Neurology chapter 11 Bell's Palsy Flashcards
1
Q
Bell’s Palsy description
A
Disruption of facial nerve (cranial nerve VII) that results in interruption of messages to brain.
2
Q
Bell’s Palsy Etiology
A
- Edema, inflammation or compression of cranial nerve VII
- clinical diagnosis of exclusion
- idiopathic
- associated with: viral illnesses (meningitis, common cold, influezna, herpes zoster), exposure to cold, facial trauma that causes inflammation of the fallopian canal
3
Q
Bell’s palsy incidence
A
- 40,000 annually
- can occur at any age, more common between 15-60
- men = women
- disproportionate attacks in people with diabetes or upper respiratory infections.
4
Q
Bell’s Palsy
Risk Factors
A
- Lyme disease
- third trimester of pregnancy
- family history
- headaches
- chronic middle ear infection
- high blood pressure
- diabetes
- sarcoidosis
- tumors
5
Q
Bell’s Palsy
Assessment findings
A
- symptoms range from mild to severe
- symptoms begin suddenly and peak at 72 hours
- paralysis on one side of face; rarely bilateraly
- numbness/tingling on affected side
- drooping of eyelid on affected side
- drooping of corner of mouth on affected side
- drooling
- dryness of the eye or mouth
- excessive tearing/inadequate tearing
- hypersensitivity to sound
- ipsilateral loss of taste
- ipsilateral ear pain, cheek pain
- loss of nasolabial fold
6
Q
Bell’s Palsy
Assessment findings 2
A
- posterior auricular pain
- ringing in one or both ears
- impaired speech
- difficulty eating or drinking
7
Q
House-Brackmann Facial Nerve Grading System
A
- Grade 1 - normal facial function
- Grade 2 - Mild dysfunction
- Grade 3 - moderate dysfunction
- Grade 4 - Moderately severe dysfunction
- Grade 5 - severe dysfunction
- Grade 6 v- total dysfunction
8
Q
Bell’s Palsy
Differential Diagnosis
A
- stroke
- Lyme disease
- Tumor
- Trauma
- Otitis Media
- Guillain-Barre syndrome
9
Q
Bell’s Palsy
Diagnostic studies
A
- usually diagnosed on clinical presentation, unless questionable
- Lyme titer if history of tick bite
- serologic studies for infectious disease
- CT to rule out stroke or neoplasm
- Electromyography (EMG) testing; determine severity and extent of nerve involvement
- hearing test to determine if cochlear nerve or inner ear is affected
- vestibular testing to determine if the vestibular nerve is involved.
10
Q
Bell’s Palsy
Prevention
A
None
11
Q
Bell’s Plasy
Nonpharm management
A
- patient education about condition, expected outcomes, management
- eyedrops to maintain lubrication (if inadequate tearing)
- close and cover affected eye, especially at night
- warm, moist heat to affected side of face.
- ear plugs for noise sensitivity
- physical therapy to stumlate facial nerve.
- massage of facial muscles.
12
Q
Bell’s Palsy
Pharmacologic management
A
- Tapered dosage of corticosteroids (must be initiated within 3 days of onset or little benefit.
- oral antiviral agents (acyclovir, famciclovir, valacyclovir) in conjunction with oral steroids more beneficial than steroid alone.
- aspirin, tylenol, ibuprofen for pain relief.
13
Q
BP Pharm management
16 years and older
A
- Prednisone or prednisolone PO: 60mg for 5 days, then 50mg for 1 day, 40mg for 1 day, 30 mg for 1 day, 20 mg for 1 day, 10mg for 1 day (start within 72 hours of symptom onset)
- studies limited in children younger than 16. they also have higher rates of spontaneous recovery.
14
Q
Bell’s Palsy
Prognosis
A
- Good
- Recovery times vary
- extent of nerve damage determines extent of recovery
- symptoms usually improve within 2 weeks
- complete recovery typical in 4-6 months
- in rare cases, permanently impaired facial function
- may recur, sometimes on opposite side
15
Q
Bell’s Palsy
Pregnancy/lactation considerations
A
- cautious use of steroids in pregnancy
- monitor blood pressure for hypertensive disorder
