary within these
structures or in the secondary extension
from adjacent disease processes.

5. DEFINITION
• cranial nerve disease is an impaired
functioning of one of the twelve cranial
nerve. It is possible for a disorder of more
than one cranial nerve to occur at the
same time, if a trauma occurs at a location
where may cranial nerves run together,
such as the jugular fossa.

6. THIRD CRANIAL NERVE PALSY
Partial to complate weakness of the
musclebinnervated by the 3rd
(oculomotor)nerve, resulting in ptosis
of the eyelid, mydriasis, and an
outwardly turned eye during primary
gaze.
.

7. Cont…..
• When the patient attempts to turn the eye
inward, it moves slowly only to the midline.
Upward and downward gaze is compromised
in the affected eye. When downward gaze is
attempted, the superior oblique muscle
causes the eye to rotate inward

8. cause
• The many causes of 3rd cranial nerve
palsies include most major causes of CNS
disease, so choice of diagnostic tests
should be based on the clinical features of
the palsy. Intraorbital structural leaasion
producing external opthalmoplegia and
occur

9. Cont…..
• sympathies should be distinguished from
cranial nerve disease. Sympathies are
harder to diagnose but are suggested by a
partial 3rd nerve palsy. The pupil is always
spared in myopathy.

10. INVESTIGATION
• third cranial nerve palsies are most
indicative of serious disease when
associated with severe headache and
altered conciousness.
• A thorough neurologic examination
with CT and MRI is performed.
• .

11. Cont…
• Lumbar puncture is reserved for
suspected subarachnoid hemorrhage
when CT does not show blood.
• Cerebral angiography must be performed
if aneurysm causing subarachnoid
hemorrhage is strongly suspected.

12. Bell’s palsy
Bell’s palsy is the most common facial paralysis.
Palsy is a form of temporary facial paralysis
resulting from trauma to one of the two facial
nerves. it is resulted by the trauma of 7th cranial
nerve. In general, bell’s palsy affect only one of the
paired facial nerve and one side of the
face, yet, in rare cases, it can affect both sides.
The term bell’s palsy is coined by sir charles bell.

13. cause
• bell’s palsy causes significant facial
deformation. Most scientists believe that a
viral infection such as viral meningitis or the
common cold sore virus herpes simplex cause
the disorder.
• bell’s palsy involves damage to the seventh
cranial nerve. That nerve control the
movement of the muscle of the face. Other
condition such as diabetes, Lyme disease are
associated with bell’s palsy.

14. SYMPTOMS
• Twitching In Face
• Weakness In Face
• Face Feel Stuff Or Pulled To One Side
• Droopy Eyelid Or Corner Of Mouth
• Drooling Due To Inability To Control Facial
Muscle

15. Cont…..
• Dry Eye Or Mouth
•Loss Of Sense Of Taste
•Difficulty With Eating Or Drinking
•Facial Paralysis Of One Side Of The Face
•Change In Facial Expression

16. TREATMENT
• there is no cure or normal course of treatment for
bell’s palsy. The most important factor in treatment
is to remove the source of the nerve damage. Some
cases are gently and do not require treatment since
the symptom usually drop on their own within
2weeks.
• For some patients, treatment may include
medication such as acyclovir- used to fight viral
infections- combined with an anti inflammatory drug
such as the steroid prednisone used to remove
inflammation and swelling

17. Cont….
Medication such as aspirin, acetaminophen,
ibuprofen may relieve pain, but because of
possible drug interactions, patient should
always talk to their doctor before taking any
medication.

18. PROGNOSIS
the prognosis for individual with bell’s palsy is
very good. the degree of nerve damage
determines the degree of recovery. With or
without treatment, most individual begin to heal
within 2 week after the early onset of symptom
and recuperate entirely with in 3 to 6 month.

19. PREVENTION
• Taking care of yourself
• use of safety measures may reduce the
incident of head injury
• avoid hitting your head on the wall
• many of the other factors associated with
this disorder are not readily preventable.

