Supranuclear 7th nerve palsy tongue deviation

[DFIB]

The Cincinnati Stroke Scale is a fundamental diagnostic checklist to discover the suspicion of stroke and useful for the early detection of CVA/TIA. We all use it frecuently.

I know I am preaching to the choir here but for context I will mention that it evaluates three major physical findings. 1. Facial droop 2. Motor arm weakness 3. Speech abnormalities

.

I have read that a fourth sign is a tongue deviation associated with supranuclear 7th nerve palsy and that the tongue will deviate toward the side of the weakness.

Do you have experience with this sign?

Do you include it in you differential evaluation of patients’ suspect of CVA/TIA?

[paramedicmike]

Disregard. I totally misread the OP.

Edited December 23, 2011 by paramedicmike

[DwayneEMTP]

Yeah...When I was in clinicals we had a positive Cin Stroke Scale and the medic asked the pt to stick out her tongue and move it from side to side, and she was unable to move it to one side, or move it well if I remember correctly.

I've used it since but have never seen it be so pronounced as in that patient, and have never verified that it is a valid marker for stroke, or anything else for that matter...it's just one of those things that kind of stuck..

Dwayne

[ERDoc]

A good neuro exam should test each of the cranial nerves. Your source is a little off with regards to the testing. Tongue protrusion is controlled by the 12th cranial nerve. If one of the 12th CNs are involved, the tongue will deviate to the affected side. CN 7 is responsible for the sense of taste in the anterior 2/3s of the tongue as well as controlling the muscles of facial expression, which is why it is known as the facial nerve.

Cranial nerve exams can help you locate a lesion in conditions besides strokes, such as tumors or abscesses.

Edited December 24, 2011 by ERDoc

[DFIB]

A good neuro exam should test each of the cranial nerves. Your source is a little off with regards to the testing. Tongue protrusion is controlled by the 12th cranial nerve. If one of the 12th CNs are involved, the tongue will deviate to the affected side. CN 7 is responsible for the sense of taste in the anterior 2/3s of the tongue as well as controlling the muscles of facial expression, which is why it is known as the facial nerve.

Cranial nerve exams can help you locate a lesion in conditions besides strokes, such as tumors or abscesses.

It is good to see you again doc! I have missed your comments.

Here is the refernce I used to pose the question. I gues I interpreted it wrong.

http://www.ncbi.nlm.nih.gov/pubmed/11070377

Edited December 24, 2011 by DFIB

[paramedicmike]

You know, my original reply that I deleted above touched on what ERDoc said especially the part about cranial nerve innervation. After I posted it I read something about tongue deviation with a CN VII nerve palsy, thought my reply had nothing to do with the OP, so I erased it. I guess that was kinda' dumb.

That being said, my stroke assessment starts with the Cincinnati Stroke Scale. But then I move to include additional CNs attempting to test as many as I can. I catch a fair amount of grief about it as well.

[flamingemt2011]

http://www.clinicalexam.com/pda/n_cranial_nerves_exam.htm

How to test each nerve.

[ERDoc]

It is good to see you again doc! I have missed your comments.

Here is the refernce I used to pose the question. I gues I interpreted it wrong.

http://www.ncbi.nlm....pubmed/11070377

I think the issue is more with the wording in the article. I've only read the abstract, but it sounds like they are saying that tongue deviation is ASSOCIATED with a CN7 palsy, not CAUSED by a CN7 palsy.