Trigeminal Neuralgia
Definition
Trigeminal neuralgia is a
chronic pain condition
that affects the
trigeminal nerve, which
carries sensation from
your face to your brain. If
you have trigeminal
neuralgia, even mild
stimulation of your face
such as from brushing
your teeth or putting on
makeup may trigger a
jolt of excruciating pain.
You may initially
experience short, mild
attacks, but trigeminal
neuralgia can progress,
causing longer, more
frequent bouts of searing
pain. Trigeminal
neuralgia affects women
more often than men,
and it's more likely to
occur in people who are
older than 50.
Because of the variety of
treatment options
available, having
trigeminal neuralgia
doesn't necessarily mean
you're doomed to a life
of pain. Doctors usually
can effectively manage
trigeminal neuralgia with
medications, injections or
surgery. .
Symptoms
Occasional twinges of mild
pain
Episodes of severe,
shooting or jabbing pain
that may feel like an
electric shock
Spontaneous attacks of
pain or attacks triggered by
things such as touching the
face, chewing, speaking
and brushing teeth
Bouts of pain lasting from a
few seconds to several
seconds
Episodes of several attacks
lasting days, weeks,
months or longer some
people have periods when
they experience no pain
called tic douloureux, the trigeminal
nerve's function is disrupted. Usually,
the problem is contact between a
normal blood vessel in this case, an
artery or a vein and the trigeminal
nerve, at the base of your brain. This
contact puts pressure on the nerve
and causes it to malfunction.
Trigeminal neuralgia can occur as a
result of aging, or it can be related to
multiple sclerosis or a similar disorder
that damages the myelin sheath
protecting certain nerves. Less
commonly, trigeminal neuralgia can
be caused by a tumor compressing the
trigeminal nerve. In other cases, a
cause can't be found.
Triggers
A variety of triggers may set off the
pain of trigeminal neuralgia, including:
Shaving
Stroking your face
Eating
Drinking
Brushing your teeth
Talking
Putting on makeup
Encountering a breeze
Smiling
Test and Treatment
diagnosis and Drugs
A diagnosis of trigeminal Treatment and Drugs
neuralgia is primarily based on
a description of your pain, Trigeminal neuralgia
including the:
treatment usually starts with
medications, and many people
Type. Pain related to require no additional
trigeminal neuralgia is treatment.
sudden, shock-like
and brief. Medications
Location. The parts of Medications to lessen or block
your face that are
the pain signals sent to your
affected will tell your brain are the most common
doctor if the initial treatment for trigeminal
trigeminal nerve is neuralgia.
involved.
Triggers. Trigeminal Alcohol injection
neuralgia-related pain Alcohol injections provide
is typically brought on temporary pain relief by
by light stimulation of numbing the affected areas of
the cheeks, such as your face. Your doctor will
from eating, talking inject alcohol into the part of
or even encountering your face corresponding to the
a cool breeze. trigeminal nerve branch
causing pain. The pain relief
Tests used to confirm the isn't permanent, so you may
diagnosis may include: need repeated injections or a
different procedure in the
A neurological future. Side effects may
examination. include infections at the
Touching and injection site, bleeding and
damage to nearby nerves.
examining parts of
your face can help
your doctor Surgery
determine exactly The goal of surgery for
where the pain is trigeminal neuralgia is either
occurring and if to stop the blood vessel from
you appear to have compressing the trigeminal
nerve or to damage the
trigeminal neuralgia
which branches of trigeminal nerve to keep it
the trigeminal nerve from malfunctioning.
may be affected. Damaging the nerve often
Magnetic resonance causes temporary or
imaging (MRI). An permanent facial numbness,
and with any of the surgical
MRI scan of your
head can show if procedures, the pain can
multiple sclerosis is return months or years later.
causing trigeminal
neuralgia.
Guillain-Barre Syndrome
Definition
Guillain-Barre syndrome
is an uncommon disorder
in which your body's
immune system attacks
your nerves. Weakness
and numbness in your
extremities are usually
the first symptoms. These
sensations can quickly
spread, eventually
paralyzing your whole
body.
