Difference between revisions of "Bell's palsy"

(Treatment)
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*Always test CN VI function (should be normal) to rule-out [[CVA]]
 
*Always test CN VI function (should be normal) to rule-out [[CVA]]
  
==DDX==
+
==Differential Diagnosis==
 
#Lyme Disease
 
#Lyme Disease
 
#[[HIV - AIDS (Main)|HIV]]
 
#[[HIV - AIDS (Main)|HIV]]
 
#[[Otitis Media]]
 
#[[Otitis Media]]
 
#Sarcoidosis (esp if b/l)
 
#Sarcoidosis (esp if b/l)
 +
 +
==Work Up==
 +
*Clinicians should NOT obtain routine laboratory testing in patients with new-onset Bell's palsy<ref>Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref>
  
 
==Clinical Features==
 
==Clinical Features==

Revision as of 21:17, 8 April 2014

Background

  • Dysfunction of peripheral CN VII of unknown cause
  • Maximal clinical weakness around 3wks; at least partial recovery by 6 months
  • Always test CN VI function (should be normal) to rule-out CVA

Differential Diagnosis

  1. Lyme Disease
  2. HIV
  3. Otitis Media
  4. Sarcoidosis (esp if b/l)

Work Up

  • Clinicians should NOT obtain routine laboratory testing in patients with new-onset Bell's palsy[1]

Clinical Features

  • Acute onset (over hours) of unilateral facial paralysis
    • No forehead sparing
    • Mouth drawn to the non-affected side
  • Incomplete closure of the eyelids on the affected side
    • Can lead to corneal exposure keratitis

Treatment

  1. Cornea
    1. Artificial tears qhr while pt is awake AND
    2. Ophthalmic ointment at night
    3. Protective glasses or goggles
  2. Corticosteroids
    1. Give to all pts
    2. Prednisone 60-80mg qday x1wk[2]
  3. Antivirals
    1. Controversial efficacy; may have benefit in pts w/ severe palsy
    2. Valacyclovir 1000mg TID x1wk[3]
      1. Or, Acyclovir 400mg 5x per day x 1wk

Disposition

  • Discharge with ophtho f/u for monitoring of the affected cornea

See Also

Source

  • Tintinalli

References

  1. Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
  2. UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
  3. UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014