1/27. Bell's palsy in an older patient with uncontrolled hypertension due to medication nonadherence.OBJECTIVE: To describe and inform pharmacists of a rarely reported occurrence of facial palsy in an elderly patient with uncontrolled hypertension resulting from nonadherence to blood pressure medications. CASE SUMMARY: A 62-year-old Hispanic woman presented to the hypertension clinic with left facial weakness, mild eyelid lag, and auricular pain for two days. The patient self-discontinued fosinopril and minoxidil six days and two days prior to developing these symptoms, respectively. A diagnosis of idiopathic peripheral VII cranial nerve lesion was made after ruling out other possible causes. Corticosteroids were not initiated because of this patient's labile hypertension. Palliative therapy was initiated and the left facial paralysis continuously improved during the six months after discharge. DISCUSSION: patients have rarely presented with facial paralysis as the initial feature of severe hypertension. The relationship between facial paralysis and hypertension has been reported in a small number of cases, including several reports of recurrence of paralysis during acute exacerbations of hypertension. A variety of physiologic theories to explain the relationship between facial paralysis and hypertension have been published, including small hemorrhages into the facial canal which have been confirmed by two autopsies. However, the true etiology remains unknown. CONCLUSIONS: The possible relationship between facial paralysis and uncontrolled hypertension has not been reported in pharmacy literature and has been reported only twice in subspecialty medical journals since 1990. pharmacists should be aware of the complications of hypertension and should question patients about signs and symptoms at each visit. While Bell's palsy complicating hypertension does not appear to be a serious complication, pharmacists must appreciate that the patient should be immediately evaluated to rule out a more serious neurologic event.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
2/27. Bell's palsy during interferon therapy for chronic hepatitis c infection in patients with haemorrhagic disorders.Two adult patients with life-long severe haemorrhagic disorders commenced on interferon-alpha2b therapy for chronic hepatitis c infection. Both developed Bell's palsy several weeks after commencing therapy, They were started on steroids and, in addition, the first patient discontinued interferon-alpha2b therapy while the second patient elected to continue with therapy. In both cases facial paralysis improved over the ensuing weeks. Bell's palsy is often idiopathic but has been reported. in association with herpesviruses. It is not a recognised complication of chronic hepatitis b or C infection, or interferon-alpha2b therapy. However, the interferons are associated with numerous adverse reactions including various neuropsychiatric manifestations and neurological syndromes. There are several reports of nerve palsies, including optic tract neuropathy, occurring during interferon therapy, and immune-based mechanisms are thought to play a role in the aetiopathogenesis. No reports of Bell's palsy in association with interferon therapy were identified in our literature search, although one possible case has been reported to the Committee of safety in medicine. Although Bell's palsy in our patients may have occurred by chance, a neuropathic effect of interferon-alpha2b on the facial nerve cannot be excluded and we urge physicians using interferons to be aware of this potential side-effect.- - - - - - - - - - ranking = 0.16666666666667keywords = paralysis (Clic here for more details about this article) |
3/27. Bell's palsy: a 10-year experience with antiphlogistic-rheologic infusion therapy.OBJECTIVE: Treatment of idiopathic peripheral facial paralysis has remained controversial in many aspects. The authors report their experience with a protocol based on high-dose prednisolone with intravenous low-molecular-weight dextran and pentoxifylline. For this regimen, the term antiphlogistic-rheologic infusion therapy (ARIT) has been coined. STUDY DESIGN: Retrospective case-series review. SETTING: University-based hospital of otorhinolaryngology/head and neck surgery. patients: 334 patients suffering from sudden facial paralysis of unknown cause. INTERVENTION: Treatment consisted uniformly of prednisolone in a starting dosage of 250 mg tapering over 18 days and accompanying infusion of dextran and pentoxifylline. MAIN OUTCOME MEASURES: facial nerve function after 6 months, adverse effects of therapy and comorbidity. RESULTS: From 239 patients with nonrecurrent palsy having received treatment within 12 days after onset, 92% recovered completely (House-Brackmann [HB] Grade I) without sequelae. In incomplete palsy (HB Grade II-V), normal facial function was restored in 97% of cases. Results were significantly better in the group in which therapy had been started within 3 days after the onset of palsy. Other factors such as old age, hypertension, or diabetes did not seem to influence the functional outcome in this series. Serious adverse effects requiring termination of therapy were observed in 1.2% of cases. CONCLUSION: ARIT for Bell's palsy is safe and leads to recovery rates superior to the most optimistic observations of the natural course.- - - - - - - - - - ranking = 0.33333333333333keywords = paralysis (Clic here for more details about this article) |
4/27. magnetic resonance imaging findings in bilateral Bell's palsy.Bell's palsy (idiopathic facial paralysis) is the most common cause of unilateral peripheral facial neuropathy. Bilateral involvement occurs in less than 10% of cases. The authors describe a 20-year-old man with bilateral idiopathic facial weakness. brain magnetic resonance imaging (MRI) showed abnormal bilateral enhancement of the proximal intracanalicular segments of VII/VIII nerve complexes. The enhancement was most prominent in the leptomeningeal regions. There was no facial nerve swelling. Three months later he had improving residual bifacial weakness. To the authors' knowledge, this is the first report of abnormal MRI findings in bilateral Bell's palsy.- - - - - - - - - - ranking = 0.16666666666667keywords = paralysis (Clic here for more details about this article) |
