Bells Palsy ☺️

Question 1

Bells Palsy presentation

Differentiation between Bells and a stroke

Answer 1

LMN unilateral facial nerve palsy
FOREHEAD AFFECTED

Preauricular pain
Altered taste
Dry eyes
Increased sensitivity to sound

Gradual onset without forehead sparing
No impact on motor function

Question 2

Epidemiology

Etiology and pathophysiology

Answer 2

20-40s, common in pregnant

Idiopathic but linked to herpes viruses

Affects both LMNs => impacts on upper and lower face

• UMN supplying upper face => bilateral
• UMN supplying lower face => contralateral

Question 3

Management

• pharmacological
• supportive

Answer 3

Prednisolone within 72hrs of onset
Valacyclovir

Lubricating eyedrops
Eye patch - protect eyes from abrasions

Question 4

Follow up and prognosis

Answer 4

Most recover within 3-4months
If untreated => 15% have permanent moderate/severe weakness

No improvement after 3wks => ENT referral
Surgery may be needed