Diferencia entre revisiones de «Facial paralysis»
| Línea 1: | Línea 1: | ||
==Background== | ==Background== | ||
*Key to distinguish between central and peripheral facial nerve palsy | *Key to distinguish between central and peripheral facial nerve palsy | ||
===Causes=== | |||
*Central | *Central | ||
**CVA | **[[CVA]] | ||
*Peripheral | *Peripheral | ||
**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== | ||
Revisión del 03:57 22 sep 2018
Background
- 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
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