Difference between revisions of "Bell's palsy"
Ostermayer (talk | contribs) (→Clinical Features) |
Ostermayer (talk | contribs) |
||
Line 1: | Line 1: | ||
==Background== | ==Background== | ||
− | *Dysfunction of peripheral CN VII of unknown cause | + | *Dysfunction of peripheral CN VII of unknown cause due to Inflammation at geniculate ganglion <ref>Greco A. et al. Bell's palsy and autoimmunity. Autoimmun Rev. 2012;12 622-627</ref> |
*Maximal clinical weakness around 3wks; at least partial recovery by 6 months | *Maximal clinical weakness around 3wks; at least partial recovery by 6 months | ||
*Always test CN VI function (should be normal) to rule-out [[CVA]] | *Always test CN VI function (should be normal) to rule-out [[CVA]] |
Revision as of 15:24, 11 April 2014
Contents
Background
- Dysfunction of peripheral CN VII of unknown cause due to Inflammation at geniculate ganglion [1]
- 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
- Amyloidosis
- Anesthesia nerve blocks
- Cerebral Aneurysms (vertebral, basilar, or carotid)
- Botulism
- CVA
- Guillain-Barré Syndrome
- HIV
- Intracranial Hemorrhage
- Lyme Disease
- Malignant Otitis Externa
- Meningitis
- Neurosyphilis
- Otitis Media (acute or chronic)
- Parotitis
- Ramsay Hunt syndrome
- Sarcoidosis
- Tumor
- Acoustic neuroma or other cerebellopontine angle lesions
- Meningioma
- Cerebellar pontine angle
- Facial nerve schwannomaa
- Parotid
- Sarcoma
Work Up
- Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy (Level C)[2]
Clinical Features
- Acute onset (over hours) of unilateral facial paralysis
- No forehead sparing
- Inability to raise eyebrows
- Drooping of angle of the mout
- Incomplete closure of the eyelids on the affected side
- Can lead to corneal exposure keratitis
Associated Symptoms
- Alterations in Taste
- Hyperacusis
- Inability to produce tears
- Subjective feeling of facial numbness although no demonstrable numbness
Treatment
- Cornea eye protection (Level X)[3]
- Artificial tears qhr while pt is awake AND
- Ophthalmic ointment at night
- Protective glasses or goggles
- Steroids + antiviral therapy for patients <72 hours of symptom onset (Level B)[4]
Disposition
- Discharge with ophtho f/u for monitoring of the affected cornea
- Refer to a facial nerve specialist for:[7]
- New or worsening neurologic findings at any point
- Ocular symptoms developing at any point
- Incomplete facial recovery 3 months after initial symptom onset.
See Also
Source
- Tintinalli
References
- ↑ Greco A. et al. Bell's palsy and autoimmunity. Autoimmun Rev. 2012;12 622-627
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.
- ↑ UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
- ↑ UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
- ↑ Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.