Bell's palsy differential diagnosis: Difference between revisions

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{{Bell's palsy}}
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{{CMG}}; {{AE}} {{MMJ}}
 
==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|Ramsay-Hunt Syndrome]], [[Lyme disease|Lyme Disease]], [[Lyme disease|stroke]], [[Skull fracture]], head or neck [[tumor]], and [[Multiple sclerosis]].
 
==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===
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! 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="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard of diagnosis'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings
|-
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
 
|-
! 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
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Salivation
! 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
! 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
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |
| 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: #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;" |
* [[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;" |
* Diagnosis is clinical
 
* [[PCR]] test may be used to confirm the diagnosis
| 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;" |[[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;" |
* [[Enzyme linked immunosorbent assay (ELISA)|Enzyme-linked immunosorbent assay (ELISA)]]
* [[Western blot]]
| 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: #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;" |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: #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;" |[[MRI]]
| style="background: #F5F5F5; padding: 5px;" |History of [[head injury]]
|-
| 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;" |
* slow onset of the symptoms
 
* [[Headaches]]
* [[Vision]] problems
* Difficulty with balance
 
* [[Speech]] difficulties
 
* [[Personality changes|Personality or behavior changes]]
* [[Seizures]]
|-
| 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;" |
* [[Fatigue]]
* M[[Mood|ood]] problems
* [[Spasticity]]
* [[Bowel]], [[bladder]] dysfunction
* Eye movement problems
* [[Sexual dysfunction]]
* [[Visual loss]].
|}
 
==References==
==References==
{{reflist|2}}
{{Reflist|2}}
[[Category:Neurological disorders]]
[[Category:Otolaryngology]]
[[Category: Neurology]]
[[Category:Needs content]]
[[Category:Primary care]]
[[Category:Disease]]


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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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