Condition- Bell's palsy

Question 1

What is Bell’s palsy?

Answer 1

Acute, unilateral, idiopathic facial nerve paralysis

Question 2

List two infective causes of Bell’s Palsy

Answer 2

HSV-1 - most common

VZV

Question 3

List some of the presenting symptoms of Bell’s palsy

Answer 3

• Can’t scrunch up forehead
• Can’t shut eyes (even at night)
  
  • Corenal abrasions
  • Dry eyes
• Droopy smile

Question 4

Which investigation could you do on a patient with Bell’s Palsy?

Answer 4

Serology- check for HSV-1, VZV and Lyme’s disease

Question 5

How is Bell’s Palsy managed?

Answer 5

1. Eye patch (to prevent corneal abrasions) and Eye drops (to lubricate)
2. Prednisalon: reduces inflammation and induces remission

Question 6

How can facial paralysis caused by stroke be differentiated from Bells

Answer 6

• Bell’s is a LMN lesion so the forehead is paralysed
• Stroke is an UMN lesion so the forehead is still functional because the forehead has a double innervation

Question 7

What is the name of the facial syndrome caused by VZV reactivation in the facial nerve?

Answer 7

Ramsay Hunt Syndrome

Question 8

List some of the presenting symptoms of someone with Ramsay Hunt syndrome

Answer 8

• Facial nerve paralysis
• Pain
• Vesicles in the inner ear, anterior 2/3rds of the tongue, hard palate (shingles)
• CN8 involvement => vertigo, tinnitus, hearing loss