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Bell’s palsy

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Bell's Palsy

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Bell’s palsy

  1. 1. Bell’s Palsy http://crisbertcualteros.page.tl http://crisbertcualteros.page.tl
  2. 2. Early symptoms: • Weakness of the facial muscles • Poor eyelid closure • Aching of the ear or mastoid (60%) • Alteration of taste (57%) • Hyperacusis (30%) • Tingling or numbness of the cheek/mouth • Epiphora • Ocular pain • Blurred vision • Onset: typically sudden • Symptoms: peak in less than 48 hours
  3. 3. DX • based on history and PE & diagnostic testing • Bell’s palsy is a diagnosis of exclusion. • Clinical fx that distinguish it from other causes of facial paralysis: 1) sudden onset of unilateral facial paralysis 2) absence of signs and symptoms of CNS, ear, and cerebellopontine angle disease.
  4. 4. Symptoms: • Acute onset of unilateral upper and lower facial paralysis (over a 48-h period) • Posterior auricular pain • Decreased tearing • Hyperacusis • Taste disturbances • Otalgia
  5. 5. Investigations: • MRI: may show SOL, stroke or MS • CSF: to check for infection • Serology: 1) Lyme Disease high Borrelia antibodies 2) High VZV antibodies in Ramsay Hunt Syndrome • Nerve Conduction Studies: at 2wks predict delayed recovery by showing axonal degeneration
  6. 6. prognosis • Incomplete paralysis without axonal degeneration: covers completely within a few weeks • Complete paralysis: 80% full spontaneous recovery 15% with axonal degeneration: recovery is delayed, starting after 3 months
  7. 7. management • Prednisolone 60mg/day for 5days (tailing by 10mg/day – if given within 72hours of onset- improved recovery time - 95% making a full recovery - Prednisolone acts by reducig axonal edema and damage
  8. 8. management • Protect the eye: give Artificial tears - Dark glasses - Encourage regular eyelid closure • Aciclovir 800mg 5x/day for 5-7days

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