The exact cause of
Guillain-Barre syndrome
is unknown, but it is often
preceded by an infectious
illness such as a
respiratory infection or
the stomach flu. Luckily,
Guillain-Barre syndrome
is relatively rare,
affecting only 1 or 2
people per 100,000.
In its most severe form,
Guillain-Barre syndrome
is a medical emergency
requiring hospitalization.
There's no known cure for
Guillain-Barre syndrome,
but several treatments can
ease symptoms and
reduce the duration of the
illness. And most people
do recover completely.
Symptoms/
Causes
Guillain-Barre syndrome often
begins with weakness, tingling or
loss of sensation starting in your
feet and legs and spreading to
your upper body and arms. These
symptoms may begin often not
causing much notice in your
fingers and toes. In some people,
symptoms begin in the arms or
even the face. As the disorder
progresses, muscle weakness can
evolve into paralysis.
Signs and symptoms of Guillain-
Barre syndrome may include:
Prickling, "pins and
needles" sensations in
your fingers, toes or
both
Weakness or tingling
sensations in your legs
that spread to your
upper body
Unsteady walking or
inability to walk
Difficulty with eye
movement, facial
movement, speaking,
chewing or swallowing
The exact cause of Guillain-Barre
syndrome is unknown. In about
60 percent of cases, an infection
affecting either the lungs or the
digestive tract precedes the
disorder. But scientists don't
know why such an infection can
lead to Guillain-Barre syndrome
for some people and not for
others. Many cases appear to
occur without any triggers.
In Guillain-Barre syndrome, your
immune system which usually
only attacks foreign material and
invading organisms begins
attacking the nerves that carry
signals between your body and
your brain. Specifically, the
nerves' protective covering
(myelin sheath) is damaged and
this interferes with the signaling
process, causing weakness,
numbness or paralysis.
Test and
diagnosis
Guillain-Barre syndrome can be
difficult to diagnose in its earliest
stages. Its signs and symptoms are
similar to those of other
neurological disorders and may
vary from person to person.
The first step in diagnosing
Guillain-Barre syndrome is for
your doctor to take a careful
medical history to fully
understand the cluster of signs
and symptoms you're
experiencing.
A spinal tap (lumbar puncture)
and nerve function tests are
commonly used to help confirm a
diagnosis of Guillain-Barre
syndrome.
Spinal tap (lumbar puncture)
This procedure involves
withdrawing a small amount of
fluid from your spinal canal at
your low back (lumbar) level. This
cerebrospinal fluid is then tested
for a specific type of change that
commonly occurs in people who
have Guillain-Barre syndrome.
Nerve function tests
Your doctor may want
information from two types of
nerve function tests
electromyography and nerve
conduction velocity:
Electromyography
reads electrical activity
in your muscle to
determine if your
weakness is caused by
muscle damage or nerve
damage.
Nerve conduction
studies assess how your
nerves and muscles
respond to small
electrical stimuli.
Treatment
and Drugs
Although some people can take
months and even years to recover,
most cases of Guillain-Barre syndrome
follow this general timeline:
Following the first symptoms, the
condition tends to progressively
worsen for about two weeks.
Symptoms reach a plateau and remain
steady for two to four weeks.
Recovery begins, usually lasting six to
12 months.
There's no cure for Guillain-Barre
syndrome. But two types of
treatments speed recovery and
reduce the severity of Guillain-Barre
syndrome:
Plasmapheresis. This treatment also
known as plasma exchange is a type
of "blood cleansing" in which
damaging antibodies are removed
from your blood. Plasmapheresis
consists of removing the liquid portion
of your blood (plasma) and separating
it from the actual blood cells. The
blood cells are then put back into your
body, which manufactures more
plasma to make up for what was
removed. It's not clear why this
treatment works, but scientists
believe that plasmapheresis rids
plasma of certain antibodies that
contribute to the immune system
attack on the peripheral nerves.
Intravenous immunoglobulin.
