Cost-Effective Evaluation and Management of Cranial Neuropathy

Cost-Effective Evaluation and Management of Cranial Neuropathy
Title Page
Copyright
Dedication
Contents
Foreword
Preface
Contributors
1 Introduction to Cost-Effective Evaluation of Cranial Neuropathy
	1.1 Introduction
	1.2 Cranial Nerves
	1.3 Neuropathy
	1.4 The Clinical Challenge of Cranial Neuropathy
	1.5 An Increased Interest in Cost-Effectiveness
	1.6 Cost-Effectiveness in Cranial Neuropathy
2 Cranial Nerve I: Olfactory Nerve Disorders
	2.1 Introduction
	2.2 Epidemiology
	2.3 Anatomy and Physiology of Olfaction
	2.4 Diagnostic Evaluation
		2.4.1 History of Present Illness
		2.4.2 Physical Examination Findings
		2.4.3 Olfactory Testing
		2.4.4 Diagnostic Imaging
	2.5 Cost-Effective Evaluation of Olfactory Dysfunction
		2.5.1 Olfactory Testing
		2.5.2 Diagnostic Imaging Cost-Effectiveness
	2.6 Management
		2.6.1 Post-Viral Olfactory Dysfunction
		2.6.2 Sinonasal Disease
		2.6.3 Trauma
		2.6.4 Neurodegenerative Conditions
		2.6.5 Smell Training
	2.7 Conclusion
3 Cranial Nerve II: Visual Disorders
	3.1 Initial Evaluation and General Considerations
		3.1.1 History
		3.1.2 Physical Examination
		3.1.3 Indications for Urgent Referral and Diagnostic Testing
	3.2 Vascular
		3.2.1 Anterior Ischemic Optic Neuropathy
		3.2.2 Posterior Ischemic Optic Neuropathy
		3.2.3 Hypertensive Retinopathy
		3.2.4 Diabetic Papillitis
	3.3 Infectious
		3.3.1 Infectious Neuroretinitis
	3.4 Compressive/Neoplastic
		3.4.1 Compressive Optic Neuropathy
		3.4.2 Infiltrative Optic Neuropathy
	3.5 Degenerative
		3.5.1 Glaucoma
	3.6 Inflammatory/Autoimmune
		3.6.1 Optic Neuritis
		3.6.2 Sarcoidosis
		3.6.3 Other
	3.7 Hereditary Optic Neuropathy
		3.7.1 Dominant (Kjer) Optic Atrophy
		3.7.2 Leber Hereditary Optic Neuropathy
	3.8 Congenital Optic Disc Abnormalities
	3.9 Traumatic
		3.9.1 Traumatic Optic Neuropathy
	3.10 Metabolic
		3.10.1 Toxic Optic Neuropathy and Nutritional Optic Neuropathy
	3.11 Idiopathic
		3.11.1 Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)
	3.12 Conclusion
4 Cranial Nerves III, IV, VI: Ocular Motor Cranial Nerve Disorders
	4.1 General Considerations
		4.1.1 Diplopia
		4.1.2 Cranial Nerve III, IV, and VI Palsy
	4.2 Vascular
		4.2.1 Stroke
		4.2.2 Aneurysm
		4.2.3 Cavernous Sinus Fistula
	4.3 Infectious
		4.3.1 Herpes Zoster, Syphilis, Lyme Disease, and HIV
	4.4 Neoplastic
		4.4.1 Leptomeningeal Carcinomatous
		4.4.2 Other Tumors
	4.5 Inflammatory/Autoimmune
		4.5.1 Thyroid Eye Disease
		4.5.2 Myasthenia Gravis
		4.5.3 Miller Fisher’s Syndrome
		4.5.4 Tolosa–Hunt Syndrome
		4.5.5 Demyelinating Disease: MS-Related INO
		4.5.6 Vasculitides
	4.6 Congenital
		4.6.1 Congenital Fourth Nerve Palsy
		4.6.2 Brown Syndrome
