16 - Bell Palsy Flashcards Preview

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Flashcards in 16 - Bell Palsy Deck (26):
1

What is Bell palsy?

lower motor neuron paralysis of the facial nerve

2

Bell palsy is often caused by what virus

HSV-1

3

Who does it occur more frequently in?

pregnant women, diabetics, those with migraine or HTN

4

Up to ___% achieve spontaneous recovery without treatment

85

5

Why is eye care important?

if the eye cannot be closed voluntarily, it is at risk for corneal abraisions

6

What eye care is recommended?

-Lubricate with eye drops or ointment
-Tape eyelid closed at night and protect with glasses during the day

7

What analgesics are recommended and when?

-ibuprofen or acetaminophen are occasionally required for first 1-2 days

-opioids such as morphine are rarely needed

8

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)

9

Early treatment with corticosteroids is recommended, within ____ hours of symptom onset = max benefit

72

10

What corticosteroid is recommended?

oral prednisone

11

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

12

Which antivirals may be used?

-acyclovir
-famciclovir
-valacyclovir

13

Should antivirals be used alone for bell palsy?

No - when used alone, they provide no benefit over placebo

14

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

15

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

16

No good evidence for prednisone if started > ___ days after symptom onset

7

17

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

18

s/e of antivirals?

headache, nausea

19

s/e of prednisone?

GI upset, hyperglycemia, sodium and fluid retention, hypokalemia, hypocalcemia

20

What are risk factors for Bell palsy?

smoking, HTN, diabetes, pregnancy

21

What are risk factors for Guillain-Barre Syndrome?

infections, vaccinations, surgery, male gender, older age and Hodgkin's Lymphoma

22

Is there a cure for Guillain-Barre Syndrome?

No - supportive care and treatment do not cure it

23

What is the Tx option for Guillain-Barre Syndrome for those not recovering within 4 weeks of symptom onset?

-plasma exchange
or
-IVIG

24

s/e of plasma exchange?

hypotension and sepsis

25

describe plasma exchange

treatment is performed over 8-10 days, may be required 4-6 times, and it removes blood and other immune cells

26

s/e of high dose immunoglobulin ?

aseptic meningitis

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