Bell palsy

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By James W Russell MD MS

Bell palsy is also known as or subsumes Acute facial palsy. -ed.

Dr. James Russell of the Department of Neurology at the University of Maryland School of Medicine reviews the clinical presentation, diagnosis, pathogenesis, and management of Bell palsy. Bell palsy is an acute, usually unilateral mononeuropathy of the seventh cranial nerve. The disorder is presumed to be inflammatory and associated with one of several different viral etiologies, usually herpes simplex virus-1. The disorder is usually self-limiting, with up to 90% of affected subjects showing full recovery. Recovery occurs primarily within 4 to 6 months of onset of the disorder. The differential diagnosis is outlined in this article and specific tests may be indicated for certain patients depending on the clinical evaluation. Early treatment with steroids is recommended. Several large randomized studies clearly show that prednisone (prednisolone), given within 48 hours of onset of the palsy, improves recovery rate and promotes early recovery in affected patients. Combination therapy with antivirals is not recommended based on current clinical trial and meta-analysis data. In addition, supportive care and eye care are critical.