Materiały źródłowe

• #1 Bell’s palsy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034

  There’s no specific test for Bell’s palsy. Your healthcare professional looks at your face and asks you to move your facial muscles. You’re asked to close your eyes, lift your brow, show your teeth and frown, among making other movements. […] Other conditions such as a stroke, infections, Lyme disease, inflammatory conditions and tumors can cause facial muscle weakness that mimics Bell’s palsy. If the cause of your symptoms isn’t clear, your healthcare professional may recommend other tests, including: […] Electromyography (EMG). This test can confirm the presence of nerve damage and determine how serious it is. An EMG measures the electrical activity of a muscle in response to stimulation. It also measures the nature and speed of the conduction of electrical impulses along a nerve. […] Imaging scans. Magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture. […] Blood tests. There is no blood test for Bell’s palsy. But blood tests can be used to rule out Lyme disease and other infections.

• #2 Bell’s palsy – Wikipedia

  https://en.wikipedia.org/wiki/Bell%27s_palsy

  Bell’s palsy is a diagnosis of exclusion, meaning it is diagnosed by the elimination of other reasonable possibilities. By definition, no specific cause can be determined. There are no routine lab or imaging tests required to make the diagnosis. The degree of nerve damage can be assessed using the House-Brackmann score. […] One study found that 45% of patients are not referred to a specialist, which suggests that Bell’s palsy is considered by physicians to be a straightforward diagnosis that is easy to manage. […] Other conditions that can cause similar symptoms include herpes zoster, Lyme disease, sarcoidosis, stroke, and brain tumors.

• #3 Bell’s palsy – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/symptoms-causes/syc-20370028

  If you have facial weakness or drooping, see your healthcare professional to find out the cause and the severity of the illness. […] Seek medical help right away if you experience any type of paralysis because you may be having a stroke. Bell’s palsy is not caused by a stroke, but the symptoms of both conditions are similar.

• #4

  https://www.cbsnews.com/news/what-is-bells-palsy-tiffany-chen-causes-symptoms/

  Since Bell’s palsy symptoms can appear similar to other conditions that cause facial weakness, experts say it’s important to seek medical attention immediately to rule out things like a brain tumor or stroke. […] „Studies have shown very early treatment of (Bell’s palsy) reduces long-term problems.” […] Most people who develop Bell’s palsy recover over time without treatment. There are different treatment options for Bell’s palsy, including medications to help recover facial nerve function and relieve pain. […] In rare cases, the NIH says, „cosmetic or reconstructive surgery may be needed to correct some damage such as an eyelid that will not fully close or a crooked smile.” […] „Long term, if patients don’t get recovery, we’ve pioneered surgeries and treatments with Botox and physiotherapy that can actually help people recover well,” Azizzadeh adds.

• #5 Bell Palsy: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0400/bell-palsy.html

  Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. […] Laboratory testing and imaging are not required for diagnosis. […] Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. […] Alternative diagnoses should be considered in patients with bilateral involvement, sparing of the forehead, abnormal extraocular movements, hearing loss, tinnitus, or vertigo. These findings indicate an upper motor neuron lesion or a lesion involving more than just cranial nerve VII. […] Other diagnoses should be considered in patients with gradual onset of symptoms, prolonged course (more than three months without improvement), limb or bulbar weakness, systemic or localized facial skin cancer, signs of infection, or risk of infection.

• #6 Bell’s Palsy: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5457-bells-palsy

  Your healthcare provider can diagnose Bells palsy based on your symptoms. Theyll ask about when your symptoms started and if theyve changed. Theyll also do a physical exam and ask you to try to move your facial muscles in certain ways. The key physical exam finding of Bells palsy is partial or complete weakness of your forehead. […] Other conditions, including stroke, sarcoidosis, Lyme disease, middle ear bacterial infections, multiple sclerosis and tumors near your facial nerve can sometimes cause facial paralysis thats similar to Bells palsy. Your provider can usually accurately diagnose Bells palsy based on your history of symptoms and examination alone. But they may sometimes suggest that you have one or more of these tests: […] Blood tests to check for conditions like Lyme disease or sarcoidosis.

