facial nerve paralysis (VII - facial muscle expression, taste ant.
2/3s of the tongue, lacrimal / salivary gland secretion), diagnosis
of exclusion, etiology generally unknown, facial nerve passes through
meatal foramen in temporal bone, bimodal age peaks - 20s and 60s.
Clinical - Unilateral facial paralysis
/ paresthesias (upper and lower face), post auricular pain, ?recent
viral syndrome, eye tearing, altered taste and hearing.
Differential - Stroke, Guillain Barre,
Herpes Zoster, HIV - AIDS, hyper- or hypothyroidism, multiple sclerosis,
otitis media, sinusitis, mastoiditis, lyme, syphilis, metastases,
skull base neoplasm, cartoid - vertebral - basilar aneurysm, meningitis
(leukemic, carcinomatosis, infectious).
Labs - No work up needed with obvious
causes, considerations (CBC, TFTs, lyme titier, HIV, ESR, VDRL,
CSF, head CT, facial CT, MRI, EMG).
Management - ? prednisone, ? acyclovir,
artificial tears (while awake), eye lubricants (while asleep), eyeglasses.