Diagnosis Of Bells Palsy/ramsay Hunt Syndrome
Your doctor can generally diagnose Bells Palsy through a physical examination. They will look for such things as weakness in the muscles of your face. They may also ask you to smile or whistle to look for any differences between the two sides of your face.
They may ask you if you are having trouble with numbness or weakness in any other parts of your body or if you are having difficulty walking. Your doctor may examine you for any signs of a shingles rash on your face and ears.
Its important that you tell your doctor if youve received the Zostavax shingles vaccine as that may assist them with your diagnosis.
Treatment Of Ramsay Hunt:
For those with Ramsay Hunt syndrome, , our preference