Bell's palsy differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Bell's palsy}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Bell%27s_palsy]]
{{CMG}}; {{AE}} {{MMJ}}
{{CMG}}; {{AE}} {{MMJ}}


==Overview==
==Overview==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
Bell's palsy must be differentiated from other diseases that cause weakness or total [[paralysis]] on one side of the face, difficulty making facial expressions in one side, impaired [[facial nerve]] reflexes, [[salivation]] and unintended eye closure, such as [[Ramsay-Hunt syndrome|Ramsay-Hunt Syndrome]], [[Lyme disease|Lyme Disease]], [[Lyme disease|stroke]], [[Skull fracture]], head or neck [[tumor]], and [[Multiple sclerosis]].
 
OR
 
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
 
==Differentiating X from other Diseases==
* [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
* [Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].
 
* As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].
 
= Facial Paralysis =
 
Facial paralysis can come on suddenly (in the case of Bell’s palsy, for example) or happen gradually over a period of months (in the case of a head or neck tumor). Depending on the cause, the paralysis might last for a short or extended period of time.
 
=== Stroke ===
A more serious cause of facial paralysis is stroke. Facial paralysis occurs during a stroke when nerves that control the muscles in the face are damaged in the brain. Depending on the type of stroke, damage to the brain cells is caused by either lack of oxygen or excess pressure on the brain cells caused by bleeding. Brain cells can be killed within minutes in each case.
 
=== Other causes ===
 
*
*
*
*
*
 
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
*[Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].
 
*As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].


==Differentiating Bells palsy from other Diseases==
*[[Bell's palsy (patient information)|Bell's palsy]] must be differentiated from other diseases that cause weakness or total [[paralysis]] on one side of the face, difficulty making facial expressions in one side, impaired [[facial nerve]] reflexes, [[salivation]] and unintended eye closure, such as [[Ramsay-Hunt syndrome|Ramsay-Hunt Syndrome]], [[Lyme disease|lyme Disease]], [[Lyme disease|stroke]], [[Skull fracture]], head or neck [[tumor]], and [[Multiple sclerosis]].
===Preferred Table===
===Preferred Table===
{|
{|
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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
| colspan="6" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
! colspan="6" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard of diagnosis'''
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
|-
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! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
|-
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
 
! colspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging
|-  
|-  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weakness or total paralysis on one side of the face
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Weakness or total paralysis on one side of the face
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Difficulty making facial expressions in one side, such as closing eye, smiling and whistling
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Difficulty making facial expressions in one side, such as closing eye, smiling and whistling
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Salivation
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Salivation
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Impaired Facial nerve reflexes  
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |[[Ataxia|Impaired Facial nerve reflexes]]
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Unintended eye closure with an effort to smile
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Unintended eye closure with an effort to smile
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Incomplete closure and the of the eye when patient attempts to close the eyes and
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |
* Incomplete closure and the of the eye when patient attempts to close the eyes


Inability to puff the cheek in affected side
* Inability to puff the cheek in affected side
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab 3
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 1
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 2
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging 3
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Bell's palsy CT|Bell's palsy]]
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |Exclusion of other causes of [[facial nerve palsy]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Facial droop]]
* Pain around the jaw or ear
* [[Paresthesia|Numbness]] in the skin of affected side
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ramsay-Hunt syndrome|Ramsay-Hunt Syndrome]]
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" | ++
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Diagnosis is clinical
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* [[PCR]] test may be used to confirm the diagnosis
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[Ramsay-Hunt syndrome|Ramsay Hunt syndrome]] is caused by the [[Varicella virus]] ([[Herpes zoster]]) that also causes [[chickenpox]] and [[shingles]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Bell's palsy
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lyme disease|Lyme Disease]]
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" |++
| style="background: #F5F5F5; padding: 5px;" |++
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Enzyme linked immunosorbent assay (ELISA)|Enzyme-linked immunosorbent assay (ELISA)]]
* [[Western blot]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Erythema chronicum migrans]]
* Young patient
* [[Heart block]]
* [[Arthritis]]
* [[Vertigo]]
* [[Hearing loss]]
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Stroke]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Sudden unilateral motor and sensory deficit in a patient with a history of [[Atherosclerosis|atherosclero]]<nowiki/>tic risk factors ([[Diabetes Mellitus|diabetes, hypertension]], smoking) or [[Atrial fibrillation|atrial fibrillation.]]
| style="background: #F5F5F5; padding: 5px;" |
|
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Skull fracture]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Skull fracture]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |-/+
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |-
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |History of [[head injury]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Lyme disease]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ramsay-Hunt syndrome|Ramsay-Hunt Syndrome]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[HIV AIDS|HIV infection]]
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Head or neck [[tumor]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Head or neck [[tumor]]
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* slow onset of the symptoms
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
* [[Headaches]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Vision]] problems
| style="background: #F5F5F5; padding: 5px;" |
* Difficulty with balance
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
* [[Speech]] difficulties
| style="background: #F5F5F5; padding: 5px;" |
 
