Pre PACES Podcast #64 Bell's palsy
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Jul 2, 2023 Dr Tom Minton, neurology registrar with Bell's palsy expertise. He defines idiopathic facial nerve palsy and explains typical sudden unilateral presentations. Short segments cover examination signs, key differentials like Ramsay Hunt and stroke, when to image, steroid timing, eye protection and follow-up pathways.
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Bell's Palsy Is An Idiopathic Lower Motor Neuron Syndrome
- Bell's palsy is an idiopathic isolated lower motor neuron facial nerve palsy diagnosed clinically when no specific cause is found.
- The facial nerve carries motor, special sensory (taste), and parasympathetic fibers, explaining taste loss, lacrimation and salivation symptoms.
Ask For Sudden Onset Pain Taste And Hyperacusis
- Expect sudden facial weakness over hours to days with post-auricular pain in ~50% and altered taste in ~30% of patients.
- Look for hyperacusis and parasympathetic symptoms and note most recover within 6 weeks to 4 months.
Use Forehead Involvement To Distinguish LMN From UMN
- Differentiate LMN from UMN pattern by forehead involvement: LMN affects the forehead, UMN typically spares it.
- Test eye closure, eyebrow raise, smile, lip closure and consider formal taste testing to confirm isolated seventh nerve palsy.