Cranial Neuritis

Cranial neuritis, often representing as Bell’s Palsy

Inflammation of the peripheral nervous system.  Often representing as Bell’s palsy. Causes can include: Diabetes mellitus, idiopathic, Mucormycosis – inflammation of cranial nerves, Polychondritis – inflammation of cranial nerves

Reactivation of herpes simplex, Zygomycosis – inflammation of cranial nerves. It is thought that as a result of inflammation of the facial nerve, pressure is produced on the nerve where it exits the skull within its bony canal, blocking the transmission of neural signals or damaging the nerve. Patients with facial palsy for which an underlying cause can be found are not considered to have Bell’s palsy per se. Possible causes include tumor, meningitis, stroke, diabetes mellitus, head trauma and inflammatory diseases of the cranial nerves (sarcoidosis, brucellosis, etc.).

Symptoms

  • Sudden weakness or paralysis on one side of your face that causes it to droop. This is the main symptom. It may make it hard for you to close your eye on that side of your face
  • Drooling
  • Eye problems, such as excessive tearing or a dry eye
  • Loss of ability to taste
  • Pain in or behind your ear
  • Numbness in the affected side of your face
  • Increased sensitivity to sound

 

Resources

Resources

  • a b “Bell’s Palsy Fact Sheet”. National Institute of Neurological Disorders and Stroke. 2003-04. Archived from the original on 8 April 2011. Retrieved 2011-05-12.
  • Shafshak, TS (2006-03). “The treatment of facial palsy from the point of view of physical and rehabilitation medicine”. Europa Medicophysica 42 (1): 41–7. PMID 16565685.
  • a b Hazin R, Azizzadeh B, Bhatti MT (November 2009). “Medical and surgical management of facial nerve palsy”. Curr Opin Ophthalmol 20 (6): 440–50. doi:10.1097/ICU.0b013e3283313cbf. PMID 19696671.
  • McAllister, K; Walker, D; Donnan, PT; Swan, I (2011 Feb 16). “Surgical interventions for the early management of Bell’s palsy”. In Swan, Iain. Cochrane database of systematic reviews (Online) (2): CD007468. doi:10.1002/14651858.CD007468.pub2. PMID 21328293.
  • a b Tiemstra, JD; Khatkhate, N (2007 Oct 1). “Bell’s palsy: diagnosis and management”. American family physician 76 (7): 997–1002. PMID 17956069.

Treatments

  • Corticosteroid such as prednisone significantly improves recovery at 6 months and are thus recommended.  Early treatment (within 3 days after the onset) is necessary for benefit with a 14% greater probability of recovery.
  • Antivirals (such as acyclovir) are ineffective in improving recovery from Bell’s palsy beyond steroids alone. They were however commonly prescribed due to a theoretical link between Bell’s palsy and the herpes simplex and varicella zoster virus. There is still the possibility that they might result in a benefit less than 7% as this has not been ruled out.
  • Physiotherapy can be beneficial to some individuals with Bell’s palsy as it helps to maintain muscle tone of the affected facial muscles and stimulate the facial nerve. It is important that muscle re-education exercises and soft tissue techniques be implemented prior to recovery in order to help prevent permanent contractures of the paralyzed facial muscles. To reduce pain, heat can be applied to the affected side of the face.
  • Surgery may be able to improve outcomes in facial nerve palsy that has not recovered.  A number of different techniques exist.  Smile surgery or smile reconstruction is a surgical procedure that may restore the smile for people with facial nerve paralysis. It is unknown if early surgery is beneficial or harmful.  Adverse effects include hearing loss which occurs in 3-15% of people.  As of 2007 the American Academy of Neurology did not recommend surgical decompression
  • The efficacy of acupuncture remains unknown because the available studies are of low quality (poor primary study design or inadequate reporting practices).

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