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Seventh nerve palsy
Neuro-Ophthalmology
Key Points
- •UMN vs LMN distinction: UMN facial palsy spares the forehead (bilateral cortical innervation of upper face) while LMN palsy affects the entire ipsilateral face including forehead - this is the single most important clinical distinction
- •Bell palsy treatment: prednisolone 1 mg/kg/day within 72 hours of onset improves complete recovery from 64% to 83% (NNT=6) - Sullivan et al. NEJM 2007
- •The most important ophthalmic complication is exposure keratopathy from lagophthalmos - aggressive lubrication, taping at night, and gold weight implant for chronic cases are the cornerstones of management
- •Bilateral facial palsy should raise suspicion for Lyme disease (25% of Lyme facial palsies are bilateral), Guillain-Barre syndrome, sarcoidosis, or bilateral Bell palsy
- •Combined CN5 + CN7 palsy is the worst-case scenario for the cornea - loss of both protective sensation (CN5) AND lid closure reflex (CN7) creates a neurotrophic + exposure keratopathy that is extremely difficult to manage
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17 more sections are included with the Clinical plan.
- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations