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Bell's palsy (BP): Herpetic peripheral facial nerve paralysis secondary to herpes simplex virus
T1WI C+ fat-saturated MR: Fundal “tuft” and labyrinthine segment CN7 show intense asymmetric enhancement
Entire intratemporal CN7 may enhance
Imaging note: Classic rapid-onset BP requires no imaging in initial stages
If atypical Bell's palsy , search with imaging for underlying lesion
Normal enhancement of intratemporal CN7
Ramsay Hunt syndrome
Lyme disease
Facial nerve schwannoma
Facial nerve venous malformation (hemangioma)
Perineural tumor from parotid
Etiology-pathogenesis (current hypothesis)
Latent herpes simplex infection of geniculate ganglion with reactivation and spread of inflammatory process along proximal and distal intratemporal facial nerve fibers
Classic clinical presentation
Acute-onset peripheral CN7 paralysis (36-hour onset)
Medical therapy for BP
Tapering course of prednisone; begin within 3 days of symptoms for best result
Antiviral agents no longer used
Surgical therapy for BP is controversial
Profound denervation (> 95%) treated with facial nerve decompression from internal auditory canal fundus to stylomastoid foramen
Bell's palsy (BP)
Herpetic facial paralysis
BP (original definition): Idiopathic acute onset of lower motor neuron facial paralysis
BP (modern definition): Herpetic facial paralysis secondary to herpes simplex virus
Named after Sir Charles Bell (1774-1842), who 1st described BP syndrome
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