Thursday, 4 November 2010

MRCP revision battle 42.1: Bell's Palsy

Yet another assault on the neurology knowledge-mountain with 7 neurology-focused battles...

MRCP revision battle 42.1: Bell's palsy
MRCP revision battle 42.2: Mononeuropathies
MRCP revision battle 42.3: Carpal tunnel syndrome
MRCP revision battle 42.4: Diabetic neuropathy
MRCP revision battle 42.5: Nystagmus
MRCP revision battle 42.6: Miosis
MRCP revision battle 42.7: Picks Disease

MRCP revision battle 42.1: Bell's palsy

Bell's palsy is an acute, unilateral, idiopathic facial nerve paralysis.

It affects LMN.

Classical features are:
  • sudden onset unilateral facial weakness
  • numbness/pain behind ipsilateral ear
  • absent taste from anterior 2/3rds of tongue
  • dry eyes
  • hypersensitivity to sound

Treatment is prednisolone for 10 days.
Some evidence suggests giving aciclovir as varicella zoster antibodies are often raised.
The eye should be protected - artificial tears, taping of eye at night, ?tarsorrhaphy.

Most cases fully recover; 15% will have a prolonged or incomplete recovery.
Some subsquently suffer from 'crocodile tears' = eating stimulates unilateral lacrimination instead of salivation.

Now on to some more mononeuropathies...