1) Bell's Palsy (BP) Is...

Metadata

• Author: @AdiG1993 on Twitter
• Full Title: 1) Bell's Palsy (BP) Is...
• Category: #tweets
• URL: https://twitter.com/AdiG1993/status/1537854333718790144

Highlights

• 1. Bell's palsy (BP) is typically defined as an IDIOPATHIC unilateral LMN type CN7 palsy.
     It is named after the Scottish neurophysiologist, Charles Bell. (vide infra)
     (View Tweet)
• 2. But an LMN type CN 7 palsy is NOT the same as Bell's palsy.
     It is merely the idiopathic form, often thought to be due to herpes or varicella induced direct nerve damage or as post infectious demyelination. (View Tweet)
• 3. There are certain RED FLAGS in the diagnosis of an LMN type CN 7 palsy.
  1. Vesicles on the tympanic membrane or ear canal (Ramsay Hunt syndrome type 2)
  2. Bilateral involvement - Lyme disease, sarcoid, GBS, Melkersson-Rosenthal syndrome, Mobius syndrome etc! (View Tweet)
• 3. Systemic manifestations --> fever, bleeding diathesis, rash etc --> we had a case of leukemia with middle ear bleed (hemotympanum) --> facial nerve palsy.
     If you are in the US, you must look for the rash of Lyme disease! (View Tweet)
• 4. Sudden onset with maximal severity at onset
  5. Insidious onset of symptoms
  6. Progressive worsening beyond 3 weeks
  7. No recovery at all beyond 4 months
     These are hard RED FLAG signs for Bell's palsy. (View Tweet)
• 6. The last 3 red flags are important to rule out --> a tumour of the pontomedullary junction (intra or extra axial), CP angle tumours, internal acoustic canal, middle ear and the parotid gland +/- mets to the same! (View Tweet)
• 7. Rarely, a lesion restricted to the lower motor branches of the facial nerve (that supply the superficial muscles of facial expression) --> can mimic a UMN type of CN 7 palsy as well --> beware of these cases! (View Tweet)
• 8. Ear discharge +/- earache +/- ear fullness --> you must rule out middle ear pathology like a choleasteatoma/COM.
     Severe infection in these causes can cause petrous ridge osteomyelitis of the temporal bone --> Gradenigo syndrome --> triad of CN 6,7 palsy, retroorbital pain (View Tweet)
• 9. One must never forget to ask about tinnitus and vertiginous sensations +/- frank dizziness.
     Since CP angle tumours like vestibular schwannoma are very slow growing, the asymmetry of vestibular input develps very slowly --> patients can complain of only very mild dizziness! (View Tweet)
• 10. As we can see, Bell's palsy is very different from a CN7 palsy of the LMN type.
      Missing out on important diagnoses and labelling something as an idiopathic variety without a proper evaluation ---> NO NO!
      #MedTwitter
      #NeuroTwitter
      #JustinBieber
      #RamsayHuntSyndrome (View Tweet)
• This was a milestone!
  https://t.co/iRwc1X4POX (View Tweet)