FACIAL PARALYSIS
FACIAL PARALYSIS: Excerpt from Algorithmic Diagnosis of Symptoms and Signs
Ask the Following Questions:
- Is it acute or gradual onset? If it is acute onset, Bell's palsy, diabetic neuropathy, and cerebral vascular accident must be considered. If it is gradual onset, one must consider an acoustic neuroma, advancing petrositis, or a brain tumor or abscess.
- Is there associated hemiplegia or hemiparesis? If there is associated hemiplegia or hemiparesis and it is acute onset, one should consider cerebral vascular accident or extradural or subdural hematoma. If the hemiparesis, however, is contralateral, one should consider a brain stem thrombosis or hemorrhage. There are two clinical syndromes that are due to basilar artery lesions: Foville's syndrome and Millard-Gubler syndrome. If the hemiparesis is gradual onset, one should consider brain tumor or abscess or degenerative disease.
- Is there earache or hearing loss? Associated earache or hearing loss should make one think of acoustic neuroma, petrositis, mastoiditis, herpes zoster, and cholesteatoma.
DIAGNOSTIC WORKUP
Immediate referral to a neurologist is indicated. One should do a complete examination of the ear, nose, and throat to determine if there is any rupture of the drum, discharge, evidence of otitis media, etc. Then x-rays of the mastoids and petrous bones should be done along with tomography. A CT scan of the brain with emphasis on the internal auditory foramina should be done if acoustic neuroma is suspected. Culture of the discharge from the ears and blood culture should be done if there are associated signs of an infectious process. Testing for Lyme disease may be indicated. Spinal fluid analysis should be done to look for Guillain-Barré syndrome. If myasthenia gravis is suspected, a Tensilon test may be done. Spinal fluid culture should be done in cases of brain abscess. Carotid scans and a workup for an embolic source should be done in cases of cerebral vascular accident. Of course, when there is a brain tumor or abscess or a cerebral vascular accident is suspected, CT scans of the brain should be done. If these are not helpful or are inconclusive, MRI of the brain can be done. Glucose tolerance testing should be done to rule out diabetic neuropathy. If lead poisoning is suspected, a blood level for lead should be done.
Book Source Details
- Book Title: Algorithmic Diagnosis of Symptoms and Signs
- Author(s): R. Douglas Collins
- Year of Publication: 2003
- Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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