Characteristic of Bell’s Palsy in Clinical Neurologic at Sanglah Hospital Denpasar Bali Indonesia

Introduction/Aim: Bell's Palsy is a lower motor neuron facial weakness caused by idiopathic etiology with the absence of other neurologic diseases. The incidence of this syndrome is around 23 cases per 100,000 people each year. The clinical manifestations are sometimes being considered to be a stroke or tumor. This study was conducted to find characteristic of bell’s palsy in clinical neurologic at Sanglah Hospital Denpasar, Bali Indonesia Methods: This study is a descriptive study with a cross sectional design in polyclinic of Sanglah Hospital, Denpasar for the period 2016 to 2019. Sampling was carried out using a consecutive non-random sampling method. Result: A total of 31 subjects in rainy season 51.6% having female 61.3% and male 38.7%, with the range of age 46-55 years old. Most of the patients complaints the weakness of the right face 58.1%, postauricular pain 64.5%. Electroneuromyography examination with seddon classification having results of Neuropraxia 67.7%. Conclusion: Characteristic of bell’s palsy in clinical neurologic most of participant in woman with postauricular pain and neuropraxia Keywords: Bell's Palsy, neuropraxia, postauricular pain, seddon classification.

Unusual Case of Head Injury Presented with Brain Gliomas

Seven years female child came with parents who gave us history that 1month back, child during playing had fall on face and lost consciousness which remained for 30 min followed by convulsion. On examination patient was conscious, responds to command, vitals were stable, aphasia was present, pupils were equal and reactive to light bilaterally and horizontal gaze was restricted. There was no facial weakness, Tone increase more in left upper and lower limb .Deep tendon reflexes (DTR) increase in left side. Plantar reflex were extensors. MRI was done which shows intra axial space occupying lesion in brainstem with expansion of brainstem with hydrocephalus. Pt was inoperable and ventriculoperitoneal shunt was done for hydrocephalus. Post operatively patient was kept on assisted ventilation. Conclusion: Unusual presentation of brainstem gliomas as head injury.

Correlation between Electrophysiological Change and Facial Function in Parotid Surgery Patients

This observational study investigated intraoperative electrophysiological changes and their correlation with postoperative facial expressions in parotidectomy patients with visual confirmation of facial nerve (FN) continuity. Maximal electromyography(EMG) amplitudes of the facial muscles corresponding to temporal, zygomatic, buccal and mandibular branches were compared before/after FN dissection, and facial function at four facial regions were evaluated before/after parotidectomy in 112 patients. Comparisons of 448 pairs of EMG signals revealed at least one signal decrease after FN dissection in 75 (67%) patients. Regional facial weakness was only found in 13 of 16 signals with >50% amplitude decreases. All facial dysfunctions completely recovered within 6 months. EMG amplitude decreases often occur after FN dissection. An amplitude decrease >50% in an FN branch is associated with a high incidence of dysfunction in the corresponding facial region. This study tries to establish a standard facial nerve monitoring (FNM) procedure and a proper facial function grading system for parotid surgery that will be useful for the future study of FNM in parotid surgery.

Case Report on Right Acoustic and Left Trigeminal Schwannoma, Hydrocephalus with Neurofibroma a Rare Case

A vestibular schwannoma or acoustic neurinoma, or acoustic neurilemoma is a slow growing benign tumor arises balance and hearing nerves in the inner ear. It is caused by overabundance of Schwann type of cell, which support and insulate nerve fibers, wrap onion skin around them. The nerves that control hearing and balance are impaired when vestibular schwannoma increases in size, resulting in hearing loss that is one-sided or asymmetric, tinnitus and loss of balance. When a tumor develops large enough, obstruct the facial nerve, resulting in numbness in the face. Vestibular schwannomas can also damage the facial nerve, resulting in facial weakness or paralysis on the tumor's side. If the tumor becomes large enough, it press against surrounding brain areas like the cerebellar and brainstem, posing a life-deteriorating hazard.(1) 17 years old male child was admitted in neuro ward with rare case of right acoustic and left trigeminal schwannoma, hydrocephalus with neurofibroma. In the present case, the treatment approach was mainly underwent in the form of right V.P.Shunt done and treated with antibiotics, antacids, anticonvulsants, analgesics, brain stimulants, protectants, multivitamins and other supportive treatment. Nurses have to play an important role to identify such type of symptoms and they should think critically, take action immediately to provide care to such type of patients.

Approach to Facial Weakness

Facial palsy is a common neurologic concern and is the most common cranial neuropathy. The facial nerve contains motor, parasympathetic, and special sensory functions. The most common form of facial palsy is idiopathic (Bell's palsy). A classic presentation requires no further diagnostic measures, and generally improves with a course of corticosteroid and antiviral therapy. If the presentation is atypical, or concerning features are present, additional studies such as brain imaging and cerebrospinal fluid analysis may be indicated. Many conditions may present with facial weakness, either in isolation or with other neurologic signs (e.g., multiple cranial neuropathies). The most important ones to recognize include infections (Ramsay-Hunt syndrome associated with herpes zoster oticus, Lyme neuroborreliosis, and complications of otitis media and mastoiditis), inflammatory (demyelination, sarcoidosis, Miller–Fisher variant of Guillain–Barré syndrome), and neoplastic. No matter the cause, individuals may be at risk for corneal injury, and, if so, should have appropriate eye protection. Synkinesis may be a bothersome residual phenomenon in some individuals, but it has a variety of treatment options including neuromuscular re-education and rehabilitation, botulinum toxin chemodenervation, and surgical intervention.

Embolic MCA Stroke Treated With tPA and TICI-3 Mechanical Thrombectomy Complicated by Hemiballismus: A Case Study and Literature Review

ABSTRACT This report examines the etiology of hemiballistic movements that began 24 hours after a 63-year-old male with vascular risk factors received tissue plasminogen activator (tPa) and thrombolysis in cerebral ischemia 3 (TICI3) thrombectomy for a left middle cerebral artery (MCA) ischemic stroke. The clinical course was reviewed from an admission at a large academic institution where assessments included physical exams, head and neck computed tomography angiography (CTA), and head magnetic resonance imaging (MRI) without contrast. The patient’s initial physical exam was consistent with a left MCA syndrome and included a National Institute of Health Stroke Scale (NIHSS) of 20. CTA showed an embolic M2 occlusion. After tPA and TICI 3 thrombectomy, NIHSS improved to 3 for dysarthria, facial weakness, and language deficits. MRI showed left insular diffusion restriction. New right-sided hemiballistic movements began 24 hours after treatment. At his six-week follow-up outpatient appointment, the movements were no longer present, and his neurologic exam was unremarkable, including an NIHSS of zero. No prior cases of hemiballism have been reported as a likely complication of treatment with tPa and thrombectomy. The globus pallidus is the suspected origin of the ballistic movements either from a decreased insular signal or embolic event during treatment. As stroke interventions improve, the susceptibility of certain tissues to brief ischemic events during treatment must be assessed.