Bells Palsy Aetiology l l Most cases unknown

Bells Palsy

Aetiology l l Most cases unknown Most likely cause is viral

Incidence l l Commonest in age group 10 -40 yrs 20 cases per 100, 000 people

Examination l l l Differentiate between upper and lower motor neurone lesion UML: frontalis is spared allowing normal furrowing of brow and eye blinking LML: all muscles of facial expression are affected

Examination continued l l Check no other cranial nerves involved (BP is an isolated VII lesion) Look for a painful rash over the ears (Ramsay Hunt caused by H zoster)

Red flags which may necessitate referral l l Bilateral BP Recurrent BP Association with rash elsewhere or with feeling generally unwell (sarcoid or Lyme disease) Previous episode which might have been demyelination ? SOL

Treatment l l l Prednislone 1 mg/kg up to 80 mg max per day tailing off in second week (reduces oedema) Aciclovir 800 mg 5 x daily for 5 days given within first 72 hrs (prevents viral replication) Consider tape/eye pad so patient can sleep Consider prescription for artificial tears Reassure patient that he hasn’t had a CVA

Follow up l l l 2/3 rds of patients have spontaneous recovery 85% show improvement in the first 3/52 15% show some improvement in 3 -6/12 Refer all cases to ENT after initiating Rx Consider referral to eye specialist for tarsorrhaphy for those patients who have failed to make a complete recovery