CLINICAL-BELL'S PALSY

SUMMARY

1. LMN CN VII palsy; idiopathic or caused by infection, occasionally results in no taste sensation on the anterior 2/3 of tongue, loss of lacrimation, and hyperacusis.

2. Pregeniculate lesions are associated with the loss of taste, salivation, and lacrimation, while more distal lesions spare these functions.

3. Causes: HSV; VZV which present(s) with vesicles involving the TM & EAC (Ramsay Hunt syndrome); Lyme disease; HIV.

4. Know that if the palsy is preceded by a period of facial twitching, the risk of tumor is higher - urgent imaging required.

5. Patients who begin to improve within 3 weeks will commonly recover completely.

6. A week of prednisone shortens the course and improves function if started within 7 days of clinical onset

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].