Bells Palsy
Bell’s palsy involve the 7th cranial nerve and results in paralysis of the facial muscles, both the upper and lower part of the face. Evaluate eye closure may need eye protection Mild to moderate Prednisone 60-80 daily for 7 days Severe to complete Prednisone as above Valacyclovir (Valtrex) 1...
Trigeminal Neuralgia
Unilateral electric shock like pain involves one or more division of Trigeminal nerve over 80% caused by an aberrant loop of artery Less common: acoustic neuroma, meningioma, cyst, rarely an aneurysm or avm Treatment Carbamazepine, (Tegretol) most studied and effective. Start 100 to 200 mg bid, up to max...
Ramsey Hunt syndrome
aka: herpes Zoster oticus Triad: ipsilateral facial weakness, ear pain, vesicles on the ear. May also have: ipsilateral taste change, tongue lesion, haring abnormality and lacrimation. May have vestibular disturbances. Cause: reactivation of virus in geniculate ganglia, spread to VIII nerve. Treatment: Valtrex 1 g tid x 7 day...
Meniere and vertigo
Meniere disease: triad of episodic vertigo, tinnitus, hearing loss Meniere syndrome: above from other inner ear disorders Treatment Avoid high salt, caffeine, alcohol, nicotine, stress MSG Vestibular rehabilitation Vasodilator: Betahistine 8-16 mg tid, available only as compounded preparation in US Diuretic: hctz 25 mg/Triamterene 37.5 mg = Dyazide As...