What is Bell’s Palsy? It is an ipsilateral Cranial Nerve VII (lower motor neurone) palsy. There is usually a sudden onset of facial weakness, that progressively worsens over 48 hours. The diagnosis itself, is one of exclusion. CASE A 60 yo male presents to the emergency department, with a 2 day history of progressive right facial…

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When examining a patient with a facial nerve palsy and we wish to determine if the lesion is central or peripheral, we are often told do not ask the patient to smile. It always seemed strange to me. Here’s the reason…. When examining a patient with facial weakness, with a potential central cause, we need to…

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An excellent review article on Trigeminal Neuralgia, has just come out in the NEJM(1). Here is a quick summary. FACTS Usually affects the mandibular or maxillary division of the Trigeminal Nerve F>M Right face > left. Bilateral is rare – look for other causes CLINICAL PICTURE Trigeminal Neuralgia is diagnosed clinically and must have 3…

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