Facial ( Seventh Cranial) Nerve Palsy or Bell Palsy Flashcards
Most cases of facial palsy are of this cause ____
idiopathic.
Some identified causes are
Lyme disease, sarcoidosis, herpes zoster, and tumors.
classic presentation would be:
Paralysis of the entire side of the face
How is a Stroke palsy?
Stroke will paralyze only the lower half of the face because the upper half of the face receives innervation
from both cerebral hemispheres.
If the patient can wrinkle her forehead on the affected side, think about
stroke
If the patient cannot wrinkle his forehead on the affected side, think about:
Bell palsy (idiopathic palsy)
Two additional features are:
Hyperacusis:
Taste disturbances:
why Hyperacusis?
Sounds are extra loud because the seventh cranial nerve normally supplies the stapedius muscle, which acts as a “shock absorber” on the ossicles of the middle ear.
why Taste disturbances?
The seventh cranial nerve supplies the sensation of taste to the anterior two-thirds of the tongue
how does someone with palsy eat?
Eating is “sloppy” because of difficulty closing the lips.
when asked “What is the most likely diagnosis?” look for statements like:
“the face feels stiff” or “pulled to one side”
Diagnostic Tests
No test is usually done because of the characteristic presentation of paralysis of half of the face
most accurate test (if asked) is
electromyography and nerve conduction studies.
Treatment / Best Initial Tx
Sixty percent of patients have full recovery even without treatment.
best initial therapy is prednisone.
Additional Therapies
Acyclovir is sometimes added but does not clearly help.
