Download Bell`s Palsy - IAP Neurology Chapter

Bell’s Palsy
•
Neurolgy Chapter of IAP
Bell’s Palsy
• Characterized by:
– Peripheral facial paralysis
– Acute benign cranial polyneuritis
Acute disorder characterized by a disruption
of the motor branches of cranial nerve VII
on one side of the face. (in absence of
stroke)
Neurolgy Chapter of IAP
Bell’s Palsy
• Can affect any age
group, though more
common from 2060.
• Etiology unknown;
though reactivated
herpes simplex may
be involved.
• Reactivation causes
edema,
inflammation,
ischemia, and
eventual
demyelination of the
nerve, creating pain
and alteration in
motor and sensory
function.
Neurolgy Chapter of IAP
Clinical manifestations
• Benign, with 85% of
people recovering in
6 months-remaining
15% have some
asymmetry of facial
muscles
Neurolgy Chapter of IAP
•
Clinical manifestations
• Often accompanied by an outbreak of herpes
vesicles in or around the ear.
• Pain around or behind the ear
• Fever, tinnitus, hearing deficits
• Flaccidity of the affected side of the face with
drooping of the mouth accompanied by
drooling DT paralysis of the facial nerve
(motor branches)
Neurolgy Chapter of IAP
Clinical manifestations
• Inability to close the eyelids, with an upward
movement of the eyeball when closure is attempted;
lower lid may turn out
• Wide palpebral fissure (opening between eyelids)
• Flattening of the nasolabial fold
• Inability to smile, frown, or whistle
• Unilateral loss of taste
• Altered chewing ability; loss of or excessive tearing
Neurolgy Chapter of IAP
Complications
• Psychological withdrawal DT changes in
appearance,malnutrition or dehydration,
mucous membrane trauma, corneal
abrasion, muscle stretching, and facial
spasms and contractures.
Neurolgy Chapter of IAP
Diagnostic Studies
• Diagnosis made on basis of symptoms
in the absence of other causes of
paralysis such as stroke.
• No definitive test
• EMG may determine nerve excitability
or absence
Neurolgy Chapter of IAP
Therapeutic Management
• Corticosteroids- drug of choice
• Prednisone may be started immediately!
– Best if initiated before paralysis is complete
– Taper off over 2 weeks
– Decrease edema and pain
Analgesics may be needed for pain
Antivirals : Acyclovir (Zovirax) and Famvir because
HSV is implicated in 70% of cases.
See Lewis 1719-1720- Nursing Implementation
Neurolgy Chapter of IAP