Bells Palsy

Question 1

What is Bells palsy?

1 - weakness or paralysis of facial muscles on one side of the face
2 - over activation of facial muscles
3 - inhibition of ACh, and no innervation of facial muscles
4 - all of the above

Answer 1

1 - weakness or paralysis of facial muscles on one side of the face

Question 2

Bells palsy is a weakness or paralysis of facial muscles on one side of the face. Which cranial nerve is affected that causes Bells palsy?

1 - trigeminal nerve (CN V)
2 - oculomotor nerve (CN III)
3 - vestibulocochlear nerve (CN VIII)
4 - facial nerve (CN VII)

Answer 2

4 - facial nerve (CN VII)

Question 3

What is the incidence of Bells palsy?

1 - 20-40 / 100
2 - 20-40 / 1000
3 - 20-40 / 10,000
4 - 20-40 / 100,000

Associated with a virus (most commonly herpes simplex virus)
but 3x higher risk of pregnancy, also associated with diabetes, immunocompromise, obesity, hypertension, upper respiratory infections

Answer 3

4 - 20-40 / 100,000

Question 4

Is their a gender effect in Bells palsy?

Answer 4

• no

Question 5

What age is most commonly affected in Bells palsy?

1 - 9 months - 12 years old
2 - 12-36 years old
3 - 15-45 years old
4 - >55 years old

Answer 5

3 - 15-45 years old

Question 6

All of the following can increase the risk of Bells Palsy, but which 2 have the largest risk factor?

1 - pregnancy
2 - diabetes
3 - immunocompromised patients
4 - hypertension
5 - upper respiratory infections
6 - obesity

Answer 6

1 - pregnancy
- increases the risk by 3

2 - diabetes
- increases the risk by 5

Question 7

CN VII (7) is affected in Bells palsy. CN VII originates from where?

1 - cerebrum
2 - mid brain
3 - pons
4 - medulla oblongata

Answer 7

3 - pons

2 - cerebrum
2 - midbrain
4 - pons
4 - medulla oblongata

Question 8

CN VII (7) is affected in Bells palsy. CN VII originates in the pons before traveling through the temporal bone and through which canal in the skull?

1 - carotid canal
2 - facial canal
3 - hypoglossal canal
4 - optic canal

Answer 8

2 - facial canal

Question 9

Where does CN VII leave the skull?

1 - stylomastoid foreman
2 - foramen spinosum
3 - roramen rotundum
4 - jugular foramen

Answer 9

1 - stylomastoid foreman

Question 10

Which of the following is NOT part of CN VII the facial nerve?

1 - temporal
2 - zygomatic
3 - maxillary
4 - buccal
5 - mandibular
6 - cervical

Answer 10

3 - maxillary

Question 11

CN VII (7) is involved in both motor and sensory information. For the lower half of the face the upper motor neuron travels from the motor cortex, before synapsing with the lower motor neuron (LMN) for CN VII in the pons of the brain stem. Does this then remain ipsilateral or contralateral?

Answer 11

• contralateral
• crosses over to the opposite side and synapses with CN VII in pons
• innervates the lower half of the face

Question 12

CN VII (7) is involved in both motor and sensory information. For the upper half of the face the upper motor neuron (UMN) travels from the motor cortex, before synapsing with the lower motor neuron (LMN) for CN VII in the pons of the brain stem. Does this then remain ipsilateral or contralateral?

Answer 12

• contralateral
• crosses over to the opposite side and synapses with CN VII in pons
• innervates the upper half of the face

Question 13

There are 2 the upper motor neurons (UMN) that travel from the motor cortex and synapse with the CN VII in the pons:

• 1 innervates lower half of face on contralateral side of the face
• 1 innervates upper half of face on contralateral side of the face

There is also a 3rd motor neuron that travels down from the motor cortex to innervate the top half of the face. Does this innervate ipsilateral or contralaterally?

Answer 13

• ipsilateral
• does not cross onto the opposite side of the pons
• remains on the same side and innervates the upper half of the same side of the face

Question 14

Which of the following does CN VII innervate?

1 - sublingual gland
2 - submandibular gland (saliva)
3 - mucus membranes
4 - lacrimal glands
5 - all of the above

Answer 14

5 - all of the above

Question 15

In the ear, which of the following does CN VII innervate?

1 - stapedius muscles
2 - tensor tympani muscle
3 - tympanic membrane
4 - all of the above

Answer 15

1 - stapedius muscles
- used to dampen the vibrations of the stapes, essentially protects you from loud noises

Question 16

Which of the following sensory aspects does CN VII innervate?

1 - posterior 1/3 of the tongue
2 - smell
3 - anterior 2/3 or the tongue
4 - corneal reflex

Answer 16

3 - anterior 2/3 or the tongue

Question 17

Although all of the following can cause Bells Palsy, which of the following is most common?

1 - herpes simplex virus
2 - epstein-Barr virus
3 - varicella-zoster virus
4 - borrelia burgdorferi

Answer 17

1 - herpes simplex virus

Question 18

Which of the following can cause a lower-motor neuron disorder such as Bells Palsy?

1 - gullain-barre
2 - lyme
3 - HIV
4 - sarcoid
5 - myasthenia gravis
6 - all of the above

Answer 18

6 - all of the above

Question 19

In Bells palsy, is the whole face or just the lower half of the face affected?

Answer 19

• whole side of the face
• the LMN is damaged so information from both ipsilateral and contralateral UMN does not reach the face

Question 20

In a stroke, is the whole face or just part of the face affected?

Answer 20

• part of the face is affected
• 2 UMN on contralateral sides affected (1 for lower half and 1 for upper half of face)
• BUT UMN on ipsilateral is unaffected

Question 21

In Bells Palsy which of the following would NOT be present?

1 - inability to raise the eyebrows
2 - inability to keeps eyes shut (orbicularis oculi)
3 - inability to show teeth
4 - inability to puff out cheeks
5 - inability to grimace
6 - inability to speak

Answer 21

6 - inability to speak
- patients can still speak

Question 22

Does Bells palsy affect the patients sense of taste?

Answer 22

• yes
• anterior 2/3 of the tongue are affected in Bells Palsy

Question 23

In patients with partial paralysis, how long does it typically take to spontaneously recover?

1 - 24h
2 - 48h
3 - <1 week
4 - 2-3 weeks

Answer 23

4 - 2-3 weeks

Question 24

In patients with complete paralysis, what % make a spontaneous recover?

1 - 15%
2 - 35%
3 - 55%
4 - 85%

Answer 24

4 - 85%
- 15% have axonal degeneration

Question 25

Synkinesis is a complication of Bells palsy, what is Synkinesis?

1 - involuntary facial muscle contraction
2 - involuntary gustatory lacrimation
3 - paralysis of the opposite side of the face
4 - all of the above

Answer 25

1 - involuntary facial muscle contraction

Question 26

Bogorad syndrome is a complication of Bells palsy, what is Bogorad syndrome?

1 - involuntary facial muscle contraction
2 - involuntary gustatory lacrimation
3 - paralysis of the opposite side of the face
4 - all of the above

Answer 26

2 - involuntary gustatory lacrimation
- can cause crocodile tears when eating or drinking

Question 27

In patients who present with Bells Palsy within 72h, they should be treated with what?

1 - NSAIDs
2 - prednisolone
3 - cyclizine
4 - tinzaparin

Answer 27

2 - prednisolone

Question 28

Are anti-virals, such as aciclovir typically given in Bells Palsy?

Answer 28

• yes
• commonly prescribed alongside prednisolone but the evidence for the use of them is lacking