Bell's palsy

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

DDX

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

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
3. Antivirals
   1. Controversial efficacy; may have benefit in pts w/ severe palsy
   2. Valacyclovir 1000mg TID x1wk

Disposition

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

Source

• Tintinalli