Bell's Management
Is surgery necessary in the management of most Bell’s Palsy cases
No
Which type of stroke would you deliberately allow to have a higher blood pressure during treatment - ischaemic or haemorrhagic?
Ischaemic
True or false: Bell’s palsy patients tend to begin seeing improvement after about 2-3 weeks
True
Which type of stroke generally has a better long-term survival rate?
ischemic stroke
Haemorrhagic strokes raise intracranial pressure due to expanding haematomas, this can lead to Brain H_________.
Herniation
True or false: More than 50% of Bell’s palsy cases resolve on their own
True
Does mechanical thrombectomy (MT) treat big or small clots better than thrombolytic agents for ischemic strokes?
bigger
True or false: Some people retain some level of muscle weakness and asymmetry after recovery.
True
__ months after their initial stroke, about 79% of patients survive?
3 months
A complication of Bell' s palsy is keratoconjunctivitis sicca. What does that mean in layman's terms?
it means dry eyes
Why might artificial tears be necessary in Bell’s palsy management?
Paralysed facial muscles leads to inability to close the eye, causing dryness and corneal damage.
Name of thrombolytic agent used to treat ischemic strokes <4.5hr since onset
Altepase (tPA)
Name two risk factors which may cause poorer prognosis...
Complete paralysis at onset,
age >60 years,
severe pain,
associated comorbidities (e.g. diabetes, hypertension),
no improvement within 3 weeks
Which type of stroke has a higher chance or recurring?
Hemorrhagic strokes
Contracture and synkinesis may occur in 16-29% of patients with Bell’s palsy without treatment. What does synkinesis mean?
Synkinesis: involuntary and undesirable facial movements (aka “simultaneous movement”) associated with voluntary facial movements
E.g. eye closes (involuntary) when you smile (voluntary)
This complication is not life threatening, but may impact social function or mental health of affected person
What is a contracture? How could we potentially manage Bell’s palsy to prevent this?
Muscle/tendon hardening (think Dupuytren’s contracture in the hand). Physiotherapy.
What angle should you keep the head at to manage intracranial pressure
30 degrees
What percentage of patients have a full recovery?
around 75-80%
On average, people who have had a stroke lose ___ years of life expectancy compared to the general population.
5-6 years
Gustatory hyperlacrimation, or crocodile tears, is characterised by shedding tears while eating or drinking. It is theorised that this complication occurs due to (1)_______. This condition is usually (2) acute/ chronic and (3) worsens/ does not worsen over time.
aberrant regeneration of pre-ganglionic parasympathetic fibres carried within the facial nerve that supply the lacrimal gland (and other mucosal glands) (abnormal regeneration of facial nerve is fine as an answer)
Chronic
Does not worsen
What is a class of drugs which may be used in first line management of Bell’s palsy?
Steroids
S__________ hemorrhagic strokes is the only type of stroke that can be treated with endovascular coiling
Subarachnoid
What is an EMG, and how could it show complete denervation?
Electromyography. Detects, amplifies and records electrical activity of skeletal muscles (of the face). Denervation - No electrical activity in these muscles.
Stroke mortality is described as “front-loaded”, why might this be?
The highest risk of death occurs in the first few months after a stroke
What is a hemorrhagic transformation of an ischemic stroke?
When infarcted/damaged brain tissue starts to bleed.