		4.6.3 CPEO and KSS
	4.7 Trauma
		4.7.1 Trauma-Induced Palsies
	4.8 Metabolic/Toxic
		4.8.1 Diabetes
		4.8.2 Wernicke Encephalopathy
		4.8.3 Medication, Toxin, Vitamin Deficiency–Induced Ophthalmoparesis
	4.9 Idiopathic
		4.9.1 Idiopathic Intracranial Hypertension
	4.10 Conclusion
5 Cranial Nerve V: Trigeminal Nerve
	5.1 Introduction
	5.2 Anatomy
	5.3 Clinical Evaluation
	5.4 Differential Diagnosis
	5.5 Diagnostic Evaluation and Challenges
	5.6 Medical Management
	5.7 Surgical Management
	5.8 Outcomes
	5.9 Conclusion
6 Cranial Nerve VII: Facial Nerve Disorders
	6.1 Introduction
	6.2 Anatomy
	6.3 Clinical Assessment
	6.4 Peripheral versus Central Lesions
	6.5 Diagnostic Studies
	6.6 Differential Diagnosis
	6.7 Bell’s Palsy
		6.7.1 Clinical Features
		6.7.2 Electrodiagnostic Studies
		6.7.3 Medical Treatment
		6.7.4 Surgical Decompression
		6.7.5 Bell’s Palsy Clinical Guidelines
	6.8 Herpes Zoster Oticus
	6.9 Trauma
	6.10 Acute Otitis Media
	6.11 Chronic Otitis Media
	6.12 Lyme Disease
	6.13 Facial Nerve Tumors or Neoplasm
	6.14 Cost Discussion
		6.14.1 Cost-Effective Treatment Algorithm
	6.15 Long-Term Sequelae of Facial Paralysis
7 Cranial Nerve VIII: Hearing Disorders
	7.1 Introduction
	7.2 Hearing Loss
		7.2.1 Auditory Anatomy and Physiology
		7.2.2 Epidemiology and Economic Impact of Hearing Loss
		7.2.3 Clinical Approach of Hearing Loss
		7.2.4 History
		7.2.5 Physical Examination
		7.2.6 Audiological Evaluation
		7.2.7 Pure-Tone Audiometry
		7.2.8 Speech Audiometry
		7.2.9 Acoustic Immittance Testing
		7.2.10 Otoacoustic Emissions
		7.2.11 Auditory Evoked Potentials
		7.2.12 Imaging
	7.3 Cost-Effective Clinical Approach to Specific Hearing Loss Disorders
		7.3.1 Presbycusis
		7.3.2 Asymmetric Sensorineural Hearing Loss
		7.3.3 Sudden Sensorineural Hearing Loss
		7.3.4 Conductive Hearing Loss
		7.3.5 Otitis Media with Effusion
		7.3.6 Chronic Otitis Media
		7.3.7 Otosclerosis
	7.4 Acoustic Neuroma/Vestibular Schwannoma
		7.4.1 Diagnosis
		7.4.2 Treatment
	7.5 Newborn Hearing Evaluation
	7.6 Cochlear Implants for Profound Sensorineural Hearing Loss
	7.7 Cost–Utility Analysis
	7.8 Outcome Measurements
	7.9 Unilateral Pediatric Implantation
	7.10 Bilateral Pediatric Implantation
	7.11 Unilateral Adult Implantation
	7.12 Bilateral Adult Implantation
	7.13 Conclusion
8 Cranial Nerve VIII: Vestibular Disorders
	8.1 Vestibular Anatomy and Physiology
	8.2 Overview of Dizziness
	8.3 Epidemiology and Economic Impact of Dizziness
	8.4 History
	8.5 Physical Examination
	8.6 Laboratory Testing
		8.6.1 Cost-Effectiveness of Laboratory Testing for Peripheral Vestibular Disorders
		8.6.2 Videonystagmography/Electronystagmography
		8.6.3 Caloric Testing
		8.6.4 Gaze Test
		8.6.5 Dix–Hallpike Maneuver
