Bell's Palsy Flashcards
What is Bell’s palsy?
an acute, sudden onset unilateral facial palsy
What is the usual cause of Bell’s palsy?
- unknown
- reactivation of HSV-1
What can increase risk of getting Bell’s Palsy?
- Risk in pregnancy increase 3x
2. And in diabetes 5x
What is the onset for Bell’s palsy like?
abrupt
What are RF for Bell’s palsy?
- Black or Hispanic ancestry
- Arid/cold climate
- Hypertension
- Diabetes
- Pregnancy
- Internasal influenza vaccination
- Positive FHx
What are symptoms and signs of Bell’s palsy?
- Unilateral
- Absence of constitutional symptoms
- Involvement of all nerve branches
- Pain
- Synkinesis
- Keratoconjunctivitis sicca
- Decrease taste
- Numbness
- Hypersensitivity to sounds
What are possible DDx of Bell’s palsy?
- Herpes zoster oticus
- Lyme disease
- Benign/malignant facial tumour
- Blunt force trauma to face or temporal bone
- Cerebrovascular accident
What investigations do you do for Bell’s palsy and why?
- Clinical diagnosis of exclusion
- Electroneuronography
- Needle electromyography
- Serology for Borrelia burgdorferi (high in Lyme)
- MRI for SOL and stroke
- Unable to wrinkle forehead
What is the management plan for Bell’s palsy?
- High dose corticosteroids e.g. prednisolone
- Eye protection
- Concomitant antiviral agents
- Severe: surgical decompression
- Physiotherapy
What are some complications of Bell’s Palsy?
- Keratoconjunctivitis sicca, exposure keratopathy and ulcerative keratitis
- Ectropion
- Contracture and synkinesis
- Gustatory hyperlacrimation
What is the general prognosis of Bell’s palsy?
- Usually 72hrs of onset
- Demonstrate any return of hemi-facial tone or movement within 4 to 6 months suggests alternative diagnosis
What is incomplete paralysis in Bell’s palsy prognosis?
recover within few weeks
What is complete paralysis in Bell’s palsy prognosis?
80% make full recovery but 15% have axonal degeneration (can have synkinesis and crocodile tears)
What is Keratoconjunctivitis sicca?
dry eye unable to close
What is thebhypersensitivity to sounds like in bell’s palsy?
hyperacuisis (stapedius paralysis (impaired stapedius reflex)
