Bell's Palsy Flashcards
What are some causes of VII nerve palsy. (6)
Bell's palsy (70% of cases). Ramsay Hunt syndrome. Lyme disease. Meningitis. TB, viruses (HIV). Mycoplasma (rare).
What is Bell’s palsy.
Idiopathic facial nerve palsy.
What percentage of facial nerve palsies are die to Bell’s palsy.
70%.
What are some unique features that distinguish facial nerve palsy as Bell’s palsy. (6)
Abrupt onset.
With complete unilateral facial weakness at 24-72h.
Ipsilateral numbness or pain around the ear.
Reduction in taste (ageusia).
Hypersensitivity to sounds.
(other pathologies may be indicated by bilateral symptoms,, UMN signs, other cranial neuropathies, limb weakness and rashes).
What is the incidence of Bell’s palsy.
15-40/100,000/ year.
What is the ratio of male:female in Bell’s palsy.
1:1.
What are some features that increase the risk of Bell’s palsy. (2)
Risk increases in pregnancy (x3).
Diabetes (x5).
What are some other symptoms of VII nerve palsy (from any cause). (5)
Unilateral sagging of the mouth, which is drawn upwards on the normal side on smiling, causing a grimace.
Drooling of saliva.
Food trapped between gum and cheek.
Speech difficulty.
Failure of eye closure may cause a watery or dry eye, ectropion (sagging and turning out of the lower lid), injury from foreign bodies or conjunctivitis.
What are the signs of facial nerve palsy. (2)
Ask the patient to wrinkle their forehead and close their eyes forecefully (under bilateral cortical control, so spared in UMN lesion).
Whistling/blowing out of cheeks to check buccinators.
What is a characteristic of facial nerve palsy caused by Guillain-Barre.
It is often bilateral.
What are some brainstem causes of facial nerve palsy. (3)
Stroke.
Tumour.
MS.
What are some ENT causes of facial nerve palsy. (5)
Orofacial granulomatosis. Parotid tumours. otitis media or cholestaetoma. Trauma to skull base. Diving.