Immunoglobulin contains healthy
antibodies from blood donors. High
doses of immunoglobulin can block
the damaging antibodies that may
contribute to Guillain-Barre syndrome.
Each of these treatments is equally
effective. Mixing the treatments or
administering one after the other is no
more effective than using either
method alone.
Often before recovery begins,
caregivers may need to manually
move your arms and legs to help keep
your muscles flexible and strong. After
recovery has begun, you'll likely need
physical therapy to help regain
strength and proper movement so
that you'll be able to function on your
own. You may need training with
adaptive devices, such as a wheelchair
or braces, to give you mobility and
self-care skills.
Definition
If you've recently
experienced a spinal cord
injury, it might seem like
every aspect of your life
will be affected by this
injury. A spinal cord
injury often causes
permanent disability or
loss of movement
(paralysis) and sensation
below the site of the
injury.
Many scientists are
optimistic that advances
in research will someday
make the repair of spinal
cord injuries an attainable
goal. In the meantime,
treatments and
rehabilitation allow many
people with a spinal cord
injury to lead productive,
independent lives.
Symptoms/
Causes
Your ability to control your limbs after
spinal cord injury depends on two factors:
the neurological level of the injury and the
completeness of injury. The lowest normally
functioning segment of your spinal cord is
referred to as the neurological level of your
injury. The completeness of the injury is
classified as either:
Complete. If all sensory
(feeling) and motor function
(ability to control movement) is
lost below the neurological
level, your injury is called
complete.
Incomplete. If you have some
motor or sensory function
below the affected area, your
injury is called incomplete.
Additionally, paralysis from a spinal cord
injury may be referred to as:
Tetraplegia or quadriplegia.
This means your arms, trunk,
legs and pelvic organs are all
affected by your spinal cord
injury.
Paraplegia. This paralysis
affects all or part of the trunk,
legs and pelvic organs.
Your health care team will perform a series
of tests to determine the neurological level
and completeness of your injury.
Spinal cord injuries of any kind may result in
one or more of the following signs and
symptoms:
Loss of movement
Loss of sensation, including the
ability to feel heat, cold and
touch
Common causes of spinal cord injury
The most common causes of spinal cord injuries in
the United States are:
Motor vehicle accidents. Auto and
motorcycle accidents are the leading
cause of spinal cord injuries,
accounting for more than 40 percent
of new spinal cord injuries each
year.
Acts of violence. As many as 15
percent of spinal cord injuries result
from violent encounters, often
involving gunshot and knife wounds,
according to the National Institute of
Neurological Disorders and Stroke.
Falls. Spinal cord injury after age 65
is most often caused by a fall.
Overall, falls cause about one-
quarter of spinal cord injuries.
Test and
diagnosis
In the emergency room, a doctor may
be able to rule out a spinal cord injury
by careful inspection, testing for
sensory function and movement, and
asking some questions about the
accident. But if the injured person
complains of neck pain, isn't fully
awake, or has obvious signs of
weakness or neurological injury,
emergency diagnostic tests may be
needed.
These tests may include:
X-rays. Medical personnel
typically order these tests
on all people who are
suspected of having a
spinal cord injury after
trauma. X-rays can reveal
vertebral (spinal column)
problems, tumors,
fractures or degenerative
changes in the spine.
Computerized tomography
(CT) scan. A CT scan may
provide a better look at
abnormalities seen on an
X-ray. This scan uses
computers to form a series
of cross-sectional images
that can define bone, disk
and other problems.
Magnetic resonance
imaging (MRI). MRI uses a
strong magnetic field and
radio waves to produce
computer-generated
images. This test is
extremely helpful for
looking at the spinal cord
and identifying herniated
disks, blood clots or other
masses that may be
compressing the spinal
cord.
Myelography.
Myelography allows your
doctor to visualize your
spinal nerves more clearly.
After a special dye is
injected into your spinal
canal, X-rays or CT scans of
your vertebrae can suggest
a herniated disk or other
lesions. This test is used
when MRI isn't possible or
when it may yield
important additional
information that isn't
provided by other tests.
Treatment
and Drugs
Unfortunately, there's no way to
reverse damage to the spinal
cord. But, researchers are
continually working on new
treatments, including innovative
treatments, prostheses and
medications that may promote
nerve cell regeneration or
improve the function of the
nerves that remain after a spinal
cord injury.
In the meantime, spinal cord
injury treatment focuses on
preventing further injury and
empowering people with a spinal
cord injury to return to an active
and productive life.
Emergency actions
Urgent medical attention is critical
to minimizing the effects of any
head or neck trauma. So
treatment for a spinal cord injury
often begins at the scene of the
accident.
Emergency personnel typically
immobilize the spine as gently
and quickly as possible using a
rigid neck collar and a rigid
carrying board, which they'll use
to transport you to the hospital.
Early (acute) stages of treatment
In the emergency room, doctors
focus on:
Maintaining your ability
to breathe
Preventing shock
Immobilizing your neck
to prevent further spinal
cord damage
Avoiding possible
complications, such as
stool or urine retention,
respiratory or
cardiovascular difficulty,
and formation of deep
vein blood clots in the
extremities
Definition
Thrombophlebitis (throm-bo-fluh-
BI-tis) occurs when a blood clot
causes swelling in one or more of
your veins, typically in your legs.
Rarely, thrombophlebitis
(sometimes called phlebitis) can
affect veins in your arms or neck.
The affected vein may be near the
surface of your skin, causing
superficial thrombophlebitis, or
deep within a muscle, causing
deep vein thrombosis (DVT). A
clot in a deep vein increases your
risk of serious health problems,
including a dislodged clot
(embolus) traveling to your lungs
and blocking a pulmonary artery
(pulmonary embolism).
Thrombophlebitis can be caused
by prolonged inactivity, such as
sitting for a long time or lengthy
bed rest.
Self-care methods can ease pain
and reduce your risk of clots.
Various treatments, including
medications and surgery, are
available for thrombophlebitis.
Symptoms/ Test and Treatment
Causes diagnosis and Drugs
Thrombophlebitis symptoms include: To diagnose thrombophlebitis, If thrombophlebitis occurs in a
your doctor will ask you about vein just under your skin, your
Warmth, tenderness and the discomfort you've had and doctor may recommend self-care
pain in the affected area then look for any affected veins steps that include applying heat
Redness and swelling near the surface of your skin. To to the painful area, elevating the
determine whether you have affected leg and using an over-
superficial thrombophlebitis or the-counter nonsteroidal anti-
When a vein close to the surface of
inflammatory drug (NSAID). The
your skin is affected, you may see a deep vein thrombosis, your
red, hard and tender cord just under condition usually doesn't require
doctor may choose one of these
the surface of your skin. When a deep hospitalization and improves
tests:
vein in the leg is affected, your leg within a week or two.
may become swollen, tender and
painful, most noticeably when you Ultrasound. A wand- Your doctor may also recommend
stand or walk. You may also have a like device (transducer)
fever. However, many people with these treatments for
deep vein thrombosis have no
moved over the thrombophlebitis, including deep
symptoms. affected area of your vein thrombosis:
leg sends sound waves
into your leg. As the
When to see a doctor Blood-thinning
See your doctor if you have a red, sound waves travel medications
swollen or tender vein especially if through your leg tissue
you have one or more risk factors for Clot-dissolving
and reflect back, a
thrombophlebitis, such as being medications.
computer transforms
inactive for a long period of time or a Support stockings.
family history of the clotting disorder. the waves into a Filter..
moving image on a
If vein swelling and pain are severe or Varicose vein stripping.
you have shortness of breath or are video screen. A clot
Clot removal or bypass.
coughing up blood, go to an may be visible in the
emergency room. These signs and image.
symptoms may indicate deep vein
thrombosis, which increases your risk CT or MRI scans. Both
computerized
of a dislodged blood clot traveling
through your veins to your lungs. tomography (CT) and
magnetic resonance
The cause of thrombophlebitis is a imaging (MRI) can
blood clot. Blood clots can be caused provide visual images
by many different things namely of your veins and may
anything that causes your blood not to
circulate properly. It's possible a blood
show if a clot is
clot that causes thrombophlebitis present.
could be caused by: Blood test. Almost all
people who develop
An injury to a vein acute thrombosis have
An inherited blood-clotting an elevated blood level
disorder of a clot-dissolving
substance called D
Blood clots can occur for a number of dimer. However, D
reasons. One concern many people dimer is elevated in
have is that blood clots can be caused other conditions, too.
by sitting for hours at a time, as when So, although a test for
you're traveling by car or airplane.
While sitting for long periods can
D dimer is very
promote a blood clot that can lead to sensitive, it's not very
thrombophlebitis, this occurs conclusive. Currently,
relatively rarely. By taking proper it's most useful for
precautions, such as periodically ruling out deep vein
stretching your legs or getting up to
thrombosis or for
walk around, you can decrease your
risk of developing thrombophlebitis. identifying people at
risk of developing
thrombophlebitis
repeatedly.
Orthostatic Hypotension
Definition
Orthostatic hypotension
also called postural
hypotension is a form of
low blood pressure that
happens when you stand up
from sitting or lying down.
Orthostatic hypotension
can make you feel dizzy or
lightheaded, and maybe
even faint.
Orthostatic hypotension
can happen to anyone but
is more common in older
adults. Orthostatic
hypotension is often mild,
lasting a few seconds to a
few minutes at most after
standing. However, long-
lasting orthostatic
hypotension can be a sign
of more-serious problems,
so talk to your doctor if you
frequently feel lightheaded
when standing up. It's even
more urgent to see a doctor
if you lose consciousness,
even momentarily.
If you have mild orthostatic
hypotension, you may not
need treatment. Many
people occasionally feel
dizzy or lightheaded after
standing, and it's usually
not cause for concern. The
treatment for more-severe
cases of orthostatic
hypotension depends on
what's causing your
episodes of low blood
pressure.
Symptoms/
Causes
The most common symptom of
orthostatic hypotension is feeling
lightheaded or dizzy when you stand
up after sitting or lying down. This
feeling, and other symptoms, usually
happens shortly after standing up and
lasts a few seconds or minutes.
Orthostatic hypotension signs and
symptoms include:
Feeling lightheaded or
dizzy after standing up
Blurry vision
Weakness
Fainting (syncope)
Confusion
Nausea
Headache
When you stand up, gravity causes
blood to pool in your legs. This
decreases blood pressure because
there's less blood circulating back to
your heart to pump. Normally, special
cells (baroreceptors) next to your
heart and neck arteries sense this
lower blood pressure and counteract
it by triggering your heart to beat
faster and pump more blood, which
stabilizes blood pressure. In addition,
these cells cause blood vessels to
narrow, which increases resistance to
blood flow and increases blood
pressure.
Orthostatic or postural hypotension
occurs when something interrupts the
body's natural process of
counteracting low blood pressure.
Orthostatic hypotension can be
caused by many different things,
including:
Dehydration.
Heart problems.
Diabetes.
Nervous system disorders.
Test and Treatment
diagnosis and Drugs
The goal in evaluating orthostatic The treatment for orthostatic
hypotension, as with all forms of low
hypotension depends on the
blood pressure, is to find the
underlying cause. This helps underlying cause. Your doctor
determine the correct treatment and will try to address the
identify any heart, brain or nervous underlying health problem
system problems that may be
dehydration or heart failure,
responsible for your low blood
for example rather than the
pressure. To help reach a diagnosis,
your doctor may recommend one or low blood pressure itself. For
more of the following: mild orthostatic hypotension,
one of the simplest treatments
Blood pressure is to sit or lie down
monitoring. Your doctor
will measure your blood
immediately after feeling
pressure both while you're
lightheaded upon standing.
sitting and while you're Your symptoms of orthostatic
standing and will compare hypotension usually disappear.
the measurements.
Blood tests. These can
When low blood pressure is
provide a certain amount
of information about your caused by medications,
treatment usually involves
overall health as well as
whether you have low changing the dose of the
blood sugar (hypoglycemia)
medication or stopping it
or a low number of red
blood cells (anemia), both entirely. There are usually
of which can cause low several options for treating
blood pressure.
orthostatic hypotension,
Electrocardiogram (ECG). including:
This noninvasive test
detects irregularities in
your heart rhythm or heart Lifestyle changes
structure, and problems Compression
with the supply of blood
stockings.
and oxygen to your heart
muscle. Medications.
Echocardiogram.
Stress test. Tilt table test.
Valsalva maneuver.
Ambulatory blood
pressure and ECG
recording.
Dementia
Definition Symptoms/
Causes
Dementia isn't a specific Dementia symptoms vary depending
on the cause, but common signs and
disease. Instead, it symptoms include:
describes a group of
symptoms affecting Memory loss
intellectual and social Difficulty communicating
abilities severely enough Inability to learn or
remember new
to interfere with daily information
functioning. It's caused Difficulty with planning and
by conditions or changes organizing
in the brain. Different Difficulty with coordination
and motor function.
types of dementia exist,
depending on the cause. Progressive dementias
Alzheimer's disease is the Several main types of progressive
dementia dementias that get worse
most common type.
with time exist.
Memory loss generally Alzheimer's disease
occurs in dementia, but Lewy body dementia.
memory loss alone Vascular dementia.
doesn't mean you have Frontotemporal dementia.
dementia. Dementia
Other disorders linked to dementia
indicates problems with
at least two brain
Huntington's disease.
functions, such as Dementia pugilistica.
memory loss along with
HIV-associated dementia.
impaired judgment or Creutzfeldt-Jakob disease.
language. Dementia can Secondary dementias.
make you confused and
unable to remember Dementia causes that can be
reversed
people and names. You Some causes of dementia or
dementia-like symptoms can be
may also experience
reversed. Your doctor can identify and
changes in personality treat causes such as:
and social behavior.
However, some causes of Infections and immune
dementia are treatable disorders..
and even reversible. Metabolic problems and
endocrine abnormalities.
Nutritional deficiencies.
Reactions to medications.
Subdural hematomas.
Poisoning.
Brain tumors.
Anoxia.
Heart and lung problems
Test and
diagnosis
Memory loss and other dementia
symptoms have many causes, so
diagnosis can be challenging and may
require several doctor visits. Diagnosis
involves a number of tests.
Medical history and physical exam
Medical history
Physical examination.
Cognitive and
neuropsychological tests
Neurological evaluation
Brain scans
CT and MRI scans.
Electroencephalogram
(EEG).
Tests that help identify treatable
medical conditions include:
A complete blood count
(CBC) to rule out anemia
A blood glucose test to rule
out diabetes
Blood tests to estimate
kidney function, to estimate
liver function and to
measure vitamin B-12 levels
A blood or urine screen to
identify drugs or alcohol
Cerebrospinal fluid analysis
(spinal tap) to rule out brain
infections
Analysis of thyroid and
thyroid-stimulating
hormone levels to rule out
hypothyroidism
Psychiatric evaluation
Treatment
and Drugs
Treatment of dementia may help slow
or minimize the development of
symptoms.
Cholinesterase inhibitors.
These drugs donepezil
(Aricept), rivastigmine
(Exelon) and galantamine
hydrobromide (Razadyne)
are Alzheimer's drugs
that work by boosting
levels of a chemical
messenger involved in
memory and judgment.
Side effects can include
nausea, vomiting and
diarrhea. Although
primarily used as
Alzheimer's drugs, they're
also used to treat vascular,
Parkinson's and Lewy body
dementias.
Memantine (Namenda).
