Diferencia entre revisiones de «Facial paralysis»
| Línea 36: | Línea 36: | ||
==Management== | ==Management== | ||
Central Process | Central Process | ||
Peripheral Process | Peripheral Process | ||
* | * Prednisone (unless diagnosed Lyme disease) | ||
* Consider | * Empiric doxycycline if high suspicion for Lyme disease | ||
* Consider valacyclovir for severe presentation if Lyme is negative | |||
* Artificial tears | |||
* Consider neurology follow-up | |||
==Disposition== | ==Disposition== | ||
Revisión del 02:18 21 sep 2018
Background
- Key to distinguish between central and peripheral facial nerve palsy
- Central
- CVA
- Peripheral
- Idiopathic (Bell's palsy)
- Lyme disease
- Varicella zoster
- HSV
- Facial trauma
Clinical Features
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
- CT
Peripheral Process
- No labs or imaging routinely necessary
- Consider lyme serologies if endemic area
Management
Central Process
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