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Bell Palsy and Herpes Simplex Virus

Spotswood L. Spruance, MD
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University of Utah School of Medicine, Salt Lake City, UT 84132. Requests for Reprints: Spotswood Spruance, MD, Health Sciences AIDS Center, University of Utah School of Medicine, Room 4B322, 50 North Medical Drive, Salt Lake City, UT 84132.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1994;120(12):1045-1046. doi:10.7326/0003-4819-120-12-199406150-00013
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Various recognized disorders can affect the function of the facial nerve, including temporal bone fractures, acoustic neuroma, otitis media, herpes zoster oticus (the Ramsay Hunt syndrome) and the Guillain-Barre syndrome. However, the most common presentation of facial paralysis is “idiopathic” or Bell palsy, which occurs in 50% to 70% of cases and is diagnosed by the exclusion of known conditions [12]. Bell palsy is widely distributed by age and occurs equally among men and women. There are no seasonal trends, and most cases develop randomly, with little evidence of epidemic clustering by time or location [1, 3]. The right and left sides of the face are equally affected. Bilateral disease is seen in 0.3% to 1% of cases, and 9% to 12% of patients have had more than one attack—some with as many as three episodes, which may occur on the same side of the face or the alternate side [12]. Simultaneous involvement of other cranial nerves has been reported, but laboratory studies are usually required to identify these abnormalities [4]. The evaluation of patients by magnetic resonance imaging has shown enhancement of the facial nerve in the fallopian canal but not of other cranial nerves [5]. The patients are typically afebrile, and most have a normal peripheral leukocyte count [1]. Mucocutaneous lesions are not a feature of the illness. Patients usually fully recover after several months, but approximately one fourth of patients are left with a deficit [12]. Although the efficacy of steroids has been controversial, a recent randomized, double-blind, placebo-controlled trial concluded that patients who received prednisone had less denervation than those who received placebo [6].

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