Neurology

Question 1

What is the approximate incidence of acute facial nerve paralysis (Bell’s Palsy)?

Answer 1

20/100,00 per year - overall

6/100,000 per year ages 1-15 years

Question 2

In children what are 4 common acquired causes of facial nerve palsy (4 items)?

Answer 2

1. Otitis media
2. Herpes simplex virus infection
3. Varicella virus infection (Ramsey Hunt)
4. Lyme disease

Question 3

How might you distinguish between a facial nerve palsy (LMN) and a stroke (UMN)? (2 items)

Answer 3

1. Upper forehead facial muscles that are supplied by UMN nerves are bilaterally innervated (nerve supply from both sides of the brain)

With a stroke - there is forehead sparing, therefore wrinkles are still present.

2. Possible concurrent abducens (VI) involvement - the nuclei for each nerve are closely located in the brainstem - therefore a clue

Question 4

Describe the facial appearance of a typical patient with an acute facial paralysis (Bell’s Palsy - 4 items)

Answer 4

1. Drooping of the muscles on the affected side
2. Asymmetrical smile - drags –> good side
3. Loss of forehead creases
4. Loss of the nasolabial fold

Question 5

Describe how acute facial nerve paralysis might affect the ipsilateral eye? (2 items)

Answer 5

1. Inability to close the eye

2. Lack of tear production (lacrimal gland not innervated)

Question 6

What additional symptoms may be present with acute facial paralysis? (2 items)

Answer 6

1. Hyperacusis
2. Loss of taste sensation anterior tongue

Not present in all cases