Flashcards in 16 - Bell Palsy Deck (26):
What is Bell palsy?
lower motor neuron paralysis of the facial nerve
Bell palsy is often caused by what virus
Who does it occur more frequently in?
pregnant women, diabetics, those with migraine or HTN
Up to ___% achieve spontaneous recovery without treatment
Why is eye care important?
if the eye cannot be closed voluntarily, it is at risk for corneal abraisions
What eye care is recommended?
-Lubricate with eye drops or ointment
-Tape eyelid closed at night and protect with glasses during the day
What analgesics are recommended and when?
-ibuprofen or acetaminophen are occasionally required for first 1-2 days
-opioids such as morphine are rarely needed
Why are corticosteriods recommended?
-have been shown to reduce rates of incomplete recovery as well as synkinesias and autonomic dysfunction in ADULTS
-anti-inflammatory action of corticosteroids minimizes nerve damage, and reduces pain
-corticosteroid-treated patients are less likely to develop denervation (loss of nerve supply)
Early treatment with corticosteroids is recommended, within ____ hours of symptom onset = max benefit
What corticosteroid is recommended?
Do we give corticosteroids to children with bell palsy?
No - risk of incomplete recovery from Bell palsy is very small & there is no benefit from corticosteroid therapy
Which antivirals may be used?
Should antivirals be used alone for bell palsy?
No - when used alone, they provide no benefit over placebo
Can antivirals be added to corticosteroid therapy?
Yes - whether antivirals add additional benefit to corticosteroids is controversial, but because s/e of antivirals is minimal, they can be offered to be added to corticosteroid therapy, esp for those who have severe case of bell palsy or who are immunocompromised
What do we do for pregnancy?
-supportive care, most recover spontaneously
-corticosteroids can be used (consider risk vs benefit)
-the effects of corticosteroids on the fetus is unclear
No good evidence for prednisone if started > ___ days after symptom onset
What is usual dose for prednisone for bell palsy?
60mg x 5 days, then taper x 5 days
(total of at least 450 mg)
*taper for short term corticosteroids not necessary but still done in practise
s/e of antivirals?
s/e of prednisone?
GI upset, hyperglycemia, sodium and fluid retention, hypokalemia, hypocalcemia
What are risk factors for Bell palsy?
smoking, HTN, diabetes, pregnancy
What are risk factors for Guillain-Barre Syndrome?
infections, vaccinations, surgery, male gender, older age and Hodgkin's Lymphoma
Is there a cure for Guillain-Barre Syndrome?
No - supportive care and treatment do not cure it
What is the Tx option for Guillain-Barre Syndrome for those not recovering within 4 weeks of symptom onset?
s/e of plasma exchange?
hypotension and sepsis
describe plasma exchange
treatment is performed over 8-10 days, may be required 4-6 times, and it removes blood and other immune cells