Bell's Palsy

Question 1

what nerve is affected in bells palsy

Answer 1

facial nerve (CN VII)

Question 2

is it UMN or LMN

Answer 2

LMN

Question 3

what causes bells palsy

Answer 3

idiopathic

can be preceded by an upper respiratory tract infection so may have a post viral aetiology

Question 4

epidemiology

Answer 4

peak incidence at ages 20-50

Question 5

risk factors for bells palsy

Answer 5

pregnancy, upper respiratory infection and intranasal influenza vaccination

Question 6

before the onset of symptoms, what may the patient have

Answer 6

prodrome of pre-auricular pain

Question 7

symptoms of bells palsy

Answer 7

unilateral facial weakness and droop, including the forehead

Question 8

what muscles does bells palsy spare

Answer 8

extra-ocular muscles and muscles of mastication

Question 9

difference between a stroke and bells palsy

Answer 9

in a stroke, the forehead is spared

in a stroke, there will be weakness in the limbs (arms and legs) but in bells palsy this will not be the case

Question 10

what may an EMG show for a patient with bells palsy

Answer 10

local axonal conduction block

Question 11

management of bells palsy

Answer 11

The central component of Bell’s Palsy management is the prompt administration of oral steroids: 50mg OM for 10 days, followed by a taper.

Supportive treatments including artificial tears and ocular lubricants, and an eye patch/tape (especially if protective Bell’s phenomenon is absent) should be considered.

Question 12

what syndrome is bells palsy similar to

Answer 12

Ramsay hunt

Question 13

features of Ramsay hunt syndrome

Answer 13

prominent otalgia, and vesicular rash in the external auditory meatus, palate or tongue

Question 14

prognosis bells palsy

Answer 14

85-90% recover function within 2-12 weeks with or without treatment