Bells, Ramsey Hunt, Temporal and Basal Skull Fractures ☺️

Question 1

Facial palsy

• presentation
• differentiating between UMN, LMN issue
• differentials for UMN
• differentials for LMN

Answer 1

Weakness/paralysis of facial muscles

Forehead sparing in UMN

UMN - SDH, stroke,
LMN - Bells, Ramsay Hunt, acoustic neuroma, parotid tumour

Question 2

Bell’s palsy

• presentation
• investigations
• management

Answer 2

Recent viral infection

Painless unilateral LMN facial weakness

• cannot close eyes or cry
• increased sensitivity to sound
• metallic taste

Clinical diagnosis
-serology to rule out RHS

Supportive eye care - eye patch, lubricating drops
Medical - PO steroids + antivirals
Surgical if no change or not Bells

Question 3

Ramsay Hunt Syndrome

• pathophysiology
• presentation
• investigations
• management

Answer 3

Reactivation of HZV

Ear pain => facial palsy, ipsilateral vertigo, increased sensitivity to sound, blisters on VII region

Clinical diagnosis

Medical - PO steroids + antivirals

Question 4

Basal skull fracture

• presentation
• investigations
• management

Answer 4

High impact trauma => ATLS

• Battle sign, raccoon eyes
• Ear, nose discharge
• Hematoma
• Blood behind eardrum

Head CT in 1hr of A&E presentation

NEUROSURGERY REFERRAL
Supportive - A-E approach

Question 5

Temporal bone fracture

• presentation
• investigations
• management

Answer 5

Significant blunt trauma

• Battle sign
• VII, VIII damage => sensorineural loss, vertigo, balance, facial paralysis

Head CT

Manage facial nerve injury, hearing and vestibular function, CSF leak

• immediate facial paralysis => surgery
• delated/incomplete facial paralysis => tapered CS