herpes zoster
Baby2501
SamplePresentation1.pptxBell’s Palsy
Jose Camilo Tabraue
Yodany Martinez
Miami Regional College
Description
A 40-year-old male with no serious medical history approached a healthcare provider with complaints of “left facial nerve paralysis, dry eyes, and noise sensitivy” that started a week time earlier with such initial symptoms as slight left jaw pinching at opening the mouth wide that lasted for 2 days. Furthermore, the discussed patient specified that further disorder progression was evident from a mild “left eyelid twitching,” slight left lip numbness that gradually progressed into mild left facial paralysis that affected functionality of the facial muscles from the left side. Further physical examination allowed diagnosing Bell’s palsy without additional tests and imaging studies.
Epidemiology
11 to 40 persons per 1000 worldwide.
40,000 to 60,000 cases in the United States (Callen & Pray, 2019).
23 cases per 100,000 annually (Mestrovic, 2014).
More after age 40 (Patel & Levin, 2015).
More prevalent in women
Diabetics and immunocompromised.
Guillain-Barré syndrome, meningitis, Lyme disease, sarcoidosis, or bilateral neurofibromas.
Etiology and Risk Factors
Inflammation of the facial nerve followed
by compression, ischemia, and demyelination.
Idiopathic.
HSV-1
HZV
Cytomegalovirus.
Epstein-Barr virus.
Adenovirus
Rubella virus.
Mumps
Influenza B
Coxsackie
Associated Conditions
Diabetes.
Hypertension.
Lyme disease.
Myasthenia gravis.
Guillain-Barré syndrome.
Multiple sclerosis.
Sarcoidosis.
Toxic substances.
Otitis media.
Ramsay Hunt syndrome.
Herpes simplex virus
Physical Exam
Tests
CBC.
ESR.
Thyroid function studies.
Serum glucose level
Cerebrospinal fluid.
Electromyography (EMG).
Computed tomography (CT)
Magnetic resonance imaging (MRI).
Differential Diagnosis
Structural damage parotid gland.
Guillain-Barré syndrome.
Lyme disease.
Otitis media.
Ramsay Hunt syndrome.
Sarcoidosis.
Tumors.
Multiple sclerosis.
Stroke
Treatment
Eye patches, eye drops, and lubricants.
Corticosteroids (prednisolone).
Antiviral (acyclovir and valacyclovir).
Surgery.
Physical therapies (tailored facial exercises, acupuncture, massage, thermotherapy and electrical stimulation).
Prognosis
Complete recover within 6 to 18 weeks.
Neurapraxia or local nerve conduction block.
Patients with complete paralysis, reduced taste, increased salivation, increased lacrimation and “pain in the posterior auricular area” can have poor prognosis for full recovery.
Conclusion
Acute, idiopathic, cranial neuropathy associated with unilateral or bilateral facial nerve paralysis.
Etiology: uncertain, infective, immune, and ischemic mechanism.
Diagnosis: physical examination, laboratory tests and imaging studies.
Treatment: Corticosteroid, antiviral, physical therapies.
References
Angulo, M., & Babcock, E. (2015). Bell palsy. Journal of the American Academy of Pas, 28(10), 1. doi: 10.1097/01.JAA.0000470511.20862.36
Callen, E.D., & Pray, W.S. (2019). Bell’s palsy and the pharmacist. U.S. Pharmacist, 1, 26-30. Retrieved from https://bt.e-ditionsbyfry.com/publication/?i=556044#{%22issue_ id%22:556044, %22 page%22:40}
Newadkar, U.R., Chaudhari, L., Khalekar, Y.K. (2016). Facial palsy, a disorder belonging to influential neurological dynasty: Review of literature. North American Journal of Medical Sciences, 8(7), 263-267. doi: 10.4103/1947-2714.187130
Nordqvist, C. (2017, December 4). What are the causes of Bell's palsy? MedicalNewsToday. Retrieved from https://www.medicalnewstoday.com/articles/158863.php
Patel, D.K. & Levin, K.H. (2015). Bell palsy: Clinical examination and management. Cleveland Clinic Journal of Medicine, 82(7), 419-426. doi:10.3949/ccjm.82a.14101
Somasundara, D., & Sullivan, F. (2017). Management of Bell's palsy. Australian Prescriber, 40(3), 94– 97. doi:10.18773/austprescr.2017.030
Taylor, D.C. (2019, June 14). Bell palsy. Medscape. Retrieved fromhttps://emedicine.medscape.com /article/1146903-overview#a7
