Bell's Palsy

Question 1

What is Bell’s palsy?

Answer 1

an acute idiopathic unilateral facial nerve mononeuropathy

LMN “lesion”

peak incidence in 4th decade of life

Question 2

Risk factors for Bell’s palsy?

Answer 2

DM and pregnancy

pregnancy due to fluid retention

Question 3

Pathophys of Bell’s palsy?

Answer 3

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

leads to compression > ischemia > demyelination

Question 4

Sxs of Bell’s Palsy?

Answer 4

onset is sudden, sxs usually peak by day 3

• facial numbness
• face feels stiff and pulled to one side
• posterior auricular pain
• dif. eating/drinking or speaking
• decreased taste
• phonophobia
• eye dryness

Question 5

PE findings in Bell’s Palsy?

Answer 5

unilateral facial muscle paralysis

tearing from the eye

loss of corneal reflex

Question 6

How do we dx Bell’s palsy?

Answer 6

clinically!

possible tests:

• Electrodiagnostic testing
• CT: if no improvement after 4 mos or concern for secondary dx
• serologic testing for borrelia bugdorferi > hx of tick bite
• audiometry

Question 7

Bell’s Palsy v. Stroke

Answer 7

Bell’s Palsy: peripheral lesion (CNVII), NO forehead sparing, 20-50 y/o, onset hrs to days

Stroke: central lesion, forehead sparing, >60 y/o, onset seconds to minutes

Question 8

Tx for Bell’s Palsy?

Answer 8

• Prednisone 60 mg daily x & day, then 5 day taper
• eye protection: artificial tears, glasses
• adjuncts: acupuncture, PT

Question 9

When should you give Valacylovir?

Answer 9

for pts with severe nerve palsy or HSV presentation

give 1000mg TID

Question 10

Px for bell’s palsy?

Answer 10

85% recover in 3 wks