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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 • Reactivation causes
group, though more edema,
common from 20- inflammation,
60. ischemia, and
eventual
• Etiology unknown; demyelination of the
though reactivated nerve, creating pain
herpes simplex may and alteration in
be involved. 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