Bells Palsy

Question 1

def

Answer 1

idiopathic LMN facial (VII) nerve palsy

Question 2

aetiology

Answer 2

idiopathic

may be preceded by a respiratory infection

Question 3

epi

Answer 3

common
20-50yrs
3x pregnancy
5x diabetes

Question 4

history

Answer 4

1 acute onset (often after sleep) unilateral facial weakness + droop
2 ipsilateral numbness/pain around the ear
3 hypersensitivity to sounds

Question 5

when is the maximum duration of facial weakness and droop

Answer 5

1-2days

Question 6

why do bells palsy patients have hypersensitivity to sounds

Answer 6

paralysis of stapedius muscle

Question 7

what is the difference in presentation between stroke and bells palsy

Answer 7

bells palsy has complete unilateral facial weakness

stroke is forehead sparing

Question 8

examination

Answer 8

LMN facial palsy- complete unilateral facial weakness (does not spare forehead muscles as an UMN facial palsy would)
Bells phenomenon - eyeballs roll up but eyes remain open when trying to close

Question 9

investigations

Answer 9

CLINICAL DIAGNOSIS AND ON EXCLUSION
1 bloods
-exclusion of lymes (borrelia antibodies) and ramsay hunt syndrome (VZV antibodies)
2 MRI
-for space-occupying lesions + stroke
3 EMG
-shows axonal block in facial nerve

Question 10

management

Answer 10

MOST IMPORTANT
high dose corticosteroids (prednisolone)

protect eyes:

• dark glasses
• artificial tears
• surgery (lateral tarsorrhaphy suturing lateral parts of eyelids tofether)

Question 11

what must be excluded before giving prednisolone

Answer 11

ramsay hunt syndrome

Question 12

how do corticosteroids treat bells palsy

Answer 12

reduce axonal oedema and damage

Question 13

complications

Answer 13

eye infection + ulcers
abberant reinnervation (blinking may cause contraction of of angle of mouth)

Question 14

prognosis

Answer 14

95% recover (incomplete takes longer than complete)