Bell's palsy differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].

OR

[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].

Differentiating X from other Diseases

• [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
• [Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].

• As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Facial Paralysis

Facial paralysis can come on suddenly (in the case of Bell’s palsy, for example) or happen gradually over a period of months (in the case of a head or neck tumor). Depending on the cause, the paralysis might last for a short or extended period of time.

Stroke

A more serious cause of facial paralysis is stroke. Facial paralysis occurs during a stroke when nerves that control the muscles in the face are damaged in the brain. Depending on the type of stroke, damage to the brain cells is caused by either lack of oxygen or excess pressure on the brain cells caused by bleeding. Brain cells can be killed within minutes in each case.

Other causes

• [Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
• [Disease name] must be differentiated from [differential dx1], [differential dx2], and [differential dx3].

• As [disease name] manifests in a variety of clinical forms, differentiation must be established in accordance with the particular subtype. [Subtype name 1] must be differentiated from other diseases that cause [clinical feature 1], such as [differential dx1] and [differential dx2]. In contrast, [subtype name 2] must be differentiated from other diseases that cause [clinical feature 2], such as [differential dx3] and [differential dx4].

Preferred Table

Diseases	Clinical manifestations						Gold standard of diagnosis	Additional findings
	Symptoms			Physical examination
									Weakness or total paralysis on one side of the face	Difficulty making facial expressions in one side, such as closing eye, smiling and whistling	Salivation	Impaired Facial nerve reflexes	Unintended eye closure with an effort to smile	Incomplete closure and the of the eye when patient attempts to close the eyes Inability to puff the cheek in affected side
Bell's palsy	++	++	++	++	++	++	Exclusion of other causes of facial nerve palsy	Facial droop Pain around the jaw or ear Numbness in the skin of affected side
Ramsay-Hunt Syndrome	++	++	++	++	++	++	Diagnosis is clinical PCR test may be used to confirm the diagnosis	Ramsay Hunt syndrome is caused by the Varicella virus (Herpes zoster) that also causes chickenpox and shingles
Lyme Disease	-/+	-/+	-/+	-/+	-/+	-/+	Enzyme-linked immunosorbent assay (ELISA) Western blot	Erythema chronicum migrans Young patient Heart block Arthritis Vertigo Hearing loss
Stroke	-/+	-/+	-/+	-/+	-/+	-/+	MRI	Sudden unilateral motor and sensory deficit in a patient with a history of atherosclerotic risk factors (diabetes, hypertension, smoking) or atrial fibrillation.
Skull fracture	-/+	-/+	-/+	-/+	-/+	-/+	MRI	History of head injury
Head or neck tumor	-/+	-/+	-/+	-/+	-/+	-/+	MRI	slow onset of the symptoms Headaches Vision problems Difficulty with balance Speech difficulties Personality or behavior changes Seizures
Multiple sclerosis	Rare	-/+	Rare	-/+	-/+	Rare	MRI	Fatigue Mood problems Spasticity Bowel, bladder dysfunction Eye movement problems Sexual dysfunction Visual loss.