Clinical Care- Bells Palsy

Question 1

overview of bells palsy:

Answer 1

(1) Acute facial palsy (paralysis) of a specific pattern
(2) Lower motor neuron disease affecting CN VII
(3) Rare (34/100,000 people) and slightly more common in pregnancy, otherwise no
predisposing factors.
(4) Idiopathic paresis of lower motor neuron type
(5) Associated with Herpse Simplex Virus, Lyme disease, HIV and sometimes idiopathic

Question 2

clinical presentation of bells palsy

Answer 2

abrupt onset

pain in the ear can accompany

face fells stiff, pulled to one side

may not be able to close eye, leading to dry eyes

changes in taste

bells phenomenon (upward rolling of the eye on attempted lid closure)

Question 3

How is Bells Palsy diagnosed?

Answer 3

clinical diagnosis

Question 4

difference between a bells palsy and stroke

Answer 4

in a stroke there is NO paralysis of the forehead.

Question 5

DDX of bells palsy

Answer 5

(1) Herpes zoster
(2) Otitis Media
(3) Lyme disease
(4) Guillain-Barre syndrome

Question 6

TX of Bells Palsy

Answer 6

evaluate eyes closure, and if inadequate implement eye protection

shorten duration of sx with oral steroids

Prednisone is used for mild to moderate Bells Palsy
60mg PO daily x7 days, then 5 day taper, best to start within 5 days of symptoms

Question 7

what medication is added to steroid treatment regiment for SEVERE Bells Palsy

Answer 7

Valacyclovir 1000mg 3 times daily for 7 days

Question 8

what are some complications from bells palsy

Answer 8

long term or permanent disfigurement of problems with CN VII
corneal ulceration

Question 9

Disposition of Bells Palsy

Answer 9

immediate referral/MEDEVAC if eye complications or suspicious of alternative diagnosis

referral to neuro/MEDADVICE if mild paresis and no other SX

follow SX and extent of paralysis while onboard.