Bells palsy

Question 1

Which gender is more commonly affected by Bells palsy

Answer 1

Both equally

Question 2

What increases the risk of Bells palsy

Answer 2

Diabetes

Pregnancy

Question 3

Describe the clinical features of Bells palsy

Answer 3

Abrupt onset (often overnight)
Complete unilateral facial weakness at 24-72h
Ipsilateral numbness or pain around the ear
Decreased taste
Hypersensitivity to sounds
Unilateral sagging of the mouth
Drooling of saliva
Food trapped between gum and cheek
Speech difficulty
Failure of eye closure may cause a watery or dry eye, ectropion, injury from foreign bodies or conjunctivitis

Question 4

Describe the features of Bells palsy present on examination

Answer 4

Unable to wrinkle forehead

Unable to whistle

Question 5

List some other causes of facial nerve palsy

Answer 5

Infective - Ramsay Hunt syndrome, Lyme disease, meningitis, TB, viruses
Brainstem lesions - stroke, tumour, MS
Cerebellopontine angle tumours - acoustic neuroma, meningiomas
Systemic disease - DM, sarcoidosis, Guillian Barre
Local disease - orofacial granulomatosis, parotid tumours, otitis media or cholesteatoma, skull base trauma

Question 6

What causes bilateral facial weakness

Answer 6

Lyme disease
Sarcoid
Guillian Barre
Trauma

Question 7

What tests are done to investigate Bells palsy

Answer 7

Rule out other causes
Bloods - ESR, glucose, Borrelia antibodies in Lyme disease, VZV antibodies in Ramsay Hunt syndrome
CT/MRI - space occupying lesion, stroke, MS
CSF - rarely done but if done then to look for infections

Question 8

Describe the prognosis of Bells palsy

Answer 8

Incomplete paralysis without axonal degeneration usually recovers completely within a few weeks
Of those with complete paralysis 80% make a full recovery but 15% have axonal degeneration in which case recovery is delayed, starting after 3 months and may be complicated by aberrant reconnections

Question 9

Describe the management of Bells palsy

Answer 9

Drugs - if given within 72hours onset, prednisolone speeds recovery
Protect the eye - dark glasses and artificial tears if evidence of drying. Encourage regular eyelid closure by pulling down the eyelid
Surgery - if the eye is a long term problem or severe ectropion

Question 10

Describe Ramsay Hunt syndrome

Answer 10

Latent varicella zoster virus reactivating in the geniculate ganglion of the 7th cranial nerve.

Question 11

What symptoms occur with Ramsay Hunt syndrome

Answer 11

Painful vesicular rash on the auditory canal and ear drum, pinna, tongue, palate or iris with ipsilateral facial palsy, loss of taste, vertigo, tinnitus, deafness, dry mouth and eyes

Question 12

How is Ramsay Hunt syndrome diagnosed?

Answer 12

Clinical, as antiviral treatment is thought to be most effective within the 1st 72hrs while the virus is replicating

Question 13

How is Ramsay Hunt syndrome treated

Answer 13

Antivirals and prednisolone