• #7 Bell’s palsy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034

  There’s no specific test for Bell’s palsy. Your healthcare professional looks at your face and asks you to move your facial muscles. You’re asked to close your eyes, lift your brow, show your teeth and frown, among making other movements. […] Other conditions such as a stroke, infections, Lyme disease, inflammatory conditions and tumors can cause facial muscle weakness that mimics Bell’s palsy. If the cause of your symptoms isn’t clear, your healthcare professional may recommend other tests, including: […] Electromyography (EMG). This test can confirm the presence of nerve damage and determine how serious it is. An EMG measures the electrical activity of a muscle in response to stimulation. It also measures the nature and speed of the conduction of electrical impulses along a nerve. […] Imaging scans. Magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture. […] Blood tests. There is no blood test for Bell’s palsy. But blood tests can be used to rule out Lyme disease and other infections.

• #8 Bell’s Palsy – Facial Palsy UK

  https://www.facialpalsy.org.uk/causesanddiagnoses/bells-palsy/

  If you suspect that you have Bells palsy, then you should visit your GP or attend A E as soon as possible. It is important to seek medical advice within 72 hours of onset, as research indicates that this is the optimum period of time in which Bells palsy will successfully respond to treatment. […] The diagnosis of Bells palsy is a diagnosis made by exclusion (that is, by ruling out other possible causes). […] A doctor will carry out a neurological examination. He/she will ask you to perform a range of facial movements, such as closing your eye, puckering your lips, raising your eyebrows and smiling. A diagnosis of Bells palsy is likely if you have rapidly lost the ability to move the affected side of your face at all, or your facial movement is severely impaired and you have no other symptoms or signs.

• #9 Bell’s Palsy – Diagnosis and Treatment : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/bells-palsy-diagnosis-and-treatment/

  Bell’s Palsy is primarily a unilateral weakness of the facial muscles. Assess for facial asymmetry and strength. There may also be decreased lacrimal production, dry mouth, hyperacusis and abnormalities of taste. […] It is CRITICAL to determine if the forehead and eyebrows are affected to the same degree as the rest of the face. Presentations that are forehead sparing raise concern for central pathology including stoke or intracranial mass. […] Bell’s Palsy is a clinical diagnosis, and no further investigation is required in the absence of atypical features. […] Atypical features indicate a more thorough work up. Neuroimaging should be pursued in the presence of clinical suspicion for stroke, tumor, or other intracranial abnormality. […] Bell’s Palsy is a clinical diagnosis of exclusion.

• #10 Bell Palsy – Brain, Spinal Cord, and Nerve Disorders – Merck Manual Consumer Version

  https://www.merckmanuals.com/home/brain-spinal-cord-and-nerve-disorders/cranial-nerve-disorders/bell-palsy

  Doctors usually base the diagnosis on symptoms. […] Facial nerve palsy can usually be diagnosed and distinguished from other disorders based on symptoms. For example, facial nerve palsy can be distinguished from a stroke because a stroke usually causes weakness only in the lower part of one side of the face rather than in the entire side of the face. People who have had a stroke can close the eyes tightly and wrinkle the brow. Also, a stroke typically causes weakness of an arm and/or a leg. […] Doctors can usually distinguish Bell palsy from other, less common disorders that cause facial nerve palsy (such as tumors, Lyme disease, other infections, sarcoidosis, diabetes, and skull fractures). These other disorders typically cause different symptoms, and in many of them, symptoms develop more slowly. Thus, if doctors are not certain that Bell palsy is the cause or if symptoms developed gradually, tests are done. These tests may include

• #11 Bell’s palsy – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/118

  Bells palsy is an acute, sudden-onset, unilateral facial palsy of probable viral etiology. […] Clinical diagnosis of exclusion. […] High-dose corticosteroids should be administered in all patients in the absence of significant contraindications. […] Failure to demonstrate any return of hemi-facial tone or movement within 4-6 months suggests an alternative diagnosis. […] It consists of deficits affecting all facial zones equally that fully evolve within 72 hours. To date, it remains a clinical diagnosis of exclusion. […] Onset of clinical recovery is nearly always demonstrated within 4-6 months of symptom onset; absence of any return of hemi-facial tone or movement by this time is highly suggestive of an alternative diagnosis. […] Facial palsy of an otherwise known etiology (e.g., Lyme disease-associated facial palsy) or facial palsy that is progressive, is waxing and waning, or affects facial zones in an uneven fashion, is not Bell’s palsy.

