Bell's palsy: Difference between revisions
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==Work Up== | ==Work Up== | ||
*Clinicians should NOT obtain routine laboratory testing in patients with new-onset Bell's palsy (Level C)<ref>Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref> | *Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy (Level C)<ref>Baugh RF, et al. Clinical practice guideline: Bell's palsy. Otolaryngol Head Neck Surg. 2013 Nov;149(3 Suppl):S1-S27.</ref> | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 21:19, 8 April 2014
Background
- Dysfunction of peripheral CN VII of unknown cause
- Maximal clinical weakness around 3wks; at least partial recovery by 6 months
- Always test CN VI function (should be normal) to rule-out CVA
Differential Diagnosis
- Lyme Disease
- HIV
- Otitis Media
- Sarcoidosis (esp if b/l)
Work Up
- Clinicians should NOT obtain routine laboratory testing or diagnostic imaging in patients with new-onset Bell's palsy (Level C)[1]
Clinical Features
- Acute onset (over hours) of unilateral facial paralysis
- No forehead sparing
- Mouth drawn to the non-affected side
- Incomplete closure of the eyelids on the affected side
- Can lead to corneal exposure keratitis
Treatment
- Cornea
- Artificial tears qhr while pt is awake AND
- Ophthalmic ointment at night
- Protective glasses or goggles
- Corticosteroids
- Give to all pts
- Prednisone 60-80mg qday x1wk[2]
- Antivirals
- Controversial efficacy; may have benefit in pts w/ severe palsy
- Valacyclovir 1000mg TID x1wk[3]
- Or, Acyclovir 400mg 5x per day x 1wk
Disposition
- Discharge with ophtho f/u for monitoring of the affected cornea
See Also
Source
- Tintinalli