Bell's palsy differential diagnosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Template:GCC
Differential diagnosis of Bell's palsy
Lyme Disease
- Facial nerve palsy is the most common cranial neuropathy associated with Lyme meningitis.
- Screening for antibodies to B. burgdorferi not recommended among patients with seventh nerve palsy with no additional manifestations of Lyme disease.
- Findings suggestive of possible Lyme disease include the development of facial palsy in a young patient, heart block, arthritis, vertigo, and hearing loss.
HIV
- HIV infection rarely causes facial palsy.
- Onset at the time of sero-conversion when a CSF lymphocytosis is usually present.
- In the later stages when cellular immunity wanes, the facial palsy is typically due to another infection such as Zoster, chronic demyelinating polyradiculopathy, or meningeal lymphomatosis.
Melkersson-Rosenthal Syndrome
- Facial paralysis, episodic facial swelling, and a fissured tongue, typically beginning in adolescence, with recurrent episodes of facial palsy.
- Incomplete forms of this syndrome outnumber those with the classic triad.
- The cause is unknown, and treatment unproven.
Other Entities
- Bacterial infection of the middle ear (otitis media)
- Cholesteatoma, or tumors should be suspected if the onset of facial palsy is gradual.
- Sarcoidosis, especially in patients with bilateral facial palsy.
- Sjogren's syndrome is an unusual cause.