• #12 Bell’s palsy – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/118?locale=th

  Bells palsy is an acute, sudden-onset, unilateral facial palsy of probable viral etiology. […] Clinical diagnosis of exclusion. […] High-dose corticosteroids should be administered in all patients in the absence of significant contraindications. […] Failure to demonstrate any return of hemi-facial tone or movement within 4-6 months suggests an alternative diagnosis. […] Bell’s palsy is an acute unilateral peripheral facial nerve palsy in patients for whom physical examination and history are otherwise unremarkable. […] It remains a clinical diagnosis of exclusion. […] Onset of clinical recovery is nearly always demonstrated within 4-6 months of symptom onset; absence of any return of hemi-facial tone or movement by this time is highly suggestive of an alternative diagnosis. […] Facial palsy of an otherwise known etiology (e.g., Lyme disease-associated facial palsy) or facial palsy that is progressive, is waxing and waning, or affects facial zones in an uneven fashion, is not Bell’s palsy.

• #13 Bell’s Palsy | National Institute of Neurological Disorders and Stroke

  https://www.ninds.nih.gov/health-information/disorders/bells-palsy

  A doctor will perform a physical exam to check for upper and lower facial muscle weakness on one side of the face (including the forehead, eyelid, and mouth). They will ask when the symptoms began. During the exam, the doctor will rule out other possible causes of facial paralysis. There is no specific laboratory test to confirm diagnosis of Bells palsy. […] Usually, routine laboratory or imaging studies are not necessary. However, these tests can sometimes help confirm a diagnosis or rule out other diseases or conditions that can cause facial weakness. If no specific cause can be identified, the condition can be diagnosed as Bells palsy. Imaging studies may be useful if there is a gradual progression of facial weakness or if more than facial expression, taste, and hearing sensitivity are affected. […] Electromyography and nerve conduction studies may help determine how serious the disorder is and the chances of recovery. Laboratory tests for Lyme disease and other viruses may be considered to aid in diagnosis.

• #14 Bell Palsy: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0400/bell-palsy.html

  Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. […] Laboratory testing and imaging are not required for diagnosis. […] Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. […] Alternative diagnoses should be considered in patients with bilateral involvement, sparing of the forehead, abnormal extraocular movements, hearing loss, tinnitus, or vertigo. These findings indicate an upper motor neuron lesion or a lesion involving more than just cranial nerve VII. […] Other diagnoses should be considered in patients with gradual onset of symptoms, prolonged course (more than three months without improvement), limb or bulbar weakness, systemic or localized facial skin cancer, signs of infection, or risk of infection.

• #15 Facial weakness and Bell’s palsy

  https://www.rch.org.au/clinicalguide/guideline_index/Facial_weakness_and_Bells_palsy/

  Bells palsy is an idiopathic unilateral lower motor neuron facial nerve palsy […] Other causes of facial weakness should be excluded before making a diagnosis of Bells palsy […] It is important to rule out other causes before making a diagnosis of Bells palsy […] Assessment of Bells palsy is aimed at confirming the diagnosis and excluding other important causes of facial weakness […] The diagnosis of Bells palsy is made on clinical history and examination. Investigations are not usually required […] Almost all children recover within 12 months without treatment (most within 6 weeks of onset). However some children may have a prolonged period of functional impairment, facial asymmetry and emotional distress.

• #16 Bell’s Palsy: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5457-bells-palsy

  Your healthcare provider can diagnose Bells palsy based on your symptoms. Theyll ask about when your symptoms started and if theyve changed. Theyll also do a physical exam and ask you to try to move your facial muscles in certain ways. The key physical exam finding of Bells palsy is partial or complete weakness of your forehead. […] Other conditions, including stroke, sarcoidosis, Lyme disease, middle ear bacterial infections, multiple sclerosis and tumors near your facial nerve can sometimes cause facial paralysis thats similar to Bells palsy. Your provider can usually accurately diagnose Bells palsy based on your history of symptoms and examination alone. But they may sometimes suggest that you have one or more of these tests: […] Blood tests to check for conditions like Lyme disease or sarcoidosis.