		8.6.6 Saccades
		8.6.7 Positional Test
		8.6.8 Smooth Pursuit
		8.6.9 Rotary Chair Testing
		8.6.10 Video Head Impulse Test
		8.6.11 Electrocochleography
		8.6.12 Vestibular Evoked Myogenic Potential Testing
		8.6.13 Cervical Vestibular Evoked Myogenic Potential
		8.6.14 Ocular Vestibular Evoked Myogenic Potential
		8.6.15 Computerized Dynamic Posturography
		8.6.16 Radiology
	8.7 Treatment
		8.7.1 Benign Paroxysmal Positional Vertigo
		8.7.2 Meniere’s Disease
		8.7.3 Vestibular Neuronitis
		8.7.4 Labyrinthitis
		8.7.5 Vestibular Schwannoma
		8.7.6 Perilymph Fistula
		8.7.7 Superior Semicircular Canal Dehiscence
	8.8 Vestibular Physical Therapy
	8.9 Central Vertigo
	8.10 Conclusion
9 Cranial Nerves IX, X, XII: Dysphagia
	9.1 Normal Swallowing Mechanism
	9.2 Initial Workup
		9.2.1 Symptoms
		9.2.2 History
		9.2.3 Examination
	9.3 Differential Diagnosis
	9.4 Workup
		9.4.1 Imaging
		9.4.2 Modified Barium Swallow Study
		9.4.3 Fiberoptic Endoscopic Evaluation of Swallowing
		9.4.4 Imaging of Brain
		9.4.5 Imaging Skull Base
		9.4.6 Imaging of Neck
	9.5 Nonsurgical Treatment
		9.5.1 Dysphagia and Voice Therapy
	9.6 Surgical Management
		9.6.1 Tracheostomy
		9.6.2 Passy–Muir Valve
		9.6.3 Treatment of the Cricopharyngeus Muscle
		9.6.4 Vocal Cord Medialization and Arytenoid Adduction
	9.7 Treatment of Velopharyngeal Insufficiency
	9.8 Definitive Surgical Treatment
		9.8.1 Laryngeal Closure Procedures
		9.8.2 Partial Resection of the Cricoid Cartilage
		9.8.3 Laryngotracheal Separation
		9.8.4 Total Laryngectomy
		9.8.5 Laryngeal Stents
	9.9 Conclusion
10 Cranial Nerve X: Dysphonia
	10.1 Initial Presentation
		10.1.1 Symptoms
		10.1.2 History
		10.1.3 Examination
	10.2 Workup
		10.2.1 Imaging
		10.2.2 Serology
		10.2.3 Laryngeal Electromyography
		10.2.4 Dysphagia Evaluation
	10.3 Treatment
		10.3.1 Voice Therapy
		10.3.2 Injection Medialization
		10.3.3 Laryngeal Framework Surgery
		10.3.4 Laryngeal Reinnervation
	10.4 Conclusion
11 Cranial Nerve XI: Spinal Accessory Neuropathy
	11.1 Introduction
	11.2 Anatomy
	11.3 Pathophysiology
	11.4 Clinical Presentation
	11.5 Diagnostic Workup
	11.6 Treatment
	11.7 Conclusion
12 Radiology in Cranial Neuropathy
	12.1 Introduction
	12.2 Cranial Nerve I: Olfactory Nerve
	12.3 Cranial Nerve II: Optic Nerve
	12.4 Cranial Nerves III, IV, and VI: Oculomotor, Trochlear, and Abducens Nerves
	12.5 Cranial Nerve V: Trigeminal Nerve
	12.6 Cranial Nerve VII: Facial Nerve
	12.7 Cranial Nerve VIII: Vestibulocochlear Nerve
	12.8 Cranial Nerves IX, X, and XI: Glossopharyngeal, Vagus, and Spinal Accessory Nerves
	12.9 Cranial Nerve XII: Hypoglossal Nerve
	12.10 Multiple Cranial Neuropathies
	12.11 Conclusion
13 Conclusion and Discussion Points
Index