Facial weakness: Bell's palsy + Ramsay Hunt syndrome Flashcards
sudden onset of unilateral facial weakness, including forehead
Unilateral lower motor neurone facial nerve lesion
Bells palsy
sudden onset of unilateral facial weakness with sparing of forehead
Unilateral upper motor neurone lesion
peak incidence of Bell’s Palsy
20-40 years old
bell’s palsy is more common in….
pregnant women
symptoms that may precede the onset of facial weakness/paralysis in Bell’s palsy
post auricular pain
other symptoms in Bell’s Palsy (3)
- hyperacusis
- dry eyes
- altered taste
4 causes of bilateral lower motor neurone facial weakness
- Bilateral Bell’s palsy
- GBS
- Sarcoidosis
- MG
causes of facial nerve lesion at the site of facial canal (3)
- tumour deposits
- middle ear infection
- bells palsy
in which condition is there an infection of the geniculate ganglion?
Ramsay Hunt Syndrome
causes of lesions of the peripheral branches of the facial nerve
- Parotid gland lesions: tumours infections, sarcoidosis
- infection
management of Bell’s Palsy
1mg/kg for 10 days, within 72 hours of onset of symptoms
what should be done to maintain eye care in Bell’s palsy
- prescription of artificial tears
- eye lubricants
- taping of eye at night
by when does the facial weakness usually recover by in Bell’s palsy
4-6 months
causes of Bell’s palsy
- idiopathic
- Herpes simplex virus activation
who is at risk of developing bells palsy
pregnant women in the 3rd trimester of pregnancy
if full recovery is not obstained within 3 months…
nerve damage may be more extensive + additional treatment required; referral to a specialist
role of Botulinum injections for Bell’s palsy
- decrease overactivity in muscles which are tight or twitchy
- relax involuntary movements
- restore a more balances facial expression
DDx for Bell’s palsy (3)
- Stroke
- Ramsay hunt syndrome
- Lyme disease
what is Ramsay Hunt syndrome?
LMN facial palsy specifically due to Varicella Zooster virus
what should be suspected in a patient experiencing severe pain around their ear, followed by rashes or blisters around; ear, scalp, hair line, mouth, throat
ramsay hunt syndrome
In ramsay hunt syndrome, where can the rashes or blisters appear
ear, scalp, hair line, mouth, throat
Pathogenesis of Ramsay hunt syndrome
Reactivation of the Varicella Zoster virus
what can reactivation of the Varicella zoster virus result in
painful, maculopapular rash called; Herpes zoster
what virus causes shingles + chicken pox
Varicella zoster virus
what happens once the symptoms have subsided from chicken pox and shingles
the varicella zoster virus estalishes latency in the dorsal root + CN ganglia
is the RHS rash contagious
yes, for people with no immunity to chicken pox can catch chicken pox by contact with the open rash or blister on the infected person
however, can not catch RHS
risk factors for RHS
- HIV/immunodeficiency
- Chronic steroid use
- Chemotherapy
- Malignancy
until the rash blisters scab over, individuals with RHS should avoid contact with:
- newborns
- pregnant women
- weak immune system
- anyone who’s never had chicken pox or vaccinated against chicken pox
describe the course of the infection in RHS
erythematous maculopapular rash –> clear vesicles –> vesicles erruption occuring in segments innervated by the affected sensory ganglion
vesicles eventually pustulate and form crusts
how long does it take for the rash blisters to resolve
4-5 weeks
symptoms in RHS before rash onset
prodromal period with burning pain, 2-3 days prior to rash
AND
pain can persist for several months after the rash resolves
RHS investigations (4)
- full examination including ear and facial nerve function
- Blood tests: Ab for VZV
- Hearing tests
- MRI
- Nerve conduction studies
management of RHS (4)
- Aciclovir within 72 hours, for 7 days
- short course of high dose steroids
- painkillers
- botulism toxin injections
management if there is no signs of improvement after 1 month in RHS?
- referral to facial palsy specialist: neurologist, plastic surgeon, ENT consultant
- specialist facial therapist
management if poor eye closure after 2-3 weeks in RHS
referral to ophthalmology
otological symptoms in RHS
- hearing loss on affected side
- dizziness/vertigo
- tinnitus