• #17 Bell’s Palsy: Causes, Symptoms, Diagnosis, Treatment, Outlook

  https://www.healthline.com/health/bells-palsy

  Your doctor will first perform a physical examination to determine the extent of the weakness in your facial muscles. Theyll also ask you questions about your symptoms, including when they occurred or when you first noticed them. […] While theres no specific lab test that your doctor can use to confirm that you definitely have Bells palsy, your doctor can use a variety of tests to help make a Bells palsy diagnosis. […] These tests can also help rule out other possible causes of facial weakness that may need addressing, such as Guillain-Barr syndrome or Lyme disease. […] These tests may include: blood tests to check for the presence of a bacterial or viral infection, blood tests to check for diabetes or other conditions, imaging tests such as an MRI or CT scan to check the nerves in your face and rule out the possibility of a stroke or brain tumor, an electromyography (EMG) test, in which a doctor inserts very thin wire electrodes into a muscle to confirm whether theres any damage to the nerves that control the facial muscles this test can also determine how much damage there is, lumbar puncture may be done if Lyme disease is suspected.

• #18 Bell Palsy Workup: Approach Considerations, Imaging Studies for Bell Palsy, Conduction Testing and EMG

  https://emedicine.medscape.com/article/1146903-workup

  Electrodiagnostic tests (eg, stapedius reflex test, evoked facial nerve electromyography [EMG], audiography) may help to improve the accuracy of prognosis in difficult cases. […] No specific diagnostic tests are available for Bell palsy, though the following may be useful for identifying or excluding other disorders: […] In addition to the above tests, blood glucose or hemoglobin A1c levels may be obtained to determine if the patient has undiagnosed diabetes. […] Serum titers for herpes simplex virus (HSV) may be obtained. However, this test is usually not helpful, owing to the ubiquitous nature of this virus. […] Electrodiagnostic testing measures the facial nerve degeneration indirectly. If a patient does not reach 90% degeneration within the first 3 weeks of the onset of paralysis, some studies suggest that the prognosis is excellent, with over 80100% of the patients recovering with excellent function.

• #19 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Bells-Palsy-Diagnosis.aspx

  Bells palsy is a clinical diagnosis that can be established based on the patient’s history and physical exam findings. It essentially represents a diagnosis of exclusion when all other possibilities are eliminated. […] Since there are no readily available laboratory tests or imaging methods that can verify the diagnosis of Bell’s palsy, the key is to differentiate this condition from other possible etiologies. […] Electroneurography, which uses electricity for stimulating facial muscles on both sides of the face, may be used to provide prognostic information in cases of complete facial paralysis. […] Two different diagnostic scales are used to grade the severity of Bell’s palsy. Those are House-Brackmann Facial Nerve Grading System and the Sunnybrook Facial Grading System. House-Brackmann system categorizes the condition into six different categories, with first category representing normal facial function and sixth category a state of complete paralysis.

• #20 Bell Palsy Workup: Approach Considerations, Imaging Studies for Bell Palsy, Conduction Testing and EMG

  https://emedicine.medscape.com/article/1146903-workup

  Electrodiagnostic tests (eg, stapedius reflex test, evoked facial nerve electromyography [EMG], audiography) may help to improve the accuracy of prognosis in difficult cases. […] No specific diagnostic tests are available for Bell palsy, though the following may be useful for identifying or excluding other disorders: […] In addition to the above tests, blood glucose or hemoglobin A1c levels may be obtained to determine if the patient has undiagnosed diabetes. […] Serum titers for herpes simplex virus (HSV) may be obtained. However, this test is usually not helpful, owing to the ubiquitous nature of this virus. […] Electrodiagnostic testing measures the facial nerve degeneration indirectly. If a patient does not reach 90% degeneration within the first 3 weeks of the onset of paralysis, some studies suggest that the prognosis is excellent, with over 80100% of the patients recovering with excellent function.

