Diferencia entre revisiones de «Facial paralysis»
| (No se muestran 7 ediciones intermedias de 2 usuarios) | |||
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==Background== | ==Background== | ||
[[File:Cranial nerve VII.png|thumb|Bilateral course of facial nerve. Note that the forehead muscles receive innervation from both hemispheres of the brain, which is why there is forehead sparing for [[stroke]] but not [[Bell's palsy]] (or other peripheral facial nerve injury).]] | |||
*Key to distinguish between central and peripheral facial nerve palsy | *Key to distinguish between central and peripheral facial nerve palsy | ||
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**Idiopathic ([[Bell's palsy]]) | **Idiopathic ([[Bell's palsy]]) | ||
**[[Lyme disease]] | **[[Lyme disease]] | ||
**[[Varicella zoster]] | **[[Varicella-zoster]] | ||
**[[HSV]] | **[[HSV]] | ||
**[[Facial trauma]] | **[[Facial trauma]] | ||
==Clinical Features== | ==Clinical Features== | ||
Central Process | [[File:Bellspalsy.jpg|thumb|A person attempting to show his teeth and raise his eyebrows with [[Bell's palsy]] on his right side; notice how the forehead is NOT spared).]] | ||
[[File:DOAeXAmWsAAAp5g.jpg|thumb|Patient with [[stroke]] (forehead sparing).]] | |||
===Central Process=== | |||
* Forehead "sparing" or normal muscle tone of the forehead | * Forehead "sparing" or normal muscle tone of the forehead | ||
Peripheral Process | ===Peripheral Process=== | ||
* Weakness of forehead muscles | * Weakness of forehead muscles | ||
Central and Peripheral | ===Central and Peripheral=== | ||
* Unable to close eye | * Unable to close eye | ||
* Loss of nasolabial fold | * Loss of nasolabial fold | ||
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==Evaluation== | ==Evaluation== | ||
Central Process | ===Central Process=== | ||
*CT | *[[head CT|CT]] | ||
Peripheral Process | ===Peripheral Process=== | ||
*No labs or imaging routinely necessary | *No labs or imaging routinely necessary | ||
*Consider lyme serologies if endemic area | *Consider lyme serologies if endemic area | ||
==Management== | ==Management== | ||
Central Process | ===Central Process=== | ||
*Treat underlying pathology | |||
Peripheral Process | ===Peripheral Process=== | ||
* Prednisone (unless diagnosed Lyme disease) | * [[Prednisone]] (unless diagnosed Lyme disease) | ||
* Empiric doxycycline if high suspicion for Lyme disease | * Empiric [[doxycycline]] if high suspicion for Lyme disease | ||
* Consider valacyclovir for severe presentation if Lyme is negative | * Consider [[valacyclovir]] for severe presentation if Lyme is negative | ||
* Artificial tears | * Artificial tears | ||
* Consider neurology follow-up | * Consider neurology follow-up | ||
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[[Category:Symptoms]] | [[Category:Symptoms]] | ||
[[Category:Neurology]] | |||
Revisión actual - 17:40 3 feb 2020
Background
Bilateral course of facial nerve. Note that the forehead muscles receive innervation from both hemispheres of the brain, which is why there is forehead sparing for stroke but not Bell's palsy (or other peripheral facial nerve injury).
- Key to distinguish between central and peripheral facial nerve palsy
Causes
- Central
- Peripheral
- Idiopathic (Bell's palsy)
- Lyme disease
- Varicella-zoster
- HSV
- Facial trauma
Clinical Features
A person attempting to show his teeth and raise his eyebrows with Bell's palsy on his right side; notice how the forehead is NOT spared).
Patient with stroke (forehead sparing).
Central Process
- Forehead "sparing" or normal muscle tone of the forehead
Peripheral Process
- Weakness of forehead muscles
Central and Peripheral
- Unable to close eye
- Loss of nasolabial fold
- Asymmetric smile
Differential Diagnosis
Facial paralysis
- Bell's palsy
- CVA
- Trigeminal neuralgia
- Tick paralysis
- Herpes zoster oticus (Ramsay Hunt syndrome)
- CNS tumor
- Acoustic neuroma or other cerebellopontine angle lesions
- Meningioma
- Cerebellar pontine angle
- Facial nerve schwannoma
- Parotid
- Sarcoma
- Anesthesia nerve blocks
- Cerebral Aneurysms (vertebral, basilar, or carotid)
Evaluation
Central Process
Peripheral Process
- No labs or imaging routinely necessary
- Consider lyme serologies if endemic area
Management
Central Process
- Treat underlying pathology
Peripheral Process
- Prednisone (unless diagnosed Lyme disease)
- Empiric doxycycline if high suspicion for Lyme disease
- Consider valacyclovir for severe presentation if Lyme is negative
- Artificial tears
- Consider neurology follow-up