5/27. Idiopathic facial paralysis: a review and case study.A holistic approach to patient care encourages oral health care professionals to look at each client's overall needs. Dental hygiene practitioners need to be aware of the causes of facial paralysis, current diagnostic techniques, treatment options and how the paralysis may be affecting a patient's emotional status. This article describes the oral health concerns of clients with idiopathic palsy, and how they can be assisted.- - - - - - - - - - ranking = 1keywords = paralysis (Clic here for more details about this article) |
6/27. Waveform changes in antidromic facial nerve responses in patients with Bell's palsy.We repeatedly tested the antidromic facial nerve response within 7 days after onset of paralysis in patients with Bell's palsy. None of 109 patients showed the triphasic waveform that reflects normal conduction of the facial nerve action potential. The waves recorded from patients showed biphasic, monophasic, or flat waveforms. Eighty-two of 88 patients with complete recovery showed biphasic waves, whereas half of the patients with nerve degeneration had monophasic or flat waves. Most patients with complete recovery maintained biphasic waves, but in patients with incomplete recovery, the waveforms changed to monophasic or flat, except in 1 case. The presence of monophasic or flat waves with a low facial score strongly suggests nerve degeneration. The antidromic facial nerve response is recommended as a method of diagnosing paralysis and monitoring the progression of intratemporal facial nerve damage during its early stages.- - - - - - - - - - ranking = 0.33333333333333keywords = paralysis (Clic here for more details about this article) |
7/27. Unique case of eleven Bell's palsy episodes.Bell's palsy (BP) is a peripheral facial nerve paralysis of unknown etiology. It is not a life-threatening condition; however, incomplete recovery may leave an individual stigmatized functionally, occupationally as well as socially. Recurrent paralyses are seldom, noted in 7-8% of all BP cases. More than two BP relapses are even less frequent. Adour et al. (1977) reported only two patients with four BP episodes from 1700 patients. Only one patient with more than four BP recurrences in the group containing 2414 BP cases were reported by Yanagihara et al. (1984). The highest reported number of BP recurrences in the accessible literature has been nine. We are presenting an unusual patient who suffered a total of eleven relapses of an idiopathic facial nerve palsy. Description of the case along with review of the relevant literature are discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = paralysis (Clic here for more details about this article) |
8/27. Facial palsy, an unusual presenting feature of childhood leukemia.facial paralysis is not a well-recognized presenting feature of leukemia in children. We present two infants and one older child in whom the initial manifestation of their leukemia was lower motor neuron facial paresis. Initial diagnosis in all the patients was Bell's palsy. The presence of Bell's palsy in young children requires a complete evaluation, including consideration of leptomeningeal disease. Leukemic children presenting with cranial neuropathy require intensive central nervous system therapy.- - - - - - - - - - ranking = 0.16666666666667keywords = paralysis (Clic here for more details about this article) |
9/27. Retroauricular pain preceding Bell's palsy: report of three cases and clinical analysis.A retroauricular pain (RAP) ipsilateral to the side of facial paralysis (FP), often experienced patients with Bell's palsy, usually occurs around the onset of FP. Whether RAP is a risk factor for incomplete recovery from FP is controversial. This paper reports three patients with Bell's palsy in whom acute RAP preceded FP by several days. The intervals between the onset of RAP and FP were 6, 12, and 12 days, and the quality of RAP was dull/tight or neuralgic. All patients received prednisolone and acyclovir orally, and their facial functions recovered within 8 weeks. Based on the serological tests, FP was diagnosed as due to varicella-zoster virus in two patients and as idiopathic in the other. Among 58 consecutive patients with Bell's palsy, including the three patients described, 26 (44.8%) experienced RAP, the onset of which ranged from 12 days before to 2 days after the onset of FP. While the prognosis of FP was not different between patients with and without RAP, FP recovered well in all seven patients in whom RAP preceded the onset of FP by 4 days or more. These findings suggest that RAP preceding by several days may predict the good prognosis of FP. As RAP can be a preceding symptom of acute FP, patients with acute RAP require medical attention for at least 2 weeks.- - - - - - - - - - ranking = 0.16666666666667keywords = paralysis (Clic here for more details about this article) |
10/27. Acute onset of facial nerve palsy associated with lyme disease in a 6 year-old child.Pediatric facial nerve palsy (FNP) can result from a variety of etiologies including lyme disease, varicella, primary gingivostomatitis, herpes zoster oticus (Ramsay Hunt syndrome), coxsackievirus, trauma, otitis media, hiv, diseases causing tumors or demyelinations, compressions, and possibly Epstein Barr virus. lyme disease has been implicated as the cause of over 50% of the FNPs in children. The paralysis of the facial nerve disturbs motor function to the muscles of facial expression and results in a flaccid appearance of the face (unilateral or bilateral). This case report derails undiagnosed lyme disease presenting as a facial palsy in a 6 year, 5 month-old white female. The palsy was recognized and consultation with the child's physician prompted definitive diagnosis and treatment. A review of the literature and the implications of facial nerve palsy are discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = paralysis (Clic here for more details about this article) |
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