• #21 Bell’s palsy – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bells-palsy/diagnosis-treatment/drc-20370034

  There’s no specific test for Bell’s palsy. Your healthcare professional looks at your face and asks you to move your facial muscles. You’re asked to close your eyes, lift your brow, show your teeth and frown, among making other movements. […] Other conditions such as a stroke, infections, Lyme disease, inflammatory conditions and tumors can cause facial muscle weakness that mimics Bell’s palsy. If the cause of your symptoms isn’t clear, your healthcare professional may recommend other tests, including: […] Electromyography (EMG). This test can confirm the presence of nerve damage and determine how serious it is. An EMG measures the electrical activity of a muscle in response to stimulation. It also measures the nature and speed of the conduction of electrical impulses along a nerve. […] Imaging scans. Magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture. […] Blood tests. There is no blood test for Bell’s palsy. But blood tests can be used to rule out Lyme disease and other infections.

• #22 Bell’s Palsy: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/5457-bells-palsy

  Electromyography (EMG) to measure nerve activity and damage. This test may help your provider predict how quickly youll recover. […] Magnetic resonance imaging (MRI) or computed tomography (CT) scans to rule out stroke, tumor, multiple sclerosis or other causes of nerve damage. […] Lumbar puncture (spinal tap) to check for meningitis, Lyme disease or sarcoidosis.

• #23 Bell Palsy Workup: Approach Considerations, Imaging Studies for Bell Palsy, Conduction Testing and EMG

  https://emedicine.medscape.com/article/1146903-workup

  Determining whether facial nerve paralysis is peripheral or central is a key step in the diagnosis. A lesion involving the central motor neurons above the level of the facial nucleus in the pons causes weakness of the lower face alone. Thorough history taking and examination, including the ears, nose, throat, and cranial nerves, must be performed. […] The minimum diagnostic criteria include paralysis or paresis of all muscle groups on one side of the face, sudden onset, and absence of central nervous system (CNS) disease. Note that the diagnosis of IFP can be made only after other causes of acute peripheral palsy have been excluded. […] If the clinical findings are doubtful or if paralysis lasts longer than 68 weeks, further investigations, including gadolinium-enhanced magnetic resonance imaging (MRI) of the temporal bones and pons, should be considered.

• #24 Acute Facial Paralysis Evaluation | Iowa Head and Neck Protocols

  https://medicine.uiowa.edu/iowaprotocols/acute-facial-paralysis-evaluation

  Duration: 3-4 weeks, if 3 weeks r/o neoplasm […] Symptoms associated with Bells Palsy: Otalgia, Taste alteration, Decreased tearing, Facial parasthesia, Hyperacusis […] Symptoms NOT associated with Bells Palsy: Vesicular eruption: think Ramsey-Hunt […] Focal neurological deficits: think stroke […] Bilateral disease: think Lyme disease or Guillain-Barre […] Recurrent disease: think neoplastic process or Melkersson-Rosenthal syndrome […] Audiogram: Conduct prior to any surgical intervention to rule out retrocochlear pathology […] Electrodiagnostic testing: Electroneurography (ENoG), most commonly used test […] Not useful if paresis present, must wait at least 3 days after total paralysis to perform […] Not useful in chronic paralysis, 1 month […] Electromyography (EMG): Complementary to ENoG

• #25 Bell’s Palsy: Description, Diagnosis, and Current Management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC11835628/

  Bells palsy is diagnosed when there is a sudden onset of impaired facial expression due to weakness of facial muscles and their nerve branches. […] Diagnostic imaging is not needed to establish the diagnosis of Bells palsy unless there are concerning features, such as parotitis, or signs of increased intracranial pressure, which could suggest a tumor instead. […] The main diagnostic challenge is to rule out whether the lesion is in the periphery and not in the central nervous system. […] Most grading systems of Bells palsy rely on the evaluation of symmetry, the degree of voluntary excursion of the facial muscles, and the degree of synkinesis. […] The House-Brackmann Scale is a commonly used grading system to diagnose Bells palsy, which analyzes the degree of facial nerve dysfunction. […] The nerve conduction study is a reliable tool to assess the degeneration of nerve fibers and prognosis overall when performed 72 hours after onset.

