Bell's Palsy Flashcards
What is Bell’s Palsy
Acute idiopathic unilateral CN VII MONOneuropathy d/t LMN lesion causing weakness and paralysis
What can Bell’s Palsy be preceded by
Herpes simplex virus
What are Bell’s Palsy RF
Pregnancy (3 trimester)
Diabetes
What is the pathophysiology behind Bell’s Palsy
Inflammation of facial nerve neat internal acoustic meatus or genticulate ganglion cause compression, ischemia, and demyelination
How does Bell’s onset
Sudden onset with peak at 3 days
What are subjective features of Bell’s palsy
Post. auricular pain face feels stiff/pulled Difficulty eating, drinking, speaking Decreased taste Dry eyes "numbness" (but no true loss of sensation)
What are objective findings in Bell’s palsy
Unilateral facial paralysis (forehead, facial creases, mouth corners, lower lids affected)
Tearing from eye
Loss of corneal reflex
What is Bell’s Palsy diagnosis based on
History and PE
What testing may be utilized for Bell’s Palsy
Electrodiagnostic testing is w/ complete paralysis
High-res CT if slow progression (>3 wk), no improvement in 4 mo, or alt. Dx suspected
Serology for B. burgdorferi (Hx tick bite)
Audiometry (Ramsay Hunt suspected)
What is the difference between a stroke and Bell’s
Bells is LMN lesion so it affects the entire unilateral face
Stroke is an UMN lesion so it affects the bottom unilateral face but SPARES the forehead
More differences between Bell’s and Stroke
Bells onset 20-50, Onset is Hrs to days
Stroke onset is >60 y/o, onset in seconds to minutes
How can you treat Bell’s Palsy
Prednisone for 7 days, 5 day taper (w/in 3 days of Sx)
Valacyclovir (severe nerve palsy from HSV, or HZV suspected)
Eye protection (artificial tears, protective glasses, consult ophtho)
Adjunct therapy for Bell’s palsy includes
Acupuncture
PT
Electrodes that pulsate, to prevent muscular atrophy
