Idiopathic Facial Palsy
Bi guo rong
Definition
Idiopathic Facial palsy is also
called Bell`s palsy or Facial
neuritis. It is characterized by a
rapid onset of facial palsy of
peripheral type
Etiology
• the cause is unclear yet
• It may be
(1)Chill
(2)inflammation of virus
vasoconstriction----ischemia---edema
(3)instability of autonomic nerve
pathology:
• swelling of facial nerve
• Demyelination and degeneration
of the axon
Clinical Features
• It may occurs at any age usually in young adults
males are commoner then females. The onset is
acute.
• At the onset there may be pain in the mastoid
region or around the angel of the jaw.
• The symptoms usually produce its maximum
effect within several hours or one to two days.
The features is paralysis of the unilateral
muscles of expression.
Clinical Features
the upper facial paralysis
• the wrinkles of the brow are
smoothed out Frowning and
raising the eyebrow are
impossible
• the palpebral fissure is wider
and closure of the eye is
impossible because of the
paralysis of the orbicularis
Bell’s phenomenon
• the palpebral fissure is wider and
closure of the eye is impossible
because of the paralysis of the
orbicular ,when the patient attempt to
close the eye ,the eye globe rolls
upwards and slightly out .
Clinical Features
the lower facial paralysis
• the nasolabial furrow is smoothed out and
the mouth is dropped and drawn over to
the sound side
• the patient is unable to purse the lips and
whistle
• Owing to paralysis of the buccinator the
food tends to accumulate between the
teeth and cheek. Dribbling may occur.
Diagnosis and Differential Diagnosis
• According to the rapid onset of facial palsy
of peripheral type
• Differential Diagnosis
1 Guillain - Barre - Syndrome
2 Otitis media. labyrinthitis
3 posterior fossa disease
Treatment
Acute phase
• prednisone 10mg tid po. 5—10days
• VitamineB1.B12
• physiatrists
• the protection of the expose cornea
Treatment
recovering phase
• exercise of the paralyzed facial muscles
• acupuncture
• physiatrists
• facio-hypoglossal anastomosis.
prognosis
• The prognosis is usually good.
• After one to two week .the patient begin to
recover .
• After one to two month .the patient recover
prominently.
• About seventy fine percent of causes can
recover completely.
• If the patient can not recover in six month,
he will suffer from the disability.
Acute inflammatory demyelinating
polyneuropathy (AIDP)
Guillain---Barre Syndrome
Definition
It is a rapidly progressive polyneuropathy.
The damaged region is usually the spinal
roots and peripheral nerves, occasionally
the cranial nerves .the pathologic change
is segmental demyelination . The
manifestation is characterized by a
symmetric tetraplegia.
Etiology
• post—infective allergic disease
Pathology
• the damaged region is usually the spinal
roots and peripheral nerves ,particularly
ventral roots, occasionally the cranial
nerve.
• Segmental demyelination of the spinal
roots and peripheral nerves. perivascular
inflammatory infiltration mainly is
lymphocyte and monocyte .
Clinical Features
• The onset is acute or subacute. Before
one to four weeks of the onset ,there may
be symptoms of the upper airway
infection or gastrointestinal infection .
Clinical Features
symmetric tetraplegia
• it is often the first symptom. The paralysis
is flaccid. The muscular tonus is low ,
tendon reflexes are diminished or lost and
pathologic reflexes are negative. When
respiratory muscles are affected,
respiratory failure may occur.
Clinical Features
sensory disturbance
• paresthesias :
numbness ,tingling ,tenderness .
• peripheral sensory impairment: stocking—
glove pattern
• the sensory symptoms are always present
it is slighter than paralysis of the limbs.
Clinical Features
cranial nerves paralysis
• the paralysis of the facial nerves on both
sides
• bulbar paralysis
• others: trigeminal hypoglossal
oculomotor trochlear and abducens
nerves .
Clinical Features
the symptoms of vegetative nervous
systems
• sweating , flushing ,swelling and nutritional
disturbance of the skin
• tachycardia , variety of the blood pressure
• the sphincter disturbance is rarely
occasionally there may be slight retention
of urine.
Clinical Features
• The disease usually produces its maximum in
one to two weeks.
• It is a self—limited—disease. About 85% of
patients would have a complete recovery .
• the most important complications are :
a. respiratory muscles paralysis.
b .pneumonia.
C .heart failure .
when the patients have all these complications,
the prognosis is not very good.