• #26 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Bells-Palsy-Diagnosis.aspx

  Bells palsy is a clinical diagnosis that can be established based on the patient’s history and physical exam findings. It essentially represents a diagnosis of exclusion when all other possibilities are eliminated. […] Since there are no readily available laboratory tests or imaging methods that can verify the diagnosis of Bell’s palsy, the key is to differentiate this condition from other possible etiologies. […] Electroneurography, which uses electricity for stimulating facial muscles on both sides of the face, may be used to provide prognostic information in cases of complete facial paralysis. […] Two different diagnostic scales are used to grade the severity of Bell’s palsy. Those are House-Brackmann Facial Nerve Grading System and the Sunnybrook Facial Grading System. House-Brackmann system categorizes the condition into six different categories, with first category representing normal facial function and sixth category a state of complete paralysis.

• #27 Idiopathic (Bell’s) palsy – diagnosis and management | Medicine Today

  https://medicinetoday.com.au/mt/2022/may/regular-series/idiopathic-bells-palsy-%E2%80%93-diagnosis-and-management

  Careful examination of the cranial nerves, with a focus on the facial nerve, should be followed by a full neurological and general physical examination. […] The severity of a facial nerve palsy can be assessed using the House Brackmann grading scale, which may be useful in monitoring long-term recovery. […] A peripheral (lower motor neuron) facial nerve palsy, such as Bells palsy, will present with unilateral flaccid paralysis of facial muscles, including the frontalis muscle of the forehead. […] Examination of the ears, including the skin, auditory canal and tympanic membrane, is essential to exclude otitis media, otitis externa and cholesteatoma, which may be complicated by facial paralysis. […] Electrodiagnostic testing procedures have been used to define severity of damage to the facial nerve and to quantify improvements over time.

• #28 Bell Palsy: Rapid Evidence Review | AAFP

  https://www.aafp.org/pubs/afp/issues/2023/0400/bell-palsy.html

  Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. […] Laboratory testing and imaging are not required for diagnosis. […] Bell palsy should be suspected in patients with acute onset of unilateral facial weakness or paralysis involving the forehead in the absence of other neurologic abnormalities. […] Alternative diagnoses should be considered in patients with bilateral involvement, sparing of the forehead, abnormal extraocular movements, hearing loss, tinnitus, or vertigo. These findings indicate an upper motor neuron lesion or a lesion involving more than just cranial nerve VII. […] Other diagnoses should be considered in patients with gradual onset of symptoms, prolonged course (more than three months without improvement), limb or bulbar weakness, systemic or localized facial skin cancer, signs of infection, or risk of infection.

• #29 Not All Facial Palsy Is Bell’s Palsy | AAO-HNS Bulletin

  https://bulletin.entnet.org/clinical-patient-care/article/22877150/not-all-facial-palsy-is-bells-palsy

  Even in patients who present with classic, rapid onset facial palsy, the expected timeline of recovery is a critical component to confirm the diagnosis. […] Importantly, patients with Bells palsy should show evidence of facial movement by three to four months after onset. […] Even in a patient with classic symptoms at onset, lack of recovery by four to six months should prompt additional workup. […] Dedicated, contrast-enhanced, fine cut imaging of the entire course of the facial nerve should be performed for patients with an initial presentation consistent with Bells palsy but who fail to show some recovery of movement by four months. […] If imaging does not reveal abnormality of the facial nerve, nerve exploration with biopsy should be considered. […] Recovery of facial function occurs in approximately 70%-85% of cases of untreated Bells palsy and up to 94.4% of cases treated with prednisolone within 72 hours of symptom onset.

• #30 Bell Palsy Differential Diagnoses

  https://emedicine.medscape.com/article/1146903-differential

  In most cases, the diagnosis of Bell palsy is straightforward as long as the patient has undergone a thorough history and physical examination. […] Failure to recognize structural, infectious, or vascular lesions leading to seventh cranial (facial) nerve damage may result in further deterioration of the patients condition. […] For example, if other cranial nerve, motor, or sensory symptoms are present, then other neurologic diseases should be considered (eg, stroke, Guillain-Barr syndrome, basilar meningitis, cerebellar pontine angle tumor). […] Symptoms associated with seventh nerve neoplasm include slowly progressive paralysis, facial hyperkinesis, severe pain, recurrent palsy, and other cranial nerve involvement. […] Patients with a progressive paralysis of the facial nerve lasting longer than 3 weeks should be evaluated for neoplasm.