20. TRIGEMINAL NEURALGIA
• a disorder of the trigeminal nerve
producing bouts of excruciating, lancination
pain, lasting between second and 2 min,
along the distribution of one or more of its
sensory divisions, most often the maxillary.
• at surgery or autopsy, intracranial arterial,
less often, venous loops compressing the
trigeminal nerve root where it enters the
brain stem have been found,

21. Cont……
• suggesting that the tic is compressive
neuropathy. The disorder usually affect
adults, especially the elderly. Pain is often
set off by touching a trigger point or by
activity( chewing, or brushing the teeth)

22. causes
•The trigeminal nerve is a mixed cranial
nerve responsible for sensory data such as
tactician, thermoception,nociception
originated from the face above the jaw line. It
is also responsible for the motor function of
the muscle of mastication, the muscle
involved in chewing but not facial expression.
•A draft of cold air direct pressure against
the nerve trunk may also cause pain.

23. Cont…..
•Certain are called trigger points or episode.
E.g. to touch or wash their hand with cold
water, shave, chew,
•When there is no structural cause, the
syndrome is called idiopathic

24. DIAGNOSIS
Trigeminal neuralgia is diagnosed via the
result of neurological and physical test,
as well as the individual medical history.

25. MANAGMENT
• Medical management:-: the anticonvulsant
carbamazepine is the first line treatment,
second line medication include phenytoin,
gabapentine.
• Uncontrolled trials have suggested that
clonazepam and lidocaine may be effective.
• Antidepressants medication such as
amitriptyline have show good efficacy in
treating trigeminal neuralgia.

26. SURGICAL MANAGMENT
• the evidence for surgery therapy is poor. Surgery is
normally recommended only after medication has proved
ineffective
NON DESTRUCTIVE:-
Micro vascular decompression:- this involves a small
incision behind the ear And Some Bone Removal From
the area. An incision through the meanings is made to
expose the nerve. Any vascular compression of the nerve
are carefully moved and sponge like pad is placed
between the compression and nerve. This technique
appears to result in the longest pain relief.

27. Cont…….
• DESTRUCTIVE
• Balloon compression :- inflation of a balloon at
this point causing damage and stopping pain
signals.
• Glycerol injection:- deposition of a corrosive
liquid called glycerol at this point cause
damage to the nerve to hinder pain signals.
• Stereotactic radio surgery:- is a form of
radiation therapy that focuses high power
energy on a small area of the body.

28. SIXTH NERVE PALSY
• Adducers nerve palsy is a disorder
associated with dysfunction of cranial
nerve 6th which is responsible for causing
contraction of the lateral rectus muscle to
abduct the eye. The inability of an eye to
turn outward results in a convergent
strabismus or esotropia of which the
primary symptom is diplopia in which the
two images appear side by side.

29. SIGN AND SYMPTOM
• Esotropia ( convergent squint or distance
fixation)
• amblyopic( permanent visual loss)
• patient sometimes adopt a face turn
toward the side of the effected eye.

30. CAUSES
• more common:-vasculopathies(diabetes,
hypertension, atherosclerosis)
• trauma
• idiopathic
• Less common:- intracranial pressure
• Giant cell arthritis
• Multiple sclerosis
• Hydrocephalus
• Stroke
• Tuberculosis meningitis

31. DIAGNOSIS
• diagnosis is more difficult because of the
problems inherent in getting infants to
cooperate with a full eye moment
investigation. Possible alternative diagnosis
for an abduction deficient would include:-
• Cross fixation which develop in the presence
of infantile esotropia or nystagmus blockage
syndrome and result in habitual weakness of
lateral recite.

32. Cont…..
• Iatrogenic injury:-abducent nerve palsy is
also known to occur with halo orthotic
placement. The resultant palsy is identified
through loss of lateral gaze after application
of the orthotic and is the most common
cranial nerve injury associated with this
device.

33. MANAGEMENT
• The first aim of management should be identified
and treat the cause of the condition, where this is
possible, and to relieve the patient’s symptoms,
where present.
• Symptom relief:- this is most commonly achieved
through the use of Fresnel prisms. This slim flexible
plastic prisms can be attached to the patient’s
glasses or to be plain glasses if the patient has no
refractive error and serve to compensate for the
inward misalignment of the effected eye.

34. SUMMARY
I have explained in the about the
introduction of the cranial nerve and
definition of cranial nerve and disorder of
the third cranial nerve, and ball’s palsy
cause and clinical manifestation,
investigation and management of ball's
palsy and trigeminal neurlolgia and its
cause and clinical manifestation and
management and prognosis.

35. BIBLIOGRAPHY
• Ansari Javed’ Published By- S. vikas,
Edition – 4th, Topic- Cranial nerve disorder,
Page no 445 to 455.
• www. Google. com