Bell's palsy diagnostic study of choice: Difference between revisions

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== Overview ==
== Overview ==
There is no single [[Diagnostic study of choice|diagnostic study]] of choice for the diagnosis of [[Bell's palsy (patient information)|Bell's palsy]]. Bell's palsy is a diagnosis of exclusion of other causes of [[facial nerve palsy]]. The [[Magnetic resonance imaging|Magnetic resonance imaging (MRI)]] or [[Computed tomography|computerized tomography (CT)]] may be performed to rule out other possible causes of [[Facial nerve palsy|facial nerve palsy.]] [[Laboratories|Laboratory studies]] are not routinely needed in the diagnosis of [[Bell's palsy CT|Bell’s palsy]] and are only recommended in patients with recurrence or absence improvement after more than 3 weeks of therapy. [[Blood]] studies for an [[Underlying representation|underlying systemic disease]] or infection may also be considered in [[Patient|patients]] with [[Bell's palsy CT|Bell's palsy]]. There is no test that provides [[Prognosis|prognostic]] information early enough to be used for guiding treatment or prognosis.


There's no specific test for Bell's palsy. Your doctor will look at your face and ask you to move your facial muscles by closing your eyes, lifting your brow, showing your teeth and frowning, among other movements.
== Diagnostic Study of Choice ==
 
Other conditions — such as a stroke, infections, Lyme disease and tumors — can also cause facial muscle weakness, mimicking Bell's palsy. If the cause of your symptoms isn't clear, your doctor may recommend other tests, including:
* '''Electromyography (EMG).''' This test can confirm the presence of nerve damage and determine its severity. An EMG measures the electrical activity of a muscle in response to stimulation and the nature and speed of the conduction of electrical impulses along a nerve.
* '''Imaging scans.''' Magnetic resonance imaging (MRI) or computerized tomography (CT) may be needed on occasion to rule out other possible sources of pressure on the facial nerve, such as a tumor or skull fracture.
 
== Diagnostic Study of Choice ==


=== Study of choice ===
=== Study of choice ===
* There is no single diagnostic study of choice for the diagnosis of Bell's palsy.
* There is no single diagnostic study of choice for the diagnosis o[[B|f Bell's palsy]].<ref name="pmid23891413">{{cite journal| author=Fahimi J, Navi BB, Kamel H| title=Potential misdiagnoses of Bell's palsy in the emergency department. | journal=Ann Emerg Med | year= 2014 | volume= 63 | issue= 4 | pages= 428-34 | pmid=23891413 | doi=10.1016/j.annemergmed.2013.06.022 | pmc=3940662 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23891413 }} </ref>
* Bell's palsy is a diagnosis of exclusion of other causes of facial nerve palsy.<ref name="pmid24717284">{{cite journal| author=Holland NJ, Bernstein JM| title=Bell's palsy. | journal=BMJ Clin Evid | year= 2014 | volume= 2014 | issue= | pages= | pmid=24717284 | doi= | pmc=3980711 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24717284 }} </ref>
*[[Bell's palsy CT|Bell's palsy]] is a diagnosis of exclusion of other causes of [[facial nerve palsy]].<ref name="pmid24717284">{{cite journal| author=Holland NJ, Bernstein JM| title=Bell's palsy. | journal=BMJ Clin Evid | year= 2014 | volume= 2014 | issue= | pages= | pmid=24717284 | doi= | pmc=3980711 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24717284  }} </ref>
 
* The '''Electromyography (EMG) or'''  should be performed when:
** The patient presented with symptoms/signs 1. 2, 3.
** A positive [test] is detected in the patient.
*
* [Disease name] is mainly diagnosed based on clinical presentation.
* Investigations:
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>
 
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].


* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:  
* The [[Magnetic resonance imaging|Magnetic resonance imaging (MRI)]] or [[Computed tomography|computerized tomography (CT)]] may be performed to rule out other possible causes of [[Facial nerve palsy|facial nerve palsy.]]<ref name="pmid24934895">{{cite journal| author=de Almeida JR, Guyatt GH, Sud S, Dorion J, Hill MD, Kolber MR et al.| title=Management of Bell palsy: clinical practice guideline. | journal=CMAJ | year= 2014 | volume= 186 | issue= 12 | pages= 917-22 | pmid=24934895 | doi=10.1503/cmaj.131801 | pmc=4150706 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24934895  }} </ref>
** Criteria 1
** Criteria 2
** Criteria 3


IF there are clear, established diagnostic criteria:
*For [[Prognostic|prognostic purpose]] ,[[Electrodiffusion|Electrodiagnostic studies]] may help us.[[Electrocardiography of traumatic heart disease|Electrodiagnostic studies]] include: [[EMBOSS|EMG-NCV]].<ref name="pmid2115651">{{cite journal| author=Hughes GB| title=Practical management of Bell's palsy. | journal=Otolaryngol Head Neck Surg | year= 1990 | volume= 102 | issue= 6 | pages= 658-63 | pmid=2115651 | doi=10.1177/019459989010200606 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2115651  }} </ref>
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*[[Laboratories|Laboratory studies]] are not routinely needed in the diagnosis of [[Bell's palsy CT|Bell’s palsy]] and are only recommended in patients with:<ref name="pmid24441932">{{cite journal| author=Zandian A, Osiro S, Hudson R, Ali IM, Matusz P, Tubbs SR et al.| title=The neurologist's dilemma: a comprehensive clinical review of Bell's palsy, with emphasis on current management trends. | journal=Med Sci Monit | year= 2014 | volume= 20 | issue=  | pages= 83-90 | pmid=24441932 | doi=10.12659/MSM.889876 | pmc=3907546 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24441932  }}</ref>
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
**Recurrence
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
**No improvement after more than 3 weeks of therapy
IF there are no established diagnostic criteria:
*There are no established criteria for the diagnosis of [disease name].


*[[Blood]] studies for an underlying [[Systemic diseases|systemic disease]] or [[infection]] may also be considered in [[Patient|patients]] with [[Bell's palsy (patient information)|Bell's palsy]].
*There is no test that provides prognostic information early enough to be used for guiding treatment or prognosis.


==References==
==References==

Latest revision as of 15:39, 8 April 2020

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

Overview

There is no single diagnostic study of choice for the diagnosis of Bell's palsy. Bell's palsy is a diagnosis of exclusion of other causes of facial nerve palsy. The Magnetic resonance imaging (MRI) or computerized tomography (CT) may be performed to rule out other possible causes of facial nerve palsy. Laboratory studies are not routinely needed in the diagnosis of Bell’s palsy and are only recommended in patients with recurrence or absence improvement after more than 3 weeks of therapy. Blood studies for an underlying systemic disease or infection may also be considered in patients with Bell's palsy. There is no test that provides prognostic information early enough to be used for guiding treatment or prognosis.

Diagnostic Study of Choice

Study of choice

References

  1. ↑ Fahimi J, Navi BB, Kamel H (2014). "Potential misdiagnoses of Bell's palsy in the emergency department". Ann Emerg Med. 63 (4): 428–34. doi:10.1016/j.annemergmed.2013.06.022. PMC 3940662. PMID 23891413.
  2. ↑ Holland NJ, Bernstein JM (2014). "Bell's palsy". BMJ Clin Evid. 2014. PMC 3980711. PMID 24717284.
  3. ↑ de Almeida JR, Guyatt GH, Sud S, Dorion J, Hill MD, Kolber MR; et al. (2014). "Management of Bell palsy: clinical practice guideline". CMAJ. 186 (12): 917–22. doi:10.1503/cmaj.131801. PMC 4150706. PMID 24934895.
  4. ↑ Hughes GB (1990). "Practical management of Bell's palsy". Otolaryngol Head Neck Surg. 102 (6): 658–63. doi:10.1177/019459989010200606. PMID 2115651.
  5. ↑ Zandian A, Osiro S, Hudson R, Ali IM, Matusz P, Tubbs SR; et al. (2014). "The neurologist's dilemma: a comprehensive clinical review of Bell's palsy, with emphasis on current management trends". Med Sci Monit. 20: 83–90. doi:10.12659/MSM.889876. PMC 3907546. PMID 24441932.

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