Bell's palsy causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Causes

Many cases are likely due to Herpes Simplex Virus (HSV) reactivation

Infectious causes

• Herpes simplex virus activation is the most likely cause of Bell's Palsy.
• Herpes Zoster may be the second most common viral infection.
• Cytomegalovirus
• Epstein Barr virus
• Adenovirus
• Rubella virus
• Mumps
• Influenza B
• Coxsackie virus
• Rickettsial infection
• Ehrlichiosis
• Borrelia burdopheri
• HIV

Non-infectious causes

• Several cases of Bell' Palsy were linked to an inactivated intranasal influenza vaccine in Switzerland
• Genetic predisposition may be likely
• Ischemia of the facial nerve
• Tumors and compression of the facial nerve
• Temporal bone fracture
• Systemic Lupus Erythematosus (SLE)
• Sarcoidosis

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.

References

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