Facial neuropathy

[latinman]

Female in 40's with complaint of facial paralysis. Patient with surgery done in past to resect vestibular schwanomma. Surgery done on Oct 2012. Presented to clinic for EMG/NCS study.

Interpretations

1) Left facial motor nerve CMAP recording at the nasalis (V2) and stimulating at the anterior mastoid revealed no response. Right facial motor nerve CMAP recording at the nasalis (V2) and stimulating at the anterior mastoid revealed amplitude response.

2) Left facial motor nerve CMAP recording at the orbicularis oculi (V1) and stimulating at the anterior mastoid revealed no response. Right facial motor nerve CMAP recording at the orbicularis oculi (V1) and stimulating at the anterior mastoid revealed amplitude response.

3) Blink Reflex for the left side of the face (V1/Supraorbital nerve) stimulating at the superior orbital fissure and recording at the orbicularis oculi revealed absent R1 and R2 latencies. Blink Reflex for the right side of the face (V1/Supraorbital nerve) stimulating at the superior orbital fissure and recording at the orbicularis oculi revealed R1 and R2 latencies.

4) EMG of left nasalis and orbiculars oris muscles was carried out. There was evidence of atrophy and chronic abnormal spontaneous activity/dennervation. No reinnervation was appreciated, and recruitment seemed to be from distal/contralateral nerve motor units.

5) EMG of orbicularis oculi muscle was technically difficult to carry out bilaterally.

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[deleted185747]

Very nice case; looks like a left trigeminal ganglion lesion.

 

[neurodoc]

Very nice case; looks like a left trigeminal ganglion lesion.

No. This is a LMN CN7 lesion, probably due to trauma from the surgery to remove the CN8 Schwannoma. CN7 is nearby and can be injured during this surgery. The Gasserian Ganglion is in a different location and can't be injured in this surgery, and furthermore the facial nerve does not run in the GG... The GG is along the pathway of CN5.