Heck, no neuralgia is fun to have. Been there, done that, and they don't have tee-shirts for it.

Fidelio, it's a hell of a thing when you're glad of an abscessed tooth.

Jim, you left out vaso-vagal syncope and Bell's palsy.

Now I'm wondering about the neurological cause of eyelid twitches (which, to my consternation, I get when I've been suffering low-grade cumulative sleep-dep.)

Damn it, the kitten is trying to type again.

Fortunately it's not a migrane - I think it's a side effect of the sluggish healing of a separated shoulder/whiplash[0]. Weird though - it's like having patches of white hot electricity lashing around different parts of the outside of skull, depending on which part of my shoulder/neck/arm complex is least happy, or under the most stress. All in all, not recommended - and unfortunately persistent.

[0] separate times, but clearly not failing to indulge in feedback between injuries
[1] I am seeing a physiotherapist for this, but job stress isn't exactly helping with the entire process

I didn't leave out vaso-vagal syncope, Teresa. I just didn't use that exact term. Stimulating the vagus slows the heart, dilates the blood vessels, and lowers the blood pressure. Usually people who vague out are out for less than a minute, don't lose bowel or bladder control, and know where they are the moment they wake up.

There's been some interesting stuff in stimulating the vagus to deal with (some kinds of) epilepsy, (some kinds of) depression, and hiccups.

Not that this is a complete treatise of the anatomy of the cranial nerves and their associated disorders. Generally speaking, if there's something wrong with your body you should go ask someone who passed medical school about it.

I have a recollection of the vagus nerve being routinely mentioned by old-time forensic pathologists, and then it almost falling out of fashion as a factor in strangulation. One martial arts type I used to know attributed the Spock Pinch to the blood flow in the carotid arteries, but what I recall she told me makes more sense if the vagus nerve is involved.

Weird thought--does anal sex slow the heart?

Steven Gould used the vagus nerve interestingly in his novel Reflex, where it figures in the answer to the question, "How do you enslave a teleport?".

The voice of Professor Goldman explained, "This frame gave us our key, but we do not claim any clear knowledge of what these inscriptions mean. Medical authorities consulted have suggested that a certain type of irritation of the tri-geminal nerve can result in the most trying pain man knows. The line from Keats is utterly meaningless, so far as we can determine; the reason for its inclusion remains to be explained in the future, if ever. The remaining frames, as you see, are in the hieroglyph."

I doubt I shall ever do the experiment, though not because of any strong aversion to the particulat sexual activity. There are other inhibitions.

And getting the grant for the research? "Let me get this straight. You want to wire volunteers up so as to monitor heartrate, blood pressure, and other medical data, while they indulge in deviant sexual practises? Let me remind you. It's an election year, and every gay Republican in Washington will be looking for a distraction like this to point at."

I wonder if I ought to try the Banzai Institute.

But I think that, if you want to slow someone's heart, splashing water on the face to trigger the diving reflex is probably easier and more convenient for all concerned than what Xopher (IIRC) once memorably described as "hhrghghlhghgling".

I fear somebody may already be working on the movie. If so, I don't want my name in the credits.

My 85yo mom finds that her trigeminal neuralgia gets triggered by a blast of cold air on her face, so aside from the drug therapy, her best bet is wrapping up with scarves like an Arctic explorer. I've offered to knit her a ski mask, but so far she isn't going for it.

(The condition seems to have been brought on by shingles, which is another 'interesting' condition that someone :: looks nonspecifically in Jim's direction :: might go into at some point.)

In a nutshell (and this isn't my research, so some of the details may be off):
RSA = how reactive your heartrate is to your breathing patterns - normally, when you inhale, heartrate increases slightly and decreases when you exhale. People under chronic stress or who have less vagal 'tone' do this less - their heartrate is less reactive to respiration.

Some correlational research has shown RSA to be positively linked to expression of positive emotions, satisfaction with life/well-being, etc.
Research is being done that looks at it in the context of people who are flourishing (vs. depressed or languishing) to see what other factors may be playing a role.

It's theorized that it may be one of the physiological factors underlying the Build aspects of positive emotions (the idea that frequent experiencing of positive emotions builds emotional and physical resources for future need).

Neat stuff. Thanks for posting this!

James P. @20:
I also heard that version, though yours is missing the last two words: "Such Happiness!" Which makes it work with the missing ones.

Unlike many of the things I memorized in nursing school (such as the origin, insertion, function, and innervation of all the human body's muscles), this set has stuck with me permanently.

