Bell's Palsy Flashcards
Which gender is more commonly affected with Bell’s palsy?
Equal
What conditions predispose patients to Bell’s palsy?
- Pregnancy
- DM
True or false: Bell’s palsy is a diagnosis of exclusion
True
What is the infectious disease that is associated with Bell’s palsy?
Lyme’s disease
Is Bell’s palsy generally a slow or gradual onset?
Sudden
True or false: there is usually associated ear pathology
False
What must be r/o to diagnose Bell’s palsy?
Other signs of CNS pathology
What are the supposed etiologies of Bell’s palsy?
- viral
- Nerve ischemia
- Autoimmune
What are the viruses associated with Bell’s palsy?
- HSV
- EBV
What is the pathophysiology of Bell’s palsy?
Neuropathy
What foramen does CN VII come out of?
Stylomastoid foramen
What are the branches of CN VII?
- Temporal
- Zygomatic
- Buccal
- Masseter
- Cervical
What is the narrowest part of the facial nerve path?
Internal Genu of the internal auditory meatus
What is the imaging modality of choice for diagnosing Bell’s palsy (assuming you are not suspecting a brain hemorrhage)?
MRI
What is the treatment for Bell’s palsy?
High dose steroids and antivirals
What are major sequelae of Bell’s palsy?
- Corneal abrasion
- Alteration of taste
- Synkinesis
CN VII provides what part of taste on the tongue?
Anterior 2/3
What provides taste to the posterior 1/3 of the tongue?
CN IX
True or false: most of the time, Bell’s palsy is a self limited disease
True
What is Ramsay Hunt syndrome? What is the classic triad of symptoms?
Reactivation syndrome of herpes zoster in the geniculate ganglion. It has variable presentation which may include a lower motor neuron lesion of the facial nerve, deafness, vertigo, and pain.
-A triad of ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle is typical for Ramsay Hunt Type II.
True or false: full recovery with Ramsay Hunt syndrome is not as likely as Bell’s palsy
True
True or false: the s/sx of Ramsay-Hunt syndrome are often more severe than that of Bell’s palsy
True
How can you differentiate Bell’s palsy from Ramsay Hunt syndrome?
Vesicles in the ear with Ramsay Hunt syndrome
What are acoustic neuromas?
Slow growing, benign tumor of the myelin sheath of the vestibulocochlear nerve
Bilateral acoustic neuromas = what disease? What is the gene that is mutated with this?
NF2
Merlin
True or false: most acoustic neuromas are bilateral
False–95% are unilateral
What are the s/sx of acoustic neuromas? (4)
- Sudden or gradual hearing loss
- New onset tinnitus
- New onset vertigo
- Facial palsy or pain
What is the best screening test for an acoustic neuroma?
Hearing test
What is the imaging modality of choice to diagnose acoustic neuromas?
MRI with gadolinium
What is the treatment for acoustic neuromas?
Surgery
True or false: once hearing loss is had with acoustic neuromas, it is irreversible
True
Where do acoustic neuromas usually grow?
- Level of the internal auditory canal
- Cerebellopontine angle
How fast (relatively) do acoustic neuromas usually grow?
Slowly
What are glomus tumors (paragangliomas)?
Benign neuroendocrine tumor of neural crest cells, that arise in the head/neck/thoracic region.
What are the s/sx of glomus tumors?
Pulsatile tinnitus
How can you check for a paraganglioma?
Listen to the ear with a stethoscope
Recurring facial nerve paralysis is suspicious for what?
Facial nerve neuromas
Where are cholesterol granulomas found?
Petrous apex, associated with hemorrhage into air cells
Hearing should be above what decibel?
20
