Bell's Palsy and Diabetic Neuropathy

Question 1

Bell’s Palsy

Answer 1

• Lesion of CN VII
• demyelination in mild cases
• demyelination and axonal damage in more severe cases

Question 2

Face Innervation

Answer 2

• Upper face: bilateral innervation

- Lower face: Unilateral

Question 3

How does Bell’s Palsy typically present?

Answer 3

• As flaccid paralysis on the IPSIL face
• Affecting the upper and lower quadrants of the face
• Neurogenic disease

Question 4

Bell’s Palsy: Etiology

Answer 4

• Unknown in most cases
• May be secondary to viral infection causing swelling in auditory canal (remember that CN VII goes through the auditory canal)
• In a small # of cases, secondary to acoustic neuroma impinging on nerve

Question 5

Bell’s Palsy: Signs & Symptoms–Motor

Answer 5

• Flaccidity
• Mouth droops
• Nasolabial fold is flattened
• Eyelid doesn’t close

Question 6

Bell’s Palsy: Signs & Symptoms–Sensory

Answer 6

Decreased taste on ipsilateral tongue

Question 7

Bell’s Palsy: Signs & Symptoms–ANS

Answer 7

Decreased tearing (dry eye)

Question 8

Bell’s Palsy: Incidence and Onset

Answer 8

• Incidence is 20/100,000 in US each year
• Typical onset is overnight
• Onset more common between 20-40 YO
• Increased risk in diabetic and pregnant woman and people with MS

Question 9

Bell’s Palsy: Medical Treatment

Answer 9

• High-dose corticosteroids for 5 days followed by a tapered dose for another 5 days
• Antiviral medications, e.g. acyclovir
• Eye patch, artificial tears
• Gentle massage and gentle heat
• E-Stim for facial mm

Question 10

Bell’s Palsy: Recovery

Answer 10

-70% of ppl recover completely within 2-3 wks or 3-6 months [in more severe cases]

Question 11

Diabetic Polyneuropathy

Answer 11

• Affects PNS axons primarily (some demyelination)

- Etiology: disrupted microcirculation [vascularization]

Question 12

Diabetic Polyneuropathy Onset

Answer 12

• After long duration diabetes
• -In diabetics who have had diabetes for 25+ years, 50% have this condition
• Occurs in insulin-dependent and non-insulin dependent diabetes
• Some regeneration with control of diabetes

Question 13

Diabetic Polyneuropathy Characteristics

Answer 13

Large nerve fiber sensory involvement of MANY NERVES IN LOWER LEGS & FEET
(Ia, Ib & II – from muscle spindles & GTOs)
-most common
-painless paresthesias in BL feet and lower legs
-decreased vibration and proprioception sense

Small nerve fiber sensory involvement (A delta & C afferent fibers)

• -deep aching pain in legs and burning feeling in feet
• -decreased touch, pain, and temperature sensations
• -nocturnal pain and paresthesias

Question 14

Possible signs and symptoms of peripheral neuropathy include

Answer 14

• Numbness/reduced ability to feel pain or changes in temp, especially in the feet & toes
• A tingling or burning feeling
• Sharp, jabbing pain
• Pain when walking
• Extreme sensitivity to the lightest touch
• Muscle weakness and difficulty walking
• ***Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain

Question 15

Diabetic Polyneuropathy Screening/Exam Tests

Answer 15

• NCVs
• Monofilament screening with 5.07 / 10 gm. filament
• Vibration

Question 16

Diabetic Polyneuropathy Complications

Answer 16

• Diabetic ulcers

- 50% of non-traumatic amputations in US are performed on individuals with diabetes