Bell’s Palsy Flashcards
(1) Acute facial palsy (paralysis) of a specific pattern
(2) Lower motor neuron disease affecting CN VII
(3) Rare (34/100,000 people) and slightly more common in pregnancy, otherwise no
predisposing factors.
(4) Idiopathic paresis of lower motor neuron type
(5) Associated with Herpse Simplex Virus, Lyme disease, HIV and sometimes idiopathic
Overview of Bell’s Palsy
(1) Abrupt onset of unilateral facial paralysis
(2) Pain about the ear precedes or accompanies the weakness in many cases but usually
lasts only for a few days.
(3) Face feels stiff and pulled on one side
(4) May be ipsilateral restriction of eye closure and difficulty with eating and fine facial
movements.
(5) May have changes in taste
(6) Tearing (68%) or dryness of the eye (16%) and less frequent blinking on the affected
side
(7) Bell’s phenomenon (upward rolling of the eye on attempted lid closure)
Clinical presentation Bell’s Palsy
(1) In a stroke, there is NO paralysis of the forehead
(2) Intact forehead muscle tone suggests STROKE not BELL’s Palsy
(3) Look for other abnormalities or neurological deficits
Bell’s Palsy Seizure vs. stroke
(1) Evaluate eye closure
(a) If there is inadequate closure eye protective measures should be implemented
(2) Can shorten duration of symptoms with oral steroids
(3) Prednisone is used for mild to moderate Bell’s Palsy
(a) Dose: 60mg PO daily x7 days, then 5 day taper, best to start within 5 days of symptoms
(b) MOA: Inhibits multiple inflammatory cytokines, inhibits both COX1 and COX2 enzymes
(c) Adverse Reactions: Adrenal insufficiency if taken longer than 7 days in a row,
Cushing syndrome with long term use, HTN, GI bleeding, emotional lability
(d) Contraindications: Systemic fungal infection, TB infection, HTN uncontrolled, CHF, uncontrolled DM
(4) Antiviral medication is added to steroid treatment regimen for severe Bell’s palsy
(a) Valacyclovir 1000mg 3 times daily for 7 days
Bell’s Palsy Treatment
(1) Herpes zoster
(2) Otitis Media
(3) Lyme disease
(4) Guillain-Barre syndrome
Differential Diagnosis Bell’s Palsy
(1) 60% of all cases recover completely without treatment
(2) 10% of all patients remain disfigured
Prognosis Bell’s Palsy
(1) Long term or permanent disfigurement and problems with CN VII
(2) Corneal ulceration (use artificial tears, lubricating ointment, and possible eye shield)
Complications: Bell’s Palsy
Intact forehead muscle tone suggests
STROKE not BELL’s Palsy
(1) Immediate referral/MEDEVAC, if eye complications or suspicious of alternative diagnosis (i.e. CVA)
(2) Referral to neurology/MEDADVICE if mild paresis and no other symptoms to suggest alternative diagnosis
(3) While onboard follow symptoms and extent of paralysis
Disposition:
