10 Minute consultation: Bell's palsy
A 32 year old man presents to you with sudden onset of weakness on the left side of his face. He also says that he is unable to close his left eye. He is otherwise well and last saw a doctor five years ago. He is anxious and thinks he has had a stroke.
Associated symptoms— Patients with Bell's palsy commonly feel pain in or behind the ear. Numbness can occur on the affected side of the face. Loss of taste on the ipsilateral anterior two thirds of the tongue is common. Ask about associated hyperacusis and any presence of rash that may indicate herpes zoster.
Cause— Ask about recent viral infection and recent immunisation. The causes of Bell's palsy are unknown, but the possibilities include viral infection, heredity, autoimmune or vascular ischaemia, of which the most likely cause is viral.
Incidence— Bell's palsy is commonest in the age group