In veterinary school, we learned the mnemonic as "On Old Olympus Towering Top, A Fat Vagrant German Viewed Some Hops", taking into consideration the official name change of "Auditory" to "Vestibulo-Cochlear".

Shingles causes neuropathic pain related to the recrudescence of herpes virus (Varicella-Zoster Virus) from the trigeminal or facial (or other nerves). A shingles outbreak always follows the nerves from which the virus reactivated. For more specific information about it, you can go to the NIH website: http://nihseniorhealth.gov/shingles/aboutshingles/01.html

Bell's Palsy is -- as mentioned above -- related to the Facial nerve, in my patients specifically where it crosses around the external ear canal. In humans, it's a number of causes, including diabetes and viral infections. In some people, the cause of the paralysis is not known. It usually heals slowly, with anti-inflammatory treatment, although the idiopathic variety might not respond to treatment. http://www.nlm.nih.gov/medlineplus/bellspalsy.html

::relurks::

The first time, I almost threw up. The dentist sent me home.

The second time, I was having some work done at a dental school. I told the student that giving me lidocaine was probably a Bad Idea. He insisted on doing it ("allergy to lidocaine is extremely rare"), and I thought well, what the hell. Let's find out if I'm really allergic to this stuff.

Nausea, light-headedness, blood pressure drop.

The student hollers for the resident. The resident hollers for the prof. Every non-occupied student on the floor tries to squeeze into the treatment cubicle. They're all staring at me.

Prof: "This is vaso-vagal syncope. It is uncommon but not rare. You will notice that the patient's blood pressure is dropping and that the face looks pale. If you lower the head and allow blood to flow towards the brain ..."

And, eventually they did lower my head and I was fine enough for them to go on.

I suppose I should get some kind of medic alert thing.

Dave Bell @ 13:

There are many (though not quite infinite) ways of "strangling" someone, varying from applying pressure on the windpipe, both cartoid arteries or by assorted nerve pinching.

In my experience, it's much easier to get either pure windpipe or combined windpipe and cartoid artery strangling to work, since the nerve bundles are tricky to get to (you need to poke fingers in, it's a small target and it's not entirely obvious when you've hit the right spot with an agitated non-cooperating subject), whereas pressure to the arteries and windpipe involves target areas that are small in at most one direction. Yes, martial arts class were, at times, quite interesting, in most senses of the word.

Yikes! You were damn lucky; too many times, that thought turns out to be the precursor to a visit to the ER. My reaction to something like that would be along the lines of, "Okay, bubba, who are you going to believe -- your book, or the patient who damn well knows her OWN MEDICAL HISTORY?" And if he still insisted, then I'd be the one hollering for the resident.

The other "explanation" I've heard from dentists is "fear of needles causing anxiety". Never mind that, other than the normal discomfort when having a large, pointy object stuck into one's mouth, I have no problem with injections; and that the only times I've had this reaction have been with the same specific drug. I tell them now to give me carbocaine instead, which actually requires more frequent injections. No side effects there.

I would like to know more about why I did have vaso-vagal from lidocaine, though.

I did in fact talk to a Real Live Neurologist about this - she did the battery mentioned in the linked page, and told me to come back if I have any new symptoms. Of any kind. I don't know if that includes talking to my nerves, though.

By the way, it resolved on its own in a week or two.

Did he clean it up for me?

My favorite mnemonic for the cranial nerves was "Oh, once one takes the anatomy final, a good vacation sounds heavenly." Then they went and changed "auditory" to "vestibulocochlear" and "spinal accessory" to "accessory" and screwed up a good mnemonic.

re weird experiments with the cranial nerves, my favorite involves pouring cold water in somene's ear to induce nystagmus. Also, in patients with "left neglect", this can make the neglect disappear temporarily. Good stuff.

Carol @ 41: Actually, I think either you remembered it wrong...

It's most likely my memory from the late 60's. I remember that he pointed to and named the corresponding bones right after the mnemonic, and showed how you ask the person to make the "salt cellar" depression where you check for a fracture. On car trips we used to trace drops of blood through the body (with those tricky pulmonary arteries and veins having the oxygenation backward), go through the alphabet (the valued "xiphoid process" surfaces again here), and so on.

The only other possibility was that there was a nomenclature change, as I prefaced the question with, "When you were in med school..." (during WWII).

Never Lower Tilly's Pants, Grandma Might Come Home lists the bones in the wrist under their old names:

Navicular, Lunate, Triquetrum, Pisiform, Greater multangular, Multangular lesser, Capitate, Hamate

The new names are Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate.

