Bell's palsy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

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