The document discusses the anatomy and clinical examination of the facial nerve. It describes the facial nerve's anatomy from its supranuclear pathways in the brain to its peripheral branches in the face. Regarding clinical examination, it outlines how to assess the motor functions of the facial nerve by inspecting facial symmetry and movements. It also describes how to test the nerve's branches and examine reflexes, sensory functions, and secretory functions. The document distinguishes between peripheral and central facial palsies and provides localization of lesions that can affect the facial nerve.
The facial nerve is the seventh cranial nerve, or simply CN VII. It emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue.
Facial nerve (VII):
Involved in facial expressions, taste sensation, and control of the lacrimal and salivary glands. The facial nerve emerges from the pons.
It has two roots
Medial Motor root
Sensory (Nervous intermedius) root
The facial nerve is the seventh cranial nerve, or simply CN VII. It emerges from the pons of the brainstem, controls the muscles of facial expression, and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue.
Facial nerve (VII):
Involved in facial expressions, taste sensation, and control of the lacrimal and salivary glands. The facial nerve emerges from the pons.
It has two roots
Medial Motor root
Sensory (Nervous intermedius) root
Ephaptic transmission of impulses between neighbouring neurons (i.e. coupling of adjacent nerve fibres due to local exchange of ions or local electric fields) leading to excessive or abnormal firing.
Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...pawan1physiotherapy
Cranial Nerve Assessment is a crucial step in neurological assessment. By following the simple theoretical aspects it can be made on your fingertips....here is an try to make the stuff easier for you....
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Ephaptic transmission of impulses between neighbouring neurons (i.e. coupling of adjacent nerve fibres due to local exchange of ions or local electric fields) leading to excessive or abnormal firing.
Cranial nerve assessment..Simple and Easy to perform for medics and Physiothe...pawan1physiotherapy
Cranial Nerve Assessment is a crucial step in neurological assessment. By following the simple theoretical aspects it can be made on your fingertips....here is an try to make the stuff easier for you....
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
6. SUPRAN UCLEAR AN ATO M Y
Has specificareason thecerebral
cortex.
Facial pyramidal fibers begin
Itis representedaccordingto thepart it
supplieson the face.
7. Path of voluntary facialexpressions
(Pyramidal)
Contralateral precentralgyrus arecarried
through corticobulbar tract (pyramidal)
Internal Capsule
Midbrain
Cross over to theopposite side
Motor Facialnerve nucleusin Pons.
DeJong's The Neurologic Examination, 6th Edition
8. EXTRAPYRAMIDAL SYSTEM
Consist of basal ganglia and the descending motor projections other
thanthefibersofthepyramidor cortico-bulbar tracts.
Extrapyramidal system, involves diffuse axonal connections
between multiple regions including the basal ganglia, hypothalamus,
andmotor cortex.
9. Facial Nerve has 4 nuclei
(lower pons)
1. Motor nucleus
2. Sup salivolacrimatory
nucleus (parasympathetic)
3. Nucleus of tractus
solitarius (gustatory)
4. Spinal tract nucleus
(sensory)
Nuclear / Intra-axial Anatomy
DeJong's The Neurologic Examination, 6th Edition
10. Motor nucleus fibres
Ventrolateral pontine tegmentum
Floor of fourth ventricle forming
facial colliculus
Fibers then course anterolaterally to exit lateral
brainstem at pontomedullary junction
17. At theentranceto theinternal auditorycanal(IAC)
The facialnerveatthispointliesin closeproximityto theanterior inferior
cerebellarartery (AICA)
18.
19. In itscourse through thefacialcanalthenerve hasfour segments:
1) Labyrinthine
II) Horizontal or tympanic
III) Pyramidal
IV)Mastoid
20. The labyrinthine segment
lies laterally between the
cochlea and vestibule, toward
the medial wall of the
tympanic cavity
It extends from the internal auditory canal to the geniculate
ganglion. (3–5 mm)
21. The nerve turns abruptly and
runs horizontallyfor about1
cm(horizontal or
tympanic segment)
Turns backwardandarches
downward behindthe
tympanic cavity.
Extends from the geniculate
ganglion to the second turn of
thefacial nerve External genu & geniculate ganglion
23. The pyramidal segment joins thehorizontal and
mastoid segments,andgivesoffthebranchto the stapedius
muscle.
The mastoid segment (13–15 mm)
extends from this point to the
stylomastoid foramen.
32. CLINICAL EXAMINATION
Examination of the Motor Functions
Inspection-
• Facial asymmetry, nasolabial fold with forehead wrinkles,
movements during spontaneous facial expression
• Tone of the muscles of facial expression,
• Atrophy and fasciculations
• Abnormal muscle contractions and involuntary movements
• Spontaneous blinking for frequency and symmetry.
33. Clinical Examination of the facial nerve
Motor
Frontalis,
Corrugator Supercilii
Orbicularis oculi
Buccinator
Orbicularis Oris
Platysma
34.
35. T
esting of Facial Nerve Branches
Testing the temporal branches of the facial nerve –
patient is asked to frown and wrinkle his or her forehead.
Testing the Zygomatic branches of the facial nerve patient
is asked to close their eyes tightly
Testing the buccal branches of the facial nerve
• Puff up cheeks (buccinator)
• Smile and show teeth (orbicularis oris)
• Tap with finger over each cheek to detect ease of air expulsion
on the affected side
37. Stapedius reflex
• Nerve to stapedius muscle test
• Impedence audiometry can record the presence or absence of
stapedius muscle contraction to sound stimuli 70 to 100 db
above hearing threshold
• Absence reflex or a reflex less than half the amplitude is due to
a lesion proximal to stapedius nerve
38.
