Bells Palsy - Taff's Well Medical Centre

Report
Bells Palsy
Aetiology
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Most cases unknown
Most likely cause is viral
Incidence
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Commonest in age group 10-40yrs
20 cases per 100,000 people
Examination
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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
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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
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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
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Prednislone 1mg/kg up to 80mg max per day
tailing off in second week (reduces oedema)
Aciclovir 800mg 5x daily for 5days given
within first 72hrs (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
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2/3rds 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

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