Diagnostic Tests for Facial paralysis

Diagnostic Test list for Facial paralysis:

The list of diagnostic tests mentioned in various sources as used in the diagnosis of Facial paralysis includes:

• Physical examination
  • Central nervous system examination, including cranial nerves looking for signs of 7th nerve palsy which may be due to brain tumor, brain stroke, brain stem stroke, brain stem tumor, multiple sclerosis, acoustic neuroma, meningioma, chronic meningitis, Bell's palsy, fracture of petrous temporal bone, otitis media, herpes zoster infection, parotid gland tumor, parotid gland sarcoidosis
  • Look for signs of Bell's palsy (7th nerve palsy of unknown cause) e.g. unable to wrinkle forehead or close eye forcefully on affected side, unable to whistle or blow out cheeks
  • Complete examination of the ears, nose and throat looking for rupture of ear drum, ear discharge or evidence of middle ear infection
  • If 7th nerve palsy, examine for a blister-like rash on the pharynx or external ear canal that would suggest herpes zoster (shingles) infection of the nerve
  • Palpate parotid gland for enlargement
  • Peripheral nervous system examination looking for paralysis or weakness of the limbs
  • Examine for signs of primary muscle disease such as Dystrophia myotonica or myasthenia gravis
• Blood tests
  • Glucose tolerance test - to rule out diabetic neuropathy.
  • Blood culture - if signs of infective process.
  • Lyme disease serology - if suspected Lyme disease.
  • Lead level - if suspect lead poisoning.
• Swab of ear discharge - if present for microscopy and culture.
• Radiological investigations
  • CT Brain and brain stem - if suspect tumor, stroke or abscess.
  • MRI of brain and brain stem - if CT scan is not helpful or inconclusive.
  • X-ray and CT scan of mastoid and petrous temporal bone - if history of trauma and have 7th nerve palsy.
  • Carotid ultrasound scan - if stroke is suspected.
• Spinal fluid analysis - to look for Guillain-Barre syndrome ( increased protein) or to culture fluid (if brain abscess present).
• Tensilon test - to look for myasthenia gravis, if suspected.
• Head x-ray
• Head CT scan

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