Facial weakness: Bell's palsy + Ramsay Hunt syndrome

Question 1

sudden onset of unilateral facial weakness, including forehead

Answer 1

Unilateral lower motor neurone facial nerve lesion

Bells palsy

Question 2

sudden onset of unilateral facial weakness with sparing of forehead

Answer 2

Unilateral upper motor neurone lesion

Question 3

peak incidence of Bell’s Palsy

Answer 3

20-40 years old

Question 4

bell’s palsy is more common in….

Answer 4

pregnant women

Question 5

symptoms that may precede the onset of facial weakness/paralysis in Bell’s palsy

Answer 5

post auricular pain

Question 6

other symptoms in Bell’s Palsy (3)

Answer 6

• hyperacusis
• dry eyes
• altered taste

Question 7

4 causes of bilateral lower motor neurone facial weakness

Answer 7

• Bilateral Bell’s palsy
• GBS
• Sarcoidosis
• MG

Question 8

causes of facial nerve lesion at the site of facial canal (3)

Answer 8

• tumour deposits
• middle ear infection
• bells palsy

Question 9

in which condition is there an infection of the geniculate ganglion?

Answer 9

Ramsay Hunt Syndrome

Question 10

causes of lesions of the peripheral branches of the facial nerve

Answer 10

• Parotid gland lesions: tumours infections, sarcoidosis

- infection

Question 11

management of Bell’s Palsy

Answer 11

1mg/kg for 10 days, within 72 hours of onset of symptoms

Question 12

what should be done to maintain eye care in Bell’s palsy

Answer 12

• prescription of artificial tears
• eye lubricants
• taping of eye at night

Question 13

by when does the facial weakness usually recover by in Bell’s palsy

Answer 13

4-6 months

Question 14

causes of Bell’s palsy

Answer 14

• idiopathic

- Herpes simplex virus activation

Question 15

who is at risk of developing bells palsy

Answer 15

pregnant women in the 3rd trimester of pregnancy

Question 16

if full recovery is not obstained within 3 months…

Answer 16

nerve damage may be more extensive + additional treatment required; referral to a specialist

Question 17

role of Botulinum injections for Bell’s palsy

Answer 17

• decrease overactivity in muscles which are tight or twitchy
• relax involuntary movements
• restore a more balances facial expression

Question 18

DDx for Bell’s palsy (3)

Answer 18

• Stroke
• Ramsay hunt syndrome
• Lyme disease

Question 19

what is Ramsay Hunt syndrome?

Answer 19

LMN facial palsy specifically due to Varicella Zooster virus

Question 20

what should be suspected in a patient experiencing severe pain around their ear, followed by rashes or blisters around; ear, scalp, hair line, mouth, throat

Answer 20

ramsay hunt syndrome

Question 21

In ramsay hunt syndrome, where can the rashes or blisters appear

Answer 21

ear, scalp, hair line, mouth, throat

Question 22

Pathogenesis of Ramsay hunt syndrome

Answer 22

Reactivation of the Varicella Zoster virus

Question 23

what can reactivation of the Varicella zoster virus result in

Answer 23

painful, maculopapular rash called; Herpes zoster

Question 24

what virus causes shingles + chicken pox

Answer 24

Varicella zoster virus

Question 25

what happens once the symptoms have subsided from chicken pox and shingles

Answer 25

the varicella zoster virus estalishes latency in the dorsal root + CN ganglia

Question 26

is the RHS rash contagious

Answer 26

yes, for people with no immunity to chicken pox can catch chicken pox by contact with the open rash or blister on the infected person however, can not catch RHS

Question 27

risk factors for RHS

Answer 27

- HIV/immunodeficiency - Chronic steroid use - Chemotherapy - Malignancy

Question 28

until the rash blisters scab over, individuals with RHS should avoid contact with:

Answer 28

- newborns - pregnant women - weak immune system - anyone who's never had chicken pox or vaccinated against chicken pox

Question 29

describe the course of the infection in RHS

Answer 29

erythematous maculopapular rash --> clear vesicles --> vesicles erruption occuring in segments innervated by the affected sensory ganglion vesicles eventually pustulate and form crusts

Question 30

how long does it take for the rash blisters to resolve

Answer 30

4-5 weeks

Question 31

symptoms in RHS before rash onset

Answer 31

prodromal period with burning pain, 2-3 days prior to rash AND pain can persist for several months after the rash resolves

Question 32

RHS investigations (4)

Answer 32

- full examination including ear and facial nerve function - Blood tests: Ab for VZV - Hearing tests - MRI - Nerve conduction studies

Question 33

management of RHS (4)

Answer 33

- Aciclovir within 72 hours, for 7 days - short course of high dose steroids - painkillers - botulism toxin injections

Question 34

management if there is no signs of improvement after 1 month in RHS?

Answer 34

- referral to facial palsy specialist: neurologist, plastic surgeon, ENT consultant - specialist facial therapist

Question 35

management if poor eye closure after 2-3 weeks in RHS

Answer 35

referral to ophthalmology

Question 36

otological symptoms in RHS

Answer 36

- hearing loss on affected side - dizziness/vertigo - tinnitus