Facial nerve palsy

Question 1

Bell’s palsy clinical features

Answer 1

Abrupt onset complete unilateral facial weakness at 24-72h
Ipsilateral numbness/pain around ear
Hyperacusis/hypoaguesia
Pt can’t wrinkle forehead/whistle

Question 2

Signs to exclude Bell’s palsy

Answer 2

Rashes
Bilateral symptoms
UMN signs
Other CN involvement
Limb weakness

Question 3

Bell’s palsy management

Answer 3

Within 72h of onset prednisolone 60mg/d PO speeds recovery
Eye care (dark glasses, artificial tears, tape eyes closed at night, manually blink)
Surgery if eye closure remains long term

Question 4

Bell’s palsy prognosis

Answer 4

Incomplete paralysis usually recovers within a few weeks

Complete paralysis 80% recover

Question 5

Bell’s palsy complications

Answer 5

Synkinesis (blinking causes upturning of mouth)
Crocodile tears (eating stimulates unilateral lacrimation instead of salivation)

Question 6

What is Ramsay Hunt syndrome

Answer 6

Latent varicella zoster reactivates in geniculate ganglion of VIIth CN

Question 7

Ramsay Hunt syndrome signs

Answer 7

Painful vesicular rash on auditory canal ± drum, pinna, tongue palate, iris
Ipsilateral facial palsy
Dry mouth and eyes

Question 8

Ramsay Hunt syndrome diagnosis

Answer 8

Clinical as antiviral treatment best within 72h

Question 9

Ramsay Hunt syndrome treatment

Answer 9

Aciclovir 800mg PO 5x daily for 7d

+ Prednisolone 60mg/d PO

Question 10

Ramsay Hunt syndrome prognosis

Answer 10

75% recover well if treated within 72h

Otherwise 1/3 well, 1/3 reasonable and 1/3 poor recovery