Laboratory Aids
CSF:
• dissociation albumino—cytologique
• the change is a great excess of protein
with a normal cell count
the high protein is most prominent after
the third week of the onset and may
persist for many weeks after recovery.
Laboratory Aids
peripheral blood phase :
• the white cells count may be high .
Diagnosis:
•
•
•
•
•
The history of a recent infection
The onset is acute or subacute
Symmetric flaccial tetreplegia
Damage of the cranial nerves
CSF: dissociation albumino—cytologique
Differential Diagnosis
•
•
•
•
Acute Poliomyelitis
Acute Myelitis
Periodic Paralysis
Myasthenic Gravis
Treatment
Etiological treatment :
• Plasma exchange: 40ml/kg
• Intravenous immunoglobulin, IVIG :
0.4g/(kg·d) ,5 days
• Corticosteroids :
Symptomatic treatment :
treatment
• Recovery stage
1.exercise of the limbs
2.acupuncture
3.physiatrics
4.massotheraohy
Acute myelitis
Definition
• Acute myelitis is an acute non-specificity
inflammation of several segments of the
spinal cord ,the cause is unkown yet, the
manifestation is characterized by that of
atransverse lesion of the spinal cord –
including motor,sensory and autonomic
disturbance.
Etiology
• The cause is unkown yet.
• Maybe the inflammation of virus or
immunization induce the auto-immune
reaction.
pathology
• To the naked eye :the lesion is edema
hyperemia and softening.
• Microscopically: the lesion is infiltrated
with inflammatory cells ,degenaration of
the axon and demyelination.
Clinical features
• Acute myelitis often occurs in youth and
adults ,the onset is acute ,before a few
weeks or after days of the onset ,the
infective symptoms of the upper airway
may occur ,the earliest symptom is usually
the weakness or numbness of the legs.
Clinical features
•
•
•
•
Acute stage
(1)motor disturbance
Spinal cord shock :
Flaccid paraplegia: the muscular tonus is
low , tendon reflexes are diminished or
lost ,pathological reflex is negative ,
retention of urine.
Clinical features
• Acute stage
• (2)sensory disturbance
• All sensations below the level of the lesion
are diminished or lost
• There may be a zone of hyperaesthesia
between the area of the sensory loss and
that of normal sensibility
Clinical features
• Acute stage
• (3)autonomic disturbance
• Impairment of sphincter control : the
retention of urine;
• others : hypohidrosis, dermal edema ,
dryness
Clinical features
• Ascending myelitis :
• It is severe when the lesion involves the
upper cervical cord and
medulla ,tetraplegia and dyspnea may
occur ,the patient often dies from
respiratory failure ,the mortality is very
high.
Clinical features
• Recovering stage
• After three or four weeks of the onset , the
acute stage is over and the patient
becomes recovering . The clinic symptoms
depends on the severity of the lesion and
absence or presence of the complication.
Clinical features
• Recovering stage
• (1)motor disturbance : the upper motor neuron
paraplegia , the muscular power progress
gradually ; tendon reflexes are increased;
pathological reflexes are present.
• (2)sensory disturbance :the level descends
gradually ,the recovery of sensory disturbance is
slower than that of motor disturbance ;
• (3)autonomic disturbance :reflex urination
Laboratory aids
• CSF :the CSF is commonly abnormal. it is
crystal clear ,the pressure is normal , with
lymphocytosis or a slightly increased
protein concentration. (especially if
examined soon after an acute relapse )
glucose and chloride of CSF are normal .
• Peripheral blood phase : the count of WBC
is normal or slightly high.
Diagnosis
• The rapid onset ;
• Premonitory infective symptom ;
• The symptoms of a transverse lesion of
the spinal cord ;
• CSF is slightly abnormal .
Differential diagnosis
• Acute inflammatory demyelinating
polyneuropathies (AIDP)
• Neuromyelitis optiea
• Hematomyelia
• Acute spinal epidural abscess
• Spinal cord compression
• TB
• Tumor
treatment
• DRUG
• (1)Corticosteroids:
• methylprednisolone 500~1000mg qd
iv ,3~5days
• dexamethasone 5~10mg qd iv 10days
• Prednisone 40~60 mg qd po 1~2months
• (2)Intravenous immunoglobulin, IVIG
• (3) antibiotics
• (4)vitamin B
treatment
• Good nursing:
• Rehabilitation :physical therapy