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Facial Nerve Palsy (Examination (Pons → Millard-Gubler Syndrome (CN6…

- - - - Facial anaesthesia + absent corneal reflex
        
        LR palsy
        
        LMN facial nerve palsy
        
        SNHL
        
        DANISH
  - - - Examine limbs for ipsilateral spasticity
      - Examine visual fields: ipsilateral homonymous
        hemianopia
    - - Look in ears
        
        Examine PNS, CN and cerebellar function
        
        Test taste
- - - - Eye dryness
      - Drooling
      - ↓ taste: ageusia
        
        Aguesia and Hyperacusis
        
        Chorda tympani and nerve to stapedius arise just distal
        to geniculate ganglion w/i the temporal bone.
        
        Loss of these functions indicates a proximal lesion
        
        Common in Ramsay Hunt: VZV @ geniculate ganglion
      - Hyperacusis
  - - - May predict delayed recovery when performed @ 2wks
  - - - Synkinesis: e.g. blinking causes up-turning of mouth
      - Crocodile tears: eating stimulates unilateral lacrimation, not salivation
- - - - Pontine: vascular, MS, SOL
        
        CPA: vestibular Schwannoma, meningioma, secondary
        
        Intra-temporal: Ramsay Hunt, Cholesteatoma, trauma
        
        Infra-temporal: Parotid tumour, trauma
        
        Systemic
        
        Neuropathy: DM, Lyme, Sarcoidosis
        
        Pseudopalsy: MG
- - - - Inflammatory oedema → compression of
        
        CNVII in narrow facial canal
        
        Probably of viral origin (HSV1)
        
        Features
        
        Sudden onset
        
        Complete LMN facial palsy
        
        Ageusia: corda tympani
        
        Hyperacusis: stapedius
        
        Assoc w/ other CN involvement in 8%