neuro

Question 1

bells palsy pathophysiology

Answer 1

idiopathic UNILATERAL seventh cranial nerve palsy
lower motor neuron lesion (cranial nerve) so NO sparing of the forehead)

: we don’t know the cause, HSV (viral infection with HSV) HAS BEEN SUGGESTED AS one of the causes but its not fully understood

Question 2

bell’s palsy presentation

Answer 2

unilateral facial droop and loss in movement and sensation in that side of face

postauricular pain
hyperacusia
(these are due to 7th cranial nerve innervation of stapedius muscle which moderates the sound coming into ear- dampens it)

change in taste (since 7th innervates anterior 2/3 of tongue)

dry eyes

Question 3

bells palsy management

Answer 3

a lot of propositions have been made but consensus now is give oral prednisolone within 72 hours of presentation

antiviral ONLLY if severe but its effectiveness is questioned

eye care!!! to prevent exposure keratopathy give artificial tears and eye lubricants

Question 4

steps if no improvement of bells palsy in 3 week follow-up from presentation

Answer 4

refer urgently to ENT

Question 5

what referral do you do if bells palsy persists for months?

Answer 5

plastics

Question 6

prognosis of bells palsy?

Answer 6

most people recover within 3-4 months
15% may get some permanent moderate-severe weakness