Bell's Palsy

Question 1

What is Bell’s palsy

Answer 1

Acute idiopathic unilateral facial nerve (CN VII) mononeuropathy

Question 2

Is Bell’s palsy upper or lower motor neuron lesion?

Answer 2

lower

Question 3

What are risk factors of Bell’s palsy?

Answer 3

Diabetes

pregnancy (3rd trimester)

Question 4

What happens in Bell’s palsy?

Answer 4

Inflammation of the facial nerve near the internal acoustic meatus or at the geniculate ganglion

-leads to compression -> ischemia -> demyelination

Question 5

Describe sx onset and MC feature

Answer 5

progressive w/o warning, peak at 3 days

Unilateral facial muscle paralysis (remember it does not spare the forehead!)

Question 6

What will happen when you do CN VII testing?

Answer 6

• inability to raise affected eyebrow or wrinkle forehead
• difficulty closing eye and inability to raise the corner on the mouth
• dropping of affected side of mouth, loss of nasolabial fold

Question 7

How do you dx Bell’s palsy?

Answer 7

hx and physical

Question 8

How do you treat Bell’s palsy?

Pt w/ severe nerve palsy?

Answer 8

-Prednisone 60 mg once daily x7 days then taper x5 days
(best within 3 days of onset)

• Valacyclovir 1000mg x7 days for pts w/ severe nerve palsy
• Eye protection is important (consider ophthalmology, liquid drops, glasses)