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    Bells Pulsy

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    ShahriarAnik
    Bell's palsy is an idiopathic, lower motor neuron facial palsy that is thought to be caused by reactivation of the herpes simplex virus. It presents with sudden onset of unilateral facial weakness and numbness without objective sensory loss. Examination reveals an ipsilateral facial nerve palsy without forehead sparing. Treatment involves corticosteroids and antivirals within 72 hours as well as facial exercises, with 70-80% recovering fully within 12 weeks. Ramsay Hunt syndrome involves the same facial palsy accompanied by a rash in the ear and soft palate as well as taste loss.

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    Bells Pulsy

    Uploaded by

    ShahriarAnik
    28 views11 pages
    Bell's palsy is an idiopathic, lower motor neuron facial palsy that is thought to be caused by reactivation of the herpes simplex virus. It presents with sudden onset of unilateral facial weakness and numbness without objective sensory loss. Examination reveals an ipsilateral facial nerve palsy without forehead sparing. Treatment involves corticosteroids and antivirals within 72 hours as well as facial exercises, with 70-80% recovering fully within 12 weeks. Ramsay Hunt syndrome involves the same facial palsy accompanied by a rash in the ear and soft palate as well as taste loss.

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    Bell's palsy is an idiopathic, lower motor neuron facial palsy that is thought to be caused by reactivation of the herpes simplex virus. It presents with sudden onset of unilateral facial weakness and numbness without objective sensory loss. Examination reveals an ipsilateral facial nerve palsy without forehead sparing. Treatment involves corticosteroids and antivirals within 72 hours as well as facial exercises, with 70-80% recovering fully within 12 weeks. Ramsay Hunt syndrome involves the same facial palsy accompanied by a rash in the ear and soft palate as well as taste loss.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views11 pages

    Bells Pulsy

    Uploaded by

    ShahriarAnik
    Bell's palsy is an idiopathic, lower motor neuron facial palsy that is thought to be caused by reactivation of the herpes simplex virus. It presents with sudden onset of unilateral facial weakness and numbness without objective sensory loss. Examination reveals an ipsilateral facial nerve palsy without forehead sparing. Treatment involves corticosteroids and antivirals within 72 hours as well as facial exercises, with 70-80% recovering fully within 12 weeks. Ramsay Hunt syndrome involves the same facial palsy accompanied by a rash in the ear and soft palate as well as taste loss.

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    Bell’s palsy

    What is Bell’s palsy?


    It is a LMN type of facial palsy.
    Sir Charles Bell(1774-1842), Scottish surgeon anatomist

    Causes of Bell’s palsy?


    Idiopathic in 95% cases; it may be related to viral infection due to
    reactivation of latent herpes simplex virus I.
    • It is more common following upper respiratory tract infections, during
    pregnancy, and in patients with diabetes, immunosuppression and
    hypertension.
    Site of lesion in Bell’s palsy?
    Facial canal, in petrous part of temporal bone (in stylomastoid foramen).

    Clinical feature:
    Symptoms usually develop subacutely over a few hours, with pain around
    the ear preceding the unilateral facial weakness. Patients often describe
    the face as 'numb' but there is no objective sensory loss (except to taste, if
    the chorda tympani is involved).
    • Hyperacusis may occur if the nerve to stapedius is involved and
    impairment of parasympathetic fibres may cause diminished salivation
    and tear secretion.
    • Examination reveals an ipsilateral lower motor neuron facial nerve
    palsy (no sparing of forehead muscles). Vesicles in the ear or on the
    palate may indicate primary herpes zoster infection. A clinical search
    for signs of other causes of lower motor neuron facial nerve weakness,
    such as parotid or scalp lesions, trauma or skull base lesions, is
    justified.
    Bell’s phenomenon?
    On attempting to close the eyes, the eyeball rolls upwards and outwards,
    and is called Bell phenomenon. It is a normal phenomenon, but cannot
    be seen when eyes closed. It is only seen in Bell’s palsy. Because eyes
    cannot be closed in BP.
    Treatment :
    • Prednisolone 40-60 mg daily for 1 week should be given within 72 hr.
    • In severe case, prednisolon plus antiviral (acyclovir or valaciclovir)
    may be given within 72 hours
    • Physiotherapy: Facial exercise and electro stimulation within 14 days.
    • Protection of eye during sleep (shut with tape, or even tarsoraphy),
    artificial tears or ointment.
    • Residual paralysis may occur in 10% cases.
    • Cosmetic surgery may be helpful.
    • During recovery, aberrant reinnervation may occur producing
    unwanted facial movement and tear during salivation (called crocodile
    tear).
    Prognosis of Bell palsy?
    • Spontaneous improvement begins in 2nd week, 70-80% cure within 12
    weeks.
    • May take 12 months.
    • Less than 10% may have residual weakness.
    • Prognosis can be detected by EMG: Reduction of amplitude of facial
    muscle action potential in the 1st week indicates slow or incomplete
    recovery.
    Ramsay hunt syndrom

    It is the herpes zoster of geniculate ganglia characterized by:


    • Ipsilateral VII th cranial nerve palsy (lower motor neuron).
    • Rash (herpetic vesicles) in the external auditory meatus and soft palate.
    • Ipsilateral loss of taste and buccal ulceration.
    • Deafness and Vth nerve lesion may also occur.

    Treatment: Antiviral like famciclovir may be given.


    However, complete recovery is less likely than Bell palsy.
    Thank You

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