Which of the following is a favorable prognostic indicator in Bell’s palsy?
Correct Answer: Persistence of the stapedial reflex
Description: BELL'S PALSY
The most common form of facial paralysis is Bell's palsy. The annual incidence of this idiopathic disorder is ~25 per 100,000 annually, or about 1 in 60 persons in a lifetime. Risk factors include pregnancy and diabetes mellitus.
Clinical Manifestations
The onset of Bell's palsy is fairly abrupt, with maximal weakness being attained by 48 hrs as a general rule. Pain behind the ear may precede the paralysis for a day or two. Taste sensation may be lost unilaterally, and hyperacusis may be present. In some cases, there is mild cerebrospinal fluid lymphocytosis. Magnetic resonance imaging (MRI) may reveal swelling and uniform enhancement of the geniculate ganglion and facial nerve and, in some cases, entrapment of the swollen nerve in the temporal bone. Approximately 80% of patients recover within a few weeks or months. Electromyography may be of some prognostic value; evidence of denervation after 10 days indicates there has been axonal degeneration, that there will be a long delay (3 months as a rule) before regeneration occurs, and that it may be incomplete. The presence of incomplete paralysis in the first week is the most favorable prognostic sign. Recurrences are reported in approximately 7% of cases.
Note: Persistence of the stapedial reflex is considered as favourable prognosis.
Ref: Harrisson Principles of Internal Medicine Ed 19th Pg 2647
Category:
Medicine
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