• #31 Bell Palsy Differential Diagnoses

  https://emedicine.medscape.com/article/1146903-differential

  Recurrent ipsilateral facial paralysis must raise the suspicion of a tumor of the facial nerve or parotid gland. […] If a patient is from the Northeast United States, Lyme disease should be considered as a cause of facial paralysis, and serologic testing should be performed. […] If a patient reports the sudden onset of hearing loss and severe pain with the onset of facial paralysis, Ramsay Hunt syndrome must be considered. […] In the setting of an appropriate history, additional considerations include the following: […] Bilateral simultaneous Bell palsy is a rare occurrence; the rate of such cases is less than 1% of that of unilateral facial nerve palsy, and it accounts for only 23% of bilateral facial paralysis cases. […] The majority of patients with bilateral facial palsy have Guillain-Barr syndrome, sarcoidosis, Lyme disease, meningitis (neoplastic or infectious), or bilateral neurofibromas (in patients with neurofibromatosis type 2).

• #32 A general practice approach to Bell’s palsy

  https://www.racgp.org.au/afp/2016/november/a-general-practice-approach-to-bell-s-palsy

  GPs should refer patients with new or worsening neurological findings, facial diplegia, ocular symptoms or complications, or incomplete facial nerve recovery three months after initial symptom onset. These patients should be referred to a neurologist or otolaryngologist. […] Investigations for neoplasms along the course of the facial nerve should be performed and include magnetic resonance imaging (MRI) or high-resolution computed tomography.

• #33 Idiopathic (Bell’s) palsy – diagnosis and management | Medicine Today

  https://medicinetoday.com.au/mt/2022/may/regular-series/idiopathic-bells-palsy-%E2%80%93-diagnosis-and-management

  However, most patients presenting with Bells palsy will be diagnosed clinically, without requiring ENOG or EMG. […] Although routine imaging at the time of diagnosis is not recommended, recent guidelines recommend contrast-enhanced MRI within one month of symptom onset (even if symptoms have resolved) to study the course of the facial nerve and exclude alternative diagnoses, including malignancy. […] Patients with any new or worsening neurological symptoms warrant specialist neurologist review, while patients with any suspicion of head or neck malignancy may be more appropriately referred to an otolaryngologist or head and neck surgeon.

• #34 Bell’s palsy: Treatment and prognosis in adults – UpToDate

  https://www.uptodate.com/contents/bells-palsy-treatment-and-prognosis-in-adults

  Idiopathic facial nerve palsy, also referred to as Bell’s palsy, is the most common cause of spontaneous peripheral facial paralysis. A viral etiology (ie, activation of the herpes simplex virus) is suspected in most cases of Bell’s palsy, although there is no established or widely available method of confirming a viral mechanism in clinical practice. […] The pathogenesis, clinical features, and diagnosis of Bell’s palsy in adults are discussed separately. […] A short-term course of oral glucocorticoids is recommended for all patients with new-onset Bell’s palsy. Treatment should ideally begin within three days of symptom onset, as this is the setting in which glucocorticoids have been studied and shown to be beneficial.

• #35 Bell’s Palsy: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2007/1001/p997.html

  Bell’s palsy is a peripheral palsy of the facial nerve that results in muscle weakness on one side of the face. […] Laboratory evaluation, when indicated by history or risk factors, may include testing for diabetes mellitus and Lyme disease. […] Patients with Bell’s palsy should be treated within three days of the onset of symptoms with a seven-day course of oral acyclovir (Zovirax) or valacyclovir (Valtrex), plus a tapering course of oral prednisone. […] A patient with an acute onset of unilateral facial weakness most likely has Bell’s palsy. […] Medical history should include recent rashes, arthralgias, or fevers; history of peripheral nerve palsy; exposure to influenza vaccine or new medications; and exposure to ticks or areas where Lyme disease is endemic. […] Laboratory testing is not usually indicated.

