Bell's Palsy

Question 1

What is Bell’s palsy?

Answer 1

Idiopathic facial nerve palsy

Question 2

How does it present?

Answer 2

Abrupt onset e.g. overnight

Complete unilateral facial weakness at 24-72 hours

Question 3

Does Bell’s palsy affect upper or lower motor neurones?

Answer 3

Lower

Question 4

Give some examples of other clinical features?

Answer 4

Numbness/pain around ear
Reduced taste
Hypersensitivity to sounds
Unilateral sagging of mouth
Drooling of saliva
Speech difficulty
Failure of eye closure

Question 5

How can you differential between an upper or lower motor neurone facial nerve lesion?

Answer 5

Ask patient to wrinkle forehead and close eyes forcefully

Forehead is spared in UMN lesions due to bilateral cortical input

Forehead is affected in LMN lesions (such as Bell’s palsy) as unilateral input

Question 6

What is the management of Bell’s palsy?

Answer 6

Prednisolone - if given within 72 hours speeds recovery
Protect the eye e.g. patch
Most completely recover

Question 7

What is Ramsay Hunt syndrome?

Answer 7

Latent shingles in facial nerve (can present similarly to Bell’s palsy)

Question 8

How do you test for Ramsay Hunt syndrome?

Answer 8

Increase VZV (varicella zoster virus) antibodies