Bell's Palsy

Question 1

Define Bell’s Palsy

Answer 1

Defined a 7th cranial nerve palsy with no discernible causes-diagnosis of exclusion

Question 2

Signs and Sx of Bells palsy

Answer 2

SINGLE episode

absence of constitutional symptoms

Unilateral involvement of all branches of 7th cranial nerve
Lower motor issues–NOT forehead sparing
Maxiumum intensity in 72h
examination is unremarkable except weakness

Dry eye is common with Bells

Post auricular pain

can have taste disturbance,

Question 3

Investigations of Bells Palsy

Answer 3

Mainly a clinical diagnosis–
If less Than 72h since start-EMG-reduced

Check for Lyme disease-

If suspecting something else-CT

classically differentiate with stroke- as non forehead sparing

Question 4

Management of Bells Palsy

Answer 4

By 6 months, remission of symptoms on their own (if thats not absent-think other diagnosis)
No treatment is enough

for acute bells-Steroids-withing 72h of onset

also give eye drops-to protect eye

Question 5

Complications of Bells Palsy

Answer 5

As eyelid fails to close-dry eyes, corneal abrasions, corneal abscesses

Long term-extra tears
can get permanent loss of function in 10% of people- especially if recurrent bell’s cases

Question 6

Prognosis of Bell’s Palsy

Answer 6

following complete evolution of Bell’s palsy (i.e., within 72 hours of onset) –Of those who present with incomplete paralysis on clinical examination, 94% will fully recover, as compared to 61% of those who present with complete paralysis.