Facial paralysis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Cranial nerve VII.png|thumb|Bilateral course of facial nerve. Note that the forehead muscles receive innervation from both hemispheres of the brain, which is why there is forehead sparing for [[stroke]] but not [[Bell's palsy]] (or other peripheral facial nerve injury).]] | |||
*Key to distinguish between central and peripheral facial nerve palsy | |||
===Causes=== | |||
*Central | |||
**[[CVA]] | |||
*Peripheral | |||
**Idiopathic ([[Bell's palsy]]) | |||
**[[Lyme disease]] | |||
**[[Varicella-zoster]] | |||
**[[HSV]] | |||
**[[Facial trauma]] | |||
==Clinical Features== | ==Clinical Features== | ||
[[File:Bellspalsy.jpg|thumb|A person attempting to show his teeth and raise his eyebrows with [[Bell's palsy]] on his right side; notice how the forehead is NOT spared).]] | |||
[[File:DOAeXAmWsAAAp5g.jpg|thumb|Patient with [[stroke]] (forehead sparing).]] | |||
===Central Process=== | |||
* Forehead "sparing" or normal muscle tone of the forehead | |||
===Peripheral Process=== | |||
* Weakness of forehead muscles | |||
===Central and Peripheral=== | |||
* Unable to close eye | |||
* Loss of nasolabial fold | |||
* Asymmetric smile | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
===Central Process=== | |||
*[[head CT|CT]] | |||
===Peripheral Process=== | |||
*No labs or imaging routinely necessary | |||
*Consider lyme serologies if endemic area | |||
==Management== | ==Management== | ||
===Central Process=== | |||
*Treat underlying pathology | |||
===Peripheral Process=== | |||
* [[Prednisone]] (unless diagnosed Lyme disease) | |||
* Empiric [[doxycycline]] if high suspicion for Lyme disease | |||
* Consider [[valacyclovir]] for severe presentation if Lyme is negative | |||
* Artificial tears | |||
* Consider neurology follow-up | |||
==Disposition== | ==Disposition== | ||
==See Also== | ==See Also== | ||
*[[Facial swelling]] | |||
==External Links== | ==External Links== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Symptoms]] | |||
[[Category:Neurology]] | |||
Latest revision as of 17:40, 3 February 2020
Background
Bilateral course of facial nerve. Note that the forehead muscles receive innervation from both hemispheres of the brain, which is why there is forehead sparing for stroke but not Bell's palsy (or other peripheral facial nerve injury).
- Key to distinguish between central and peripheral facial nerve palsy
Causes
- Central
- Peripheral
- Idiopathic (Bell's palsy)
- Lyme disease
- Varicella-zoster
- HSV
- Facial trauma
Clinical Features
A person attempting to show his teeth and raise his eyebrows with Bell's palsy on his right side; notice how the forehead is NOT spared).
Patient with stroke (forehead sparing).
Central Process
- Forehead "sparing" or normal muscle tone of the forehead
Peripheral Process
- Weakness of forehead muscles
Central and Peripheral
- Unable to close eye
- Loss of nasolabial fold
- Asymmetric smile
Differential Diagnosis
Facial paralysis
- Bell's palsy
- CVA
- Trigeminal neuralgia
- Tick paralysis
- Herpes zoster oticus (Ramsay Hunt syndrome)
- CNS tumor
- Acoustic neuroma or other cerebellopontine angle lesions
- Meningioma
- Cerebellar pontine angle
- Facial nerve schwannoma
- Parotid
- Sarcoma
- Anesthesia nerve blocks
- Cerebral Aneurysms (vertebral, basilar, or carotid)
Evaluation
Central Process
Peripheral Process
- No labs or imaging routinely necessary
- Consider lyme serologies if endemic area
Management
Central Process
- Treat underlying pathology
Peripheral Process
- Prednisone (unless diagnosed Lyme disease)
- Empiric doxycycline if high suspicion for Lyme disease
- Consider valacyclovir for severe presentation if Lyme is negative
- Artificial tears
- Consider neurology follow-up