39. Examination of Sensory Functions
Hypesthesia of posterior wall of the external auditory meatus in
proximal facial nerve lesions.
Taste on anterior two-thirds of the tongue-use four substances
for testing:
• Sucrose (sweet), sodium chloride (salty), quinine (bitter), and
citric acid (sour).
• Patient with a peripheral pattern of facial weakness has
impaired taste, the lesion is proximal to the junction with the
chorda tympani.
40. Examination of Secretory Functions
• Tear production may be quantitated with the Schirmer test.
• Lacrimal reflex is tearing, usually bilateral, caused by
stimulating the cornea.
• Nasolacrimal reflex is elicited by mechanical stimulation of the
nasal mucosa, or by chemical stimulation using irritating
substances such as ammonia.
• Abnormalities of salivation are usually suggested by the history.
41. Other important tests
1. Schirmer's Tear test
2. Nerve conduction andPotential Studies
3. CT /
MRI
42. (1829):THE DISCOVERY
OF THE NERVE OF
FACIAL EXPRESSION
Sir Charles Bell (1829)
3 cases of facialparalysis due
to facialnerve trauma.
45. Facial Weakness
Two types of neurogenic facial nerve weakness:
• Peripheral or lower motor neuron - result from a lesion
anywhere from the CN VII nucleus in the pons to the terminal
branches in the face.
• Central facial palsy (CFP) - due to a lesion involving the
supranuclear pathways before they synapse on the facial
nucleus.
46. Peripheral Facial Palsy
• There is flaccid weakness of all the muscles of facial expression
on the involved side, both upper and lower face, and the
paralysis is usually complete
47. • Palpebral fissure is open wider than normal, and there may be
inability to close the eye (lagophthalmos).
• V
ery mild PFP may produce only slower and less complete
blink on the involved side.
• Bell’s phenomenon- Attempting to close involved eye causes a
reflex upturning of the eyeball
• Levator sign of Dutemps and Céstan- Patient look down, then
close the eyes slowly; because the function of levator palpebrae
superioris is no longer counteracted by orbicularis oculi, upper
lid on the paralyzed side moves upward slightly.
48. • Negro’s sign- eyeball on the paralyzed side deviates outward
and elevates more than the normal one when the patient raises
her eyes.
• Bergara-Wartenberg sign- loss of the fine vibrations palpable
with the thumbs or fingertips resting lightly on the lids as the
patient tries to close the eyes as tightly as possible.
• Platysma sign of Babinski- asymmetric contraction of the
platysma, less on the involved side, when the mouth is opened
49. House-Brackmann grading system
Grade I - Normal
Grade II - Mild dysfunction, slight weakness on close inspection,
normal symmetry at rest
Grade III - Moderate dysfunction, obvious but not disfiguring
difference between sides, eye can be completely closed with effort
Grade IV - Moderately severe, normal tone at rest, obvious weakness
or asymmetry with movement, incomplete closure of eye
Grade V - Severe dysfunction, only barely perceptible motion,
asymmetry at rest
Grade VI - No movement
50. Facial Weakness of Central Origin
• Weakness of the lower face, with relative sparing of upper face
• Upper face is not necessarily completely spared, but it is always
involved to a lesser degree than the lower face.
• Lesion involving the corticobulbar fibers anywhere prior to
their synapse on the facial nerve nucleus will cause a CFP
• Lesions are most often in the cortex or internal capsule.
52. • There are two variations of CFP:
(a) Volitional, or voluntary- weakness more marked on
voluntary contraction, when patient is asked to smile or bare
her teeth.
• Result from a lesion involving either the cortical center in the
lower third of the pre-central gyrus that controls facial
movements, or the corticobulbar tract.
(b) Emotional, or mimetic. –Facial asymmetry more apparent
with spontaneous expression, as when laughing.
• Most commonly results from thalamic or striatocapsular lesions,
usually infarction, rarely with brainstem lesions
53.
54. Facial Paralysis
UPPER MOTOR NEURON LOWERMOTOR NEURON
Lesions is above the pons. Lesions is in the pons or in the
pathway from pons to its exit.
Patient can make furrows on looking
upwards
Furrows are absent on looking
upwards of the affected side of
face.
Lower part of the face is involved on
the opposite side of the lesion.
The whole face and forehead
involved on the same side of the
lesion.
Isolated involment of this type is
rare.
It is invariably associated with
hemiplegia .
Isolated involment of this type is
common.
It may be associated with
hemiplegia .
55. Localization of Lesions Affecting Cranial
Nerve VII
Supranuclear Lesions (Central Facial Palsy)
Nuclear and Fascicular Lesions (Pontine Lesions)
Peripheral FacialNerve Palsy
56. Nuclear Lesions
May affecteither the nucleus of the facialnerve or its intrapontine axons
Ipsilateral Facialpalsy with
Abducens fascicleor nucleus
Paramedian Pontine Reticular Formation
(PPRF)
(paralysis of conjugategazeto the psilateral side)
Corticospinal tract (contralateral hemiplegia)
59. Lower motor lesion of Facial nerve
• Palsy +loss of taste sensation – in the canal
• Palsy +loss of taste +hyperacusis – just after entrance
into the canal
• All the above + loss of hearing – atthe internal
auditory meatus
• All the above + lateral rectus damage – cerebo
potine angleinvolvement Bell’s palsy.
60. Millard-Gubler Syndrome
Lesion located in the ventral pons that destroys the fasciclesof the facialand
abducens nerves and the corticospinal tract
Ipsilateral peripheral-type facial paralysis
Ipsilateral lateral rectus paralysis
(diplopia with failure to abduct
the ipsilateral eye)
Contralateral hemiplegia