University:
American Career College
Course:
NURS-113 | Beginning Medical/Surgical Nursing
Academic year:

2018
Views:

65

Pages:

35
Author:

KillSteel

Facial nerve The facial nerve within the petrous temporal bone and the muscles of the face Facial nerve  Lesion of the facial nerve produce:  Weakness of all the ipsilateral facial muscles; It affects all the facial muscles including the forehead which distinguishes it from upper motor affection    Alteration of secretion in the ipsilateral lacrimal and salivary glands Impairment of taste perception on the anterior two thirds of the tongue Hyperacusis Lesion of the facial nerve Lesion of the facial nerve   Isolated unilateral LMN facial weakness: Bell’s palsy. Bilateral LMN weakness:     Sarcoidosis Lyme disease neuropathy Guillain-Barré syndrome Leprosy. Bell’s palsy   The common disease of the facial nerve is Bell’s palsy The cause is not certain, herpes simplex virus may be a cause. Treatment of Bell’s palsy    Care of the eye Facial muscle exercises Short course of steroids may improve the patient’s prospects for recovery. Vestibulo-cochlear nerve Central connections of the Vestibulo-cochlear nerve The common symptoms and signs found in patients with Vestibulo-cochlear disorders   Symptoms  Deafness  Tinnitus  Vertigo  Loss of balance Signs  Deafness of sensorineural type  Nystagmus  Positional nystagmus  Ataxia of gait Main diseases affecting hearing Main diseases affecting hearing and balance Main diseases affecting balance Diseases affecting Vestibular-cochleo nerve  Common causes of deafness    Acoustic neuroma Ménière’s disease Common diseases to affect balance without hearing loss    Infarction in the brainstem Benign paroxysmal positional vertigo Vestibular neuritis Cerebellopontine angle tumor   The tumor arising from VIII nerve It compress:     Trigeminal nerve Facial nerve The brainstem the cerebellum Glossopharyngeal, vagus and hypoglossal nerves Glossopharyngeal and vagus nerves    The glossopharyngeal nerve supplies the palate and pharynx and serve the taste perception in the posterior third of the tongue The vagus nerve supplies the pharynx and larynx Both the glossopharyngeal and vagus nerves regulate the autonomic functions. Glossopharyngeal and vagus nerves   Together they innervate the mouth and throat for normal speech and swallowing. They are commonly involved in disease processes together, to give rise to the clinical picture of bulbar palsy. Glossopharyngeal and vagus nerves   Note the patient’s voice, swallowing Movement of the soft palate: Bulbar palsy   Bilateral impairment of function in the 9th, 10th and 12th cranial nerves The clinical syndrome of bulbar palsy  Dysarthria  Dysphagia  Choking episodes with nasal regurgitation of fluids  Dysphonia and poor cough True or pseudo bulbar palsy    It can be due to upper motor neuron lesion (pseudo bulbar) Lower motor neurone lesion is called (true bulbar palsy) Main difference between true or pseudo bulbar palsy:    Jaw reflex Emotional incontinence Type of dysarthria. Common causes of bulbar palsy     Motor neurone disease Infarction of the lateral medulla Guillain–Barré syndrome Myasthenia gravis Spinal accessory nerve Spinal accessory nerve   Lesions of this nerve are uncommon It may result from surgical trauma in the posterior triangle of the neck. Spinal accessory nerve lesion  Clinically: Weakness of the sternomastoid  weakness of the trapezius (inability to shrug)   The scapula and shoulder sag downwards and outwards in the resting position. Arm elevation is impaired because of poor scapular stability and rotation A patient from behind with a right sided accessory nerve palsy (a) At rest (b) Attempting to lift his arms to the horizontal position (c) Attempting to lift his arms as high as possible The hypoglossal nerve The hypoglossal nerve   The hypoglossal nerve supply the tongue Dysfunction:  Upper motor neuron:   Tongue deviates to opposite side of the lesion Lower motor neuron:  Tongue deviates to side of the lesion with associated atrophy and fasciculations. Lower motor neuron affection of the hypoglossal Nerve Dysarthria    The speech disturbance in patients with dysarthria is a purely mechanical It is caused by defective movement of the lips, tongue, palate, pharynx and larynx Clear pronunciation of words is impaired due to the presence of a neuromuscular lesion. The upper and lower motor neurons involved in speech Upper motor neuron lesions  Unilateral lesion:   There is some slurring of speech Bilateral upper motor neuron lesion:  Speech is slow, indistinct, laboured, and stiff. Lower motor neuron lesion  Single unilateral cranial nerve lesion:   Does not usually produce a disturbance of speech Bilateral weakness of the bulbar muscles:   True bulbar palsy The speech is quiet, indistinct, with a nasal quality Basal ganglion lesions  In Parkinson’s disease:   Reduced speed and amplitude of movements due to bradykinesia. Speech is quiet and indistinct, and lacks up and down modulation (monotonous). Cerebellar lesions    Speech is irregular in both volume and timing It is referred to as a scanning or staccato dysarthria Due to:   Poor coordination of muscular actions Ataxia of the speaking musculature.