| style="background: #F5F5F5; padding: 5px;" |
* [[Personality changes|Personality or behavior changes]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Seizures]]
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| style="background: #F5F5F5; padding: 5px;" |
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|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]]
| style="background: #F5F5F5; padding: 5px;" |Rare
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |Rare
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" | -/+
| style="background: #F5F5F5; padding: 5px;" |Rare
| style="background: #F5F5F5; padding: 5px;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Fatigue]]
| style="background: #F5F5F5; padding: 5px;" |
* M[[Mood|ood]] problems
| style="background: #F5F5F5; padding: 5px;" |
* [[Spasticity]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Bowel]], [[bladder]] dysfunction
| style="background: #F5F5F5; padding: 5px;" |
* Eye movement problems
| style="background: #F5F5F5; padding: 5px;" |
* [[Sexual dysfunction]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Visual loss]].
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Middle ear infection]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Injury to [[facial nerve]] during [[labor]]
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|}
|}


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
{{WH}}
{{WS}}
[[Category: (name of the system)]]
==Overview==
==Differential diagnosis of Bell's palsy==
===Lyme Disease===
*Facial nerve palsy is the most common cranial [[neuropathy]] associated with Lyme meningitis.
*Screening for antibodies to B. burgdorferi  not recommended among patients with seventh nerve palsy with no additional manifestations of Lyme disease.
*Findings suggestive of possible [[Lyme disease]] include the development of facial palsy in a young patient, heart block, arthritis, vertigo, and hearing loss.
===HIV===
*HIV infection rarely causes facial palsy.
*Onset at the time of sero-conversion when a [[CSF]] lymphocytosis is usually present.
*In the later stages when cellular immunity wanes, the facial palsy is typically due to another infection such as Zoster, chronic demyelinating polyradiculopathy, or meningeal [[lymphomatosis]].
===Melkersson-Rosenthal Syndrome===
*Facial paralysis, episodic facial swelling, and a fissured tongue, typically beginning in adolescence, with recurrent episodes of facial palsy.
*Incomplete forms of this syndrome outnumber those with the classic triad.
*The cause is unknown, and treatment unproven.
===Other Entities===
*Bacterial infection of the middle ear ([[otitis media]])
*[[Cholesteatoma]], or tumors should be suspected if the onset of facial palsy is gradual.
*[[Sarcoidosis]], especially in patients with bilateral facial palsy.
*[[Sjogren's syndrome]] is an unusual cause.
==References==
{{Reflist|2}}
[[Category:Neurological disorders]]
[[Category:Otolaryngology]]
[[Category: Neurology]]
[[Category:Needs content]]
[[Category:Primary care]]
[[Category:Disease]]


{{WH}}
{{WH}}
{{WS}}
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Latest revision as of 14:22, 7 April 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

Bell's palsy must be differentiated from other diseases that cause weakness or total paralysis on one side of the face, difficulty making facial expressions in one side, impaired facial nerve reflexes, salivation and unintended eye closure, such as Ramsay-Hunt Syndrome, Lyme Disease, stroke, Skull fracture, head or neck tumor, and Multiple sclerosis.

Differentiating Bells palsy from other Diseases

Preferred Table

Diseases Clinical manifestations Gold standard of diagnosis Additional findings
Symptoms Physical examination
Weakness or total paralysis on one side of the face Difficulty making facial expressions in one side, such as closing eye, smiling and whistling Salivation Impaired Facial nerve reflexes Unintended eye closure with an effort to smile
  • Incomplete closure and the of the eye when patient attempts to close the eyes
  • Inability to puff the cheek in affected side
Bell's palsy ++ ++ ++ ++ ++ ++ Exclusion of other causes of facial nerve palsy
Ramsay-Hunt Syndrome ++ ++ ++ ++ ++ ++
  • Diagnosis is clinical
  • PCR test may be used to confirm the diagnosis
Ramsay Hunt syndrome is caused by the Varicella virus (Herpes zoster) that also causes chickenpox and shingles
Lyme Disease -/+ -/+ -/+ -/+ -/+ -/+
Stroke -/+ -/+ -/+ -/+ -/+ -/+ MRI Sudden unilateral motor and sensory deficit in a patient with a history of atherosclerotic risk factors (diabetes, hypertension, smoking) or atrial fibrillation.
Skull fracture -/+ -/+ -/+ -/+ -/+ -/+ MRI History of head injury
Head or neck tumor -/+ -/+ -/+ -/+ -/+ -/+ MRI
  • slow onset of the symptoms
Multiple sclerosis Rare -/+ Rare -/+ -/+ Rare MRI

References

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