Facial paralysis

Background

  • Key to distinguish between central and peripheral facial nerve palsy

Causes

Clinical Features

Right-sided peripheral facial nerve palsy with inability to wrinkle the forehead and nose, unequal lid fissures, and inability to lift the corner of the mouth.

Central Process

  • Forehead "sparing" or normal muscle tone of the forehead

Peripheral Process

  • Weakness of forehead muscles

Central and Peripheral

  • Unable to close eye
  • Loss of nasolabial fold
  • Asymmetric smile

Differential Diagnosis

Facial paralysis

Evaluation

Central Process

  • CT

Peripheral Process

  • No labs or imaging routinely necessary
  • Consider lyme serologies if endemic area

Management

Central Process

Peripheral Process

  • Prednisone (unless diagnosed Lyme disease)
  • Empiric doxycycline if high suspicion for Lyme disease
  • Consider valacyclovir for severe presentation if Lyme is negative
  • Artificial tears
  • Consider neurology follow-up

Disposition

See Also

External Links

References