MDT Bells Palsy

Question 1

Bell’s Palsy is a lower motor neuron disease that effects what cranial nerve?

Answer 1

VII

Question 2

What is Bell’s phenomenon

Answer 2

Upward rolling of the eye on attempted lid closure.

Question 3

Bells Palsy
Seizure vs. stroke
In a stroke, there is NO_____ of the forehead

Answer 3

Paralysis

Question 4

Bells Palsy
Seizure vs. stroke

Intact forehead muscle tone suggests what?

Answer 4

STROKE not BELL’s Palsy

Question 5

what is the Clinical presentation of Bells Palsy

Answer 5

-Abrupt onset of unilateral facial paralysis
-Pain about the ear that precedes or
accompanies the weakness
-Face feels stiff and pulled on one side
-May have ipsilateral restriction of eye closure and difficulty with eating and fine facial movements.
-Bell’s phenomenon

Question 6

True/ false
Herpse Simplex Virus, Lyme disease or HIV can be associated with Bells Palsy

Answer 6

True

Question 7

True/ False
60% of all patients remain disfigured from bells palsy?

Answer 7

False
60% of all cases recover completely without treatment

Question 8

What medication can be used for mild to moderate Bell’s Palsy

Answer 8

Prednisone 60mg PO daily x7 days, then 5 day taper, best to start within 5 days of
symptoms

Question 9

What medication is added to steroid treatment regimen for severe Bell’s palsy

Answer 9

Valacyclovir 1000mg 3 times daily for 7 days

Question 10

What are some Differential Diagnoses for Bells palsy

Answer 10

(1) Herpes zoster
(2) Otitis Media
(3) Lyme disease
(4) Guillain-Barre syndrome

Question 11

What can you use to help prevent Corneal ulceration for a Bells Palsy patient

Answer 11

artificial tears, lubricating ointment, and possible eye shield

Question 12

Disposition: Bells Palsy
______ if eye complications or suspicious of alternative diagnosis (i.e. CVA)

Answer 12

Immediate referral/MEDEVAC

Question 13

Disposition: Bells Palsy
_________ if mild paresis and no other symptoms to suggest alternative diagnosis

Answer 13

Referral to neurology/MEDADVICE