Bilateral facial palsy is caused by:
Correct Answer: All of the above
Description: Ans. D. All of the above. (Ref. H - 17th / pg. 2584; Greenberg Handbook of Neuro-Surgery /pg. 844)Bilateral facial palsy is caused by:# Leprosy, Gullain Barrie Syndrome, Sarcoidosis.Causes of facial palsy:# Lyme disease (Borrelia burgdorferi) can cause unilateral or bilateral facial palsies.# The Ramsay Hunt syndrome (reactivation of herpes zoster in the geniculate ganglion), consists of a severe facial palsy associated with a vesicular eruption in the external auditory canal and in the pharynx and other parts of the cranial integument; often the eighth cranial nerve is affected as well.# Facial palsy that is often bilateral occurs in sarcoidosis and in Guillain-Barrie syndrome.# Leprosy frequently involves the facial nerve, and facial neuropathy may also occur in diabetes mellitus, connective tissue diseases including Sjogren's syndrome, and amyloidosis.# The rare Melkersson-Rosenthal syndrome consists of recurrent facial paralysis; recurrent and eventually permanent facial (particularly labial) edema; and, less constantly, plication of the tongue.# Acoustic neuromas frequently involve the facial nerve by local compression (Infarcts, demyelinating lesions of multiple sclerosis, and tumors are the common pontine lesions).# Tumors that invade temporal bone (carotid body, cholesteatoma, dermoid) may cause facial palsy.# All these forms of nuclear or peripheral facial palsy must be distinguished from the supranuclear type. In the latter, the frontalis and orbicularis oculi muscles are involved less than those of the lower part of the face, since the upper facial muscles are innervated by corticobulbar pathways from both motor cortices, whereas the lower facial muscles are innervated only by the opposite hemisphere.Additional Educational points:Bell's palsy:# The most common form of facial paralysis is Bell's palsy. Q# The onset of Bell's palsy is fairly abrupt, maximal weakness being attained by 48 h 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.# 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.2# 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. Bell's palsy is associated with the presence of herpes simplex virus (HSV) type 1 DNA in endoneurial fluid and posterior auricular muscle, suggesting that a reactivation of this virus in the geniculate ganglion may be responsible.However, a causal role for HSV in Bell's palsy is unproven.# An increased incidence of Bell's palsy was also reported among recipients of inactivated intranasal influenza vaccine, and it was hypothesized that this could have resulted from the Escherichia coli enterotoxin used as adjuvant or to reactivation of latent virus.# BELL'S PALSY: RX- Symptomatic measures include:* (1) the use of paper tape to depress the upper eyelid during sleep and prevent corneal drying, and* (2) massage of the weakened muscles.- A course of glucocorticoids, given as prednisone 60-80 mg daily during the first 5 days and then tapered over the next 5 days, appears to shorten the recovery period and modestly improve the functional outcome. A recently published randomized trial found no added benefit of acyclovir (400 mg five times daily for 10 days) compared to prednisolone alone for Rx of acute Bell's palsy; the value of valacyclovir (usual dose 1000 mg daily for 5-7 days) either alone or in combination with glucocorticoids is not known.
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