Facial Weakness

Question 1

What are the sx of Bell’s Palsy?

Answer 1

• Acute onset of unilateral facial weakness
• Pain around or behind ear
• Inc sensitivity to sound ipsi
• Paresthesia of face ipsi
• Dec taste sensation
• Dry eye ipsi
• Very rarely bilateral

Question 2

What can precede Bell’s Palsy?

Answer 2

URI

Question 3

What will be found on PE in Bell’s Palsy?

Answer 3

• Unilateral facial weakness (upper & lower face)
• Cannot close eye tightly ipsi
• Speaking & chewing pose difficulties
• Dec efferent limb component of the corenal reflex
• Dry eye
• Sensation normal

Question 4

What are the technological features of Bell’s Palsy?

Answer 4

NONE

Question 5

What causes Bell’s Palsy?

Answer 5

Viral infection of the facial nerve

HSV MC

Question 6

What is the tx of Bell’s Palsy?

Answer 6

Supportive & watchful waiting

80-90% of pts obtain 80-100% improvement in 3mo

Question 7

What is the management for Bell’s Palsy?

Answer 7

• Artificial tears for dry eyes
• Eye patch to preven corenal abrasions during sleep
• MRI if no improvement in 1 mo
• Botulinum toxin injections if pt dev facial dyskinesias

Question 8

What is the hx of Facial weakness d/t cerebral hemisphere lesion?

Answer 8

• Acute in stroke
• Subacute or chronic in mass lesions such as abscess or tumor
• Sensory or motor complaints on the ipsi side of body

Question 9

What are the PE findings of Facial weakness d/t cerebral hemisphere lesion?

Answer 9

• Weakness confined to lower half of face
• Wrinking in forehead uneffected
• Efferent limb component of corneal reflex is unaffected
• Freq signs of UMN weakness or ipsi body
• Freq ipsi body & facial sensory deficit

Question 10

What are the Technological findings of Facial weakness d/t cerebral hemisphere lesion?

Answer 10

• MRI w/ & w/o contrast is the best test
• CT scan w/ & w/o contrast is the next best

Question 11

Where does the lower half of the facial nerve receive UMN control?

Answer 11

Contralateral hemisphere

Question 12

Where does the upper half of the facial nerve receive UMN control?

Answer 12

BOTH hemispheres

Question 13

What is the tx of Facial weakness d/t cerebral hemisphere lesion?

Answer 13

Diet modification & speech/swallow therapy since they they have Dysarthria & chewing problems

Question 14

What does Dysarthria & chewing issues inc risk for?

Answer 14

Aspiration

Question 15

What are the sx of Facial weakness d/t Brainstem lesion?

Answer 15

• Facial weakness
• CN sx
• Sensory sx
• Weakness
• Disequilibrium or ataxia
• Dysarthria or Dysphagia

Question 16

What are the PE findings of Facial weakness d/t brainstem lesions?

Answer 16

• Facial weakness of upper & lower face
• CONTRA UMN body weakness
• Dysarthria & dysphagia (maybe)
• Ataxia & dysequilibrium (maybe)

Question 17

What is the most sensitive imaging for brainstem lesions?

Answer 17

Brain MRI scanning