• #36

  https://journals.lww.com/continuum/fulltext/2017/04000/bell_s_palsy.10.aspx

  Bells palsy is a common outpatient problem, and while the diagnosis is usually straightforward, a number of diagnostic pitfalls can occur, and a lengthy differential diagnosis exists. […] Recognition and management of Bells palsy relies on knowledge of the anatomy and function of the various motor and nonmotor components of the facial nerve. Avoiding diagnostic pitfalls relies on recognizing red flags or features atypical for Bells palsy, suggesting an alternative cause of peripheral facial palsy. […] Bells palsy is characterized by the spontaneous acute onset of unilateral peripheral facial paresis or palsy in isolation, meaning that no features from the history, neurologic examination, or head and neck examination suggest a specific or alternative cause. In this setting, no further testing is necessary. Even without treatment, the outcome of Bells palsy is favorable, but treatment with corticosteroids significantly increases the likelihood of improvement.

• #37 Bell Palsy Workup: Approach Considerations, Imaging Studies for Bell Palsy, Conduction Testing and EMG

  https://emedicine.medscape.com/article/1146903-workup

  The patients who reach over 90% degeneration within the first 3 weeks of the onset of paralysis have a much more guarded prognosis, with only 50% having good recovery of facial motion. […] Electrodiagnostic testing is not recommended in patients with incomplete facial paralysis; however, it may be offered to those patients with complete facial paralysis. […] Brainstem auditory evoked response (BAER) may be obtained in patients with peripheral facial nerve lesions and other neurologic involvement. […] These studies were small and do not support routine use of BAER in patients with Bell palsy. However, when a patient presents with multiple cranial neuropathies (eg, of the seventh and eighth cranial nerves), BAER may be useful. […] Blepharokymographic analysis, a high-speed eyelid motion-analysis system, has been used to evaluate movement of the eyelids. Computer-based analysis may prove helpful in diagnosing Bell palsy, predicting prognosis, and evaluating response to therapeutic measures such as placement of a gold weight in the affected upper eyelid (used in cases in which spontaneous recovery has been limited). […] In a review of 12 autopsy cases of patients with Bell palsy, most cases showed inflammatory changes around the mastoid cells and walls of the arteries. […] The most common site of involvement was the geniculate ganglion.

• #38 Facial Palsy – Causes – Differential Diagnosis – Management – TeachMeSurgery

  https://teachmesurgery.com/ent/presentations/facial-palsy/

  Most cases of Bells Palsy can be diagnosed clinically and no further investigations are required, unless any other clinical features are present that suggest another pathology. […] Serology for HSV-1 and VZV can be performed, yet will unlikely alter future management if detected. This is particularly relevant where vesicular pustules are evident. […] Referral to an ENT surgeon should be considered if there is any doubt over the diagnosis, recurrent or bilateral Bell’s palsy, or no sign of improvement after 1 month. […] Diagnosis is clinical; virology studies can be requested if necessary but will add little benefit to the overall diagnosis and management.

• #39 Bell’s Palsy – Core EM

  https://coreem.net/core/bells-palsy/

  Diagnosis: For high pre-test probability of Bells Palsy, there is no indication for labs or imaging: diagnosis is based on history and physical […] If you suspect another cause of facial nerve palsy, order targeted labs and/or imaging (e.g. Lyme titers or monospot if high suspicion for viral etiology) […] Consider blood glucose in Bells Palsy patients with other diabetic risk factors as 10% of Bells Palsy patients have diabetes.

• #40 Bell’s Palsy Diagnosis: Now What? | Facial Paralysis Institute

  https://facialparalysisinstitute.com/blog/bells-palsy-diagnosis-now-what/

  A Bells palsy diagnosis can be scary and overwhelming if you dont know where to turn for help. […] It is crucial that any person who experiences the sudden onset of facial paralysis go to the emergency room right away. The only way to determine if it is in fact Bells palsy is to rule out other serious conditions like Lyme disease, tumors, or aneurism through testing and a thorough evaluation. […] If you are diagnosed with Bells palsy it is important to seek treatment right away.

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