This drug for Alzheimer's
disease works by
regulating the activity of
glutamate, another
chemical messenger
involved in all brain
function, including learning
and memory. Its most
common side effect is
dizziness. Some research
has shown that combining
memantine with a
cholinesterase inhibitor
may have even better
results. Although primarily
used to treat Alzheimer's
disease, it may help
improve symptoms in
other dementias.
Other medications.
Although no standard
treatment for dementia
exists, some symptoms can
be treated. Additional
treatments aim to reduce
the risk factors for further
brain damage.
Bells Palsy
Definition
Bell's palsy occurs when the nerve
that controls facial muscles on
one side of your face becomes
swollen or inflamed. As a result of
Bell's palsy, your face feels stiff.
Half your face appears to droop,
your smile is one-sided, and your
eye resists closing.
Bell's palsy can affect anyone, but
rarely affects people under the
age of 15 or over the age of 60.
For most people, Bell's palsy
symptoms improve within a few
weeks, with complete recovery in
three to six months. About 10
percent will experience a
recurrence of Bell's palsy,
sometimes on the other side of
the face. A small number of
people continue to have some
Bell's palsy signs and symptoms
for life.
Symptoms/
Causes
Signs and symptoms of Bell's palsy
come on suddenly, and may include:
Rapid onset of mild
weakness to total
paralysis on one side of
your face occurring
within hours to days
making it difficult to smile
or close your eye on the
affected side
Facial droop and difficulty
making facial expressions
Pain around the jaw or in
or behind your ear on the
affected side
Increased sensitivity to
sound on the affected
side
Headache
A decrease in your ability
to taste
In rare cases, Bell's palsy can affect
the nerves on both sides of your
face.
The most common cause of Bell's
palsy appears to be the herpes
simplex virus, which also causes
cold sores and genital herpes. Other
viruses that have been linked to
Bell's palsy include:
The virus that causes
chickenpox and shingles
(herpes zoster)
The virus that causes
mononucleosis (Epstein-
Barr)
Another virus in the same
family (cytomegalovirus)
With Bell's palsy, the nerve that
controls your facial muscles, which
passes through a narrow corridor of
bone on its way to your face,
becomes inflamed and swollen
usually from a viral infection.
Besides facial muscles, the nerve
affects tears, saliva, taste and a
small bone in the middle of your
ear.
Test and
diagnosis
No specific laboratory test can
confirm a diagnosis of Bell's palsy.
Your doctor may be able to make
a preliminary diagnosis of Bell's
palsy by looking at your face and
asking you to move your facial
muscles by closing your eyes,
lifting your brow, showing your
teeth and frowning, among other
movements.
Other conditions such as a
stroke, infections, Lyme disease
and tumors also may cause
facial muscle weakness,
mimicking Bell's palsy. If your
diagnosis is still in question, 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. An X-ray,
magnetic resonance
imaging (MRI) or
computerized
tomography (CT) may
be needed on occasion
to eliminate other
possible sources of
pressure on the facial
nerve, such as an
infection, tumor or skull
fracture.
Treatment
and Drugs
Most people with Bell's palsy
recover fully with or without
treatment. But your doctor may
suggest medications or physical
therapy to help speed your
recovery. Surgery is rarely an option
for Bell's palsy.
Medications
Study results have been mixed
regarding the effectiveness of two
types of drugs commonly used to
treat Bell's palsy: corticosteroids
and antiviral drugs.
Corticosteroids, such as
prednisone, are powerful
anti-inflammatory agents.
If they can reduce the
swelling of the facial
nerve, it will fit more
comfortably within the
bony corridor that
surrounds it.
Antiviral drugs, such as
acyclovir or valacyclovir,
may stop the progression
of the infection if a virus
is known to have caused
it.
Physical therapy
Paralyzed muscles can shrink and
shorten, causing permanent
contractures. A physical therapist
can teach you how to massage and
exercise your facial muscles to help
prevent this from occurring.
Surgery
One way to relieve the pressure on
the facial nerve is to surgically open
the bony passage through which it
passes. This decompression surgery
is controversial and rarely
recommended. In some cases,
however, plastic surgery may be
needed to make your face look and
work better.