Used to be that the Navicular was the most commonly fractured bone in the human body. Now the Scaphoid is the most commonly fractured bone.

Speaking of the facial nerve (Cranial nerve VII): its terminal branches are Temporal, Zygomatic, Bucccal, Marginal mandibular, and Cervical. The mnemonic is To Zanzibar By Motor Car.

I do know that unconsciousness in concussion is caused by a mechanical/chemical disruption of the brain, and that the damage from multiple concussions is cumulative.

I believe that in addition to the classic punch to the jaw, that a sudden downward jerk on an arm can have the same effect.

And I'm told that these days, in student sports, that if a player is knocked out, that he's benched for a minimum of two weeks. If he's knocked out again, he's benched for a minimum of a month. And if he's knocked out a third time, he's benched until next season (the next year).

My father used to recite this mnemonic once in a while. He graduated from NYU Medical School ca. 1939. I wonder how far back these mnemonics go.

There are a number of sites that have free downloads of hundreds of medical mnemonics. I don't have that much room on my hard drive right now, so I'm going to wait on that, but I did sample a few. Some, which make reference e.g. to Bob Marley or Randy Travis, are obviously of recent origin. But I suspect there are quite a few that go back a long time.

Incidentally, "Bell's palsy" is itself a mnemonic for its own symptoms:

"BELL'S Palsy:
Blink reflex abnormal
Earache
Lacrimation [deficient, excess]
Loss of taste
Sudden onset
Palsy of VII nerve muscles
· All symptoms are unilateral."

That's interesting. I wonder if there are any martial arts that use that technique for that specific reason. EMT-fu?

Since Colonel Fairbairn taught that technique to British commandos during WWII for just that reason, I suspect so.

Hm. I saw a demonstration on, er, one of the light science shows on British telly, showing a knock-out done with a palm strike to the side of the neck, centred slightly lower than the ear (the camera man wasn't concentrating on getting perfect shots of the impact), with the stricken person having an assortment of brain activity sensors on them and an assisting doctor, showing that the brain activity read-out did indeed indicate that they were completely unconcious. If the footage wasn't edited for time, they seemed to be out for 15-30 seconds.

This happened to a friend of mine. He was camping. Got up in the middle of the night to take care of business. Next thing he knows he's waking up a minute later unable to move and in pain because he'd passed out, fallen down, and broken his collarbone. (His camping companion was able to get him appropriate help. He's all better now.) Apparently his heart had stopped temporarily, or his blood pressure had simply lowered dramatically, while he was urinating. Something to do with the combination of that bodily process and really cold weather. He told us the medical name for the syndrome, but I can't remember it, or how rare it was said to be.

Remember, kids, always have something to lean on when you're doin' yer stuff!

So I've been walking around for the last 48 hours or so with a sort of mnemonic ear-worm: something about a fat-assed German has been repeating in a sort of sub-volitional way, the rhythm being just about exactly keyed in to something - or maybe, my mind demanding the extra time to close that open circuit. I'll have to take the time to memorize it, or risk insulting nearby Germans (with admirable anatomies and beer-drinking habits).

When I was in nursing school, the one that went around was nearly the same as the Robertson Davies version, except instead of "and hymen" it just ended in "AH!"

* He'd have approved the description, and loved a good grisly EMT story as long as he didn't have to see it.

If I remember correctly, the carotid sinus pressure sensors are connected to Cranial Nerve IX (Glossopharangeal), and from there, after the brain receives the message, Cranial Nerve X (Vagus) gets stimulated to slow the heartbeat to lower blood pressure.

But I could be entirely wrong.

=========

Commentary on cold-induced stuff (I talked about this at length in Cold Blows the Wind Today).

One thing that happens when you get cold is the blood vessels in your extremities contract to keep warm blood in your trunk. That raises your blood pressure. The body does a couple of things about that -- slowing the heart, and dumping water out through the kidneys -- to lower blood pressure. When you get warm again, and the extremity vessels open up, bingo, you're dehydrated.

Other things to think about when going into a cold environment include Mammalian Dive Reflex, when something cold hits you in the face. That can lower heart rate dramatically.

Standing up suddenly from a lying position, can put you into Positional Hypotension. The large vessels of the legs may be more dilated when you're horizontal. Stand up suddenly and the blood flows into them before they can constrict, and suddenly there isn't enough blood to pump all the way to the brain. Down you go. (I'm certain that anyone who's stood up suddenly after lying in a warm bath and felt light-headed knows what I mean by this.) Hard to tell what happened to the guy in the woods. Could be he slipped on the ground, broke his collar bone, and picked up a mild concussion too -- with retrograde amnesia so he doesn't remember the events immediately before the fall. Brief memory loss around the time of the event in head trauma is way common.

Being off your meds can have all kinds of bad effects. Diuretics are often given for high blood pressure, in order to dump fluids. Someone who's off their meds might possibly have dangerously high blood pressure, and here you get into danger of stroke and other badness. Hypertension is all-around not good for you. It puts extra strain on your heart, for example. I'm not a doctor, I can't diagnose nor prescribe, and I darned sure wouldn't even try if I were a doctor -- not from a brief description of a patient I hadn't seen.

In general, on meds, take them as prescribed. If you don't know what they're for, or you think there may be unintended interactions, ask questions of your doctor until you're satisfied that you understand.

Plus, sometimes bad stuff happens without an obvious cause. One thing is certain about this life -- no one gets out of it alive.

(pokes around a bit for their names: Lynne Cox and Lewis Pugh)

A related item from Richard Gordon's early "Doctor in the House" books also stuck in my head:

The lingual nerve
Took a swerve
Around the Hyoglossus*;
"Well, I'm mucked**",
Said Wharton's duct,
"The blighter's double-crossed us!"

*Typoed thus in my copy.
**Euphemism suspected, rather than typo.

Jon@30: how long ago was this? My previous (retired) dentist was complaining 30 years ago about the increasing tendency to working on patients that were effectively lying down rather than sitting back; his replacement has done all the (too much) required work with me horizontal. It obviously makes working on the maxilla easier, but may also be a reaction to anesthesia-related syncope.

bad news.

I was told that lidocaine was the only thing they had strong enough for what had to be done: removing the decayed remains of a dead tooth. After they lowered my head and allowed me to recover from the syncope, the anesthetic effect did work long enough for them to get the mess out. I was a little annoyed that the remains weren't salvagable; I could have used the dollar (or whatever the going rate is now; when I was ten it was a nickel).

Over the weekend, I went to visit my mother. She complained of eye pain. My brother and I started to take her to the doctor, and saw how her face was drooping on one side. We looked at her, and then each other, and thought, another TIA, or even another stroke. An ER visit followed promptly.

Finding out it was Bell's Palsy was quite a relief. Completely idiopathic, as far as anyone can tell. Two days later, she was mostly back to normal. I think she's paying us back for all those late nights she spent taking care of us when we were sick, and not a few ER visits at 3 am.

Oh, Oh, Oh, To Touch And Feel Veronica's Giant Vagina And Hymen

(Olfactory, Optic, Occularmotor, Troclear, Trigeminal, Abducent, Facial, Vestibulocochlear, Glossopharyngeal, Vagus, Accessory, Hypoglossal)

courtesy of my daughter, class of 2011.

I don't know, but if you find out can you tell me?

Here's my take on this, since I do admit patients who can't follow directions/commands, and I also admit patients who do not need thorough cranial nerve testing (like knee or hip replacement patients for example - they typically don't have anything neuro going on). Typically I state my findings as "cranial nerves II through XII appear intact and symmetric" since cranial nerve I isn't commonly testable by observation.

I - if pt states he can smell, that's intact; or if he reacts in some way to a conveniently available noxious or strong smell, that's probably intact

II - if pt can see, that's probably intact

III, IV, VI - extraocular movements intact, can be observed

V - am not really sure... that's tested by touching the face. But if pt can be observed to blink in reaction to noxious stimuli in the eye (again, you have to have a conveniently available noxious stimulus like dust blown by the wind) then V should be intact because the blink reflex is cranial nerves V and VII.

VII - observe facial symmetry while talking, smiling, or even at rest

VIII - can the pt hear? that's probably intact

IX, X - if pt talks without dysarthria, and/or can be observed to swallow, that would be intact

XI - if pt is able to shrug shoulders and move head from side to side (sternocleidomastoid) that's probably intact

XII - if pt can move tongue adequately to talk clearly, or eat without difficulty that should be intact too (I test this along with inspecting the throat, by asking the patient to say "aah" and stick out his tongue)

A sudden loud noise or bright light wouldn't count as noxious stimuli for CN V testing - she said it had to touch the eye to test the corneal reflex. Noise would test VIII + VII, bright light II + VII.
You could pretend to remove a speck of dirt from the face, though.