Types of Brain Injuries: Bell's Palsy

Bell's Palsy

What is Bell's palsy?

Bell's palsy is a weakness or paralysis of the muscles that control expression on one side of your face. The disorder results from damage to one of a pair of facial nerves that runs beneath each ear to the muscles in your face.

The condition may result in a droopy appearance of your face. This can be a blow to your self-esteem, but most often Bell's palsy isn't serious. The nerve damage may also affect your sense of taste and how you make tears and saliva. This condition comes on suddenly, often overnight, and usually gets better on its own within a few weeks.

The problem can occur at any age. Bell's palsy occurs more often in pregnant women, in people with diabetes or upper respiratory ailments, such as the flu or a cold, and in people with conditions that compromise their immune systems. Also called facial palsy, Bell's palsy is named for Dr. Charles Bell, a 19th-century surgeon from Scotland who first described the condition.

Bell's palsy clears up on its own within weeks or months for most people. In some cases, doctors prescribe a corticosteroid medication within the first few days, hoping to increase the likelihood of a good recovery.

Bell's palsy is not the result of a stroke or a transient ischemic attack (TIA). While stroke and TIA can cause facial paralysis, there is no link between Bell's palsy and either of these conditions. Palsy simply means weakness or paralysis.

What causes Bell's palsy?

The cause of Bell's palsy is not clear. Experts believe some cases may be linked to the herpes virus that causes cold sores.

In most cases of Bell's palsy, the nerve that controls muscles on either side of the face is damaged by inflammation.

Many health problems can cause weakness or paralysis of the face. If a specific reason cannot be found for the weakness, the condition is called Bell's palsy.

What are the symptoms?

The main symptom of Bell's palsy is weakness or paralysis of the muscles on one side of the face. The affected side of the face looks flat and expressionless or droopy. Other symptoms include:

  • A dry eye on the affected side because you are unable to blink.
  • Tearing in the affected eye.
  • Pain behind the ear on the affected side of the face, which may occur a day or two before the paralysis begins.
  • Increased sensitivity to sounds.
  • Drooling because you may not be able to close your mouth completely.
  • A dry mouth and problems swallowing because you make less saliva.
  • A decreased ability to taste, especially at the tip of your tongue.

The paralysis is likely to become worse for the first couple of days, then gradually get better. In most cases, all symptoms are gone within 2 months. A number of other conditions, such as stroke or Lyme disease, can also cause facial weakness and paralysis.

How is Bell's palsy diagnosed?

Bell's Palsy - Exams and Tests

Bell's palsy is usually diagnosed from a medical history, a physical exam, and a neurological exam that checks facial nerve function and rules out more serious causes of facial paralysis.

Your doctor will decide whether you could have Bell's palsy by asking you questions about your medical history, such as:

  • What are your symptoms?
  • When did you first notice them?
  • Have you ever had them before?
  • Have you recently had a head injury?
  • Do you have pain or loss of feeling in your face or head area?
  • Have you had any other problems, such as dizziness, hearing loss, changes in your ability to taste, or weakness in any other part of your body?
  • Have you recently had a cold, the flu, or a respiratory illness?

During a neurological exam, your doctor will evaluate your muscle weakness. You may be asked to:

  • Lift your eyebrows and then lower them.
  • Close your eyes tightly and then open them.
  • Smile or show your teeth.

Bell's palsy may be diagnosed when you have:

  • Weakness and paralysis that develop suddenly and affect the muscles on one side of your face.
  • No signs of any other disease or injury that might explain the weakness and paralysis.

Weakness that occurs on one side of your face should be checked by a doctor right away to rule out more serious conditions. Early detection and treatment of Bell's palsy may help prevent permanent nerve damage.

Your doctor may order additional tests to look for other possible causes of your facial weakness and paralysis. These tests include:

  • Blood tests, to rule out diseases such as Lyme disease, HIV, or syphilis.
  • Hearing tests, to determine whether your hearing or the muscles in your middle ear are affected.
  • A CT scan or MRI, to check for a brain tumor or stroke.
  • A lumbar puncture, to check for signs of infection or bleeding.

How is it treated?

Most people who have Bell's palsy recover on their own within a few weeks to a couple of months. However, a small number of people may have permanent weakness of the muscles on the affected side of the face.

Your doctor may prescribe antiviral drugs, such as acyclovir, if he or she believes that Bell's palsy is caused by a virus. If your doctor suspects that Bell's palsy is caused by inflammation from another disease, you may be given corticosteroids, such as prednisone, to reduce the inflammation.

However, there is no clear evidence that corticosteroids or antiviral medicines are effective treatments for Bell's palsy.

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