Bell's Palsy

Question 1

What is Bell’s Palsy?

Answer 1

Acute unilateral peripheral facial nerve palsy.

Idiopathic- physical examination and history need to be otherwise unremarkable.
Consists of deficits affecting all facial zones equally that fully evolve within 72 hours.
Clinical diagnosis of exclusion.

Complete recovery in 70% cases

Question 2

Other types of facial palsies? (Not Bell’s Palsy, 3)

Answer 2

Ramsay-Hunt, Lyme disease, stroke

Question 3

What is Ramsay-Hunt syndrome and what are its symptoms?

Answer 3

Rare neurological disorder; complication of shingles.
Symptoms inclu:
- Unilateral ear pain, tinnitus, deafness, blisters in or around ear/ anterior 2/3 of tongue
- Unilateral facial weakness or paralysis
- Vertigo

Question 4

What are the neurological symptoms of Lyme disease?

Answer 4

Occur when the bacteria affect PNS/ CNS.
- (Usually unilateral) facial weakness/ droop (paralysis of the facial muscles)
- Visual disturbances
- Meningism: fever, stiff neck, severe headache

Question 5

Aetiology of Bell’s Palsy?

Answer 5

Unknown but can be triggered by acute viral infection (ie: URTI)
(Some evidence points to reactivation of HSV1 within geniculate ganglion)

Question 6

Risk factors for Bell’s Palsy? (4)

Answer 6

• Diabetes
• Pregnancy
• URTI
• Cold climate (?)

Question 7

Signs and symptoms of Bell’s Palsy?

Answer 7

• Unilateral facial weakness
• No forehead sparing
• Post-auricular pain/ otalgia
• Prodrome, hyperacusis (everyday sounds seem louder than usual)
• Keratoconjunctivitis sicca (dry eye)
• Blisters
• Other pathology = UMN weakness, limb pathology, rashes
• Bell’s phenomenon

Question 8

How does keratoconjunctivitis sicca (dry eye) occur?

Answer 8

Common and occurs acutely due to loss of adequate blink function. PNS dysfunction to the lacrimal gland is also contributing factor. May lead to ulcerative keratitis (corneal ulcer) and subsequent blindness.

Question 9

What is Bell’s phenomenon?

Answer 9

Eyeballs move upwards when try to forcefully close eyelids

Question 10

Ix: Main way to diagnose Bell’s Palsy?

Answer 10

Clinically and by exclusion

Question 11

Ix: Other things to do for investigations for Bell’s Palsy?

Answer 11

EMG (electromyography): >90% decrease in amplitude of the compound muscle action potential (CMAP) on the affected side

Serology: Ramsay Hunt; Borrelia burgdorferi (Lyme disease)

MRI; Bloods- glucose, ESR (for eliminating other causes of facial palsy)

Question 12

Management for Bell’s Palsy?

Answer 12

High dose corticosteroids (60 mg orally once daily for 5d, then decrease dose by 10mg/day until stop) AND eye protection

Question 13

Management for Ramsay-Hunt syndrome?

Answer 13

Acyclovir and corticosteroids