MindMap Gallery Medicine - Peripheral Nervous System Disorders
This is a mind map about peripheral nervous system diseases, including cranial nerve diseases, idiopathic facial nerve palsy, trigeminal neuralgia, etc.
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peripheral nervous system disease
cranial nerve disease
Trigeminal neuralgia (primary)
clinical manifestations
Commonly distributed
maxillary branch
mandibular ramus
Performance
Severe electric shock/pinprick/knife-like pain in the upper and lower cheeks and tongue
sudden stop
Intermission is normal
Trigger point (sensitive area)
Light touch at the corners of the mouth, nose, and cheeks can induce
painful convulsions
In severe cases, there may be reflex twitching of facial muscles due to pain.
The corner of the mouth is directed towards the affected side
Facial onion skin sensory disorder
No other neurological damage
Auxiliary inspection
MRI
Differential diagnosis
★Secondary trigeminal neuralgia
persistent pain
Facial hypoesthesia and dull corneal reflex
Have other cranial nerve signs
common
multiple sclerosis
primary skull base tumor
Comparison with primary trigeminal neuralgia → whether there are other changes in cranial nerve signs
treat
medical treatement
Conservative treatment (preferred)
★Carbamazepine→If it fails
Inoperable
Percutaneous radiofrequency electrocoagulation of semilunar ganglion
Can be operated on
Trigeminal microvascular decompression
Idiopathic facial nerve palsy (facial neuritis) (Bell's palsy)
Pathogenesis
Facial nerve bleeding/edema
Viral infection
clinical manifestations
Performance (affected side)
Facial expression muscle paralysis
Forehead wrinkles disappear
Eye fissure cannot be closed
Physical examination
Close the eye on the affected side → turn the eyeball outward and upward → expose the white sclera → Bell’s sign
Auxiliary inspection
Electromyography (preferred)
medical treatement
Glucocorticoids (preferred)
Guillain-Barre syndrome (acute inflammatory demyelinating polydisease) (Gullain Barre) (Acute infectious polyneuritis)
Brief description
autoimmune-mediated peripheral nerve disease
Mainly damages spinal nerve roots and peripheral nerves
acute onset
Cause
Possibly related to Campylobacter jejuni (CJ)
Classification and diagnosis
AIDP (classic Guillain-Barre syndrome)
Pathology (multiple nerve roots, segmental demyelination of peripheral nerves)
clinical manifestations ★Motor impairment is more severe than sensory impairment
History of prodromal infection★ No fever
Acute onset (maximum peak within 2 weeks)
★Bilateral symmetrical flaccid muscle weakness of the limbs (progressive limb weakness)
Both lower limbs (first) → trunk muscles → cranial nerves
★Because both lower limbs are involved first → gastrocnemius tenderness may occur
The most severe involvement of the ventilator → respiratory muscle paralysis
Multiple limb paresthesia
burning/numbness
Gloves-sock-like distribution
Cranial nerve manifestations
★★★★Bilateral facial nerve palsy
Bilateral facial weakness with eyes closed/shallow nasolabial folds/inability to bulge cheeks
★★★If it is unilateral facial expression disorder
acute facial neuritis
Cranial nerve damage
Auxiliary inspection
Characteristic expression
Cerebrospinal fluid-protein separation
High protein content
Because of myelin damage
Swelling of nerve roots → compression of blood vessels → obstruction of venous return → protein leakage (cells do not change)
Normal cell content
treat
immunity therapy
plasma exchange
Immune globulin intravenous injection
Glucocorticoids
identify
acute myelitis
Have urinary and defecation difficulties
Guillain-Barre syndrome ★Special standard → Sock-like change
No bowel or bladder problems
Bilateral facial nerve palsy
Facial neuritis
Unilateral facial nerve palsy
quarrel supplement
facial nerve
The corner of the mouth turns to the healthy side
Weakness on the affected side
trigeminal neuralgia
The corner of the mouth is pulled toward the affected side
Painful contracture on the affected side
facial paralysis supplement
central facial paralysis
Supranuclear palsy → the upper part of the patient can also receive innervation from the other facial nerve → only palpebral paralysis
peripheral facial paralysis
Subnuclear paralysis → Damage to nerves from both sides → Total paralysis of the affected side
Can't close eyes
Forehead wrinkles disappear
The corner of the mouth turns to the healthy side
trigeminal neuralgia
primary
No other cranial neurological signs changes
Only sensory symptoms
Only episodic severe pain
Secondary
Have other changes in cranial nerve signs
Sensory symptoms Motor symptoms
episodic severe pain
Hyporeflexia of the cornea on the affected side
Facial hyposensitivity to pain and temperature
Facial dissociative sensory disorder
Weakness of masticatory muscles
nerve supplement
One smell, two sight, three eye movements, four slides, five forks, six abductions, seven directions, listening, nine tongues and swallows.
oculomotor nerve
Adduction up and down
eyelids open closed
pupillary light reflex
trochlear nerve
outside
abducens nerve
outside
Trigeminal nerve
facial sensation
Masticatory muscles
corneal reflex
facial nerve
facial expression
Front 3/2 taste of tongue
External auditory canal sensation hearing
Orbicularis oculi →
Insufficient eyelid closure ≠ ptosis
vestibular nerve
Dizziness Vomiting Nystagmus
Glossopharyngeal nerve
Rear tongue 3/1 taste sensation
accessory nerve
Ipsilateral sternocleidomastoid muscle and trapezius muscle
hypoglossal nerve
Unilateral injury → tip of tongue deviates to the affected side
Measure the damage on both sides → the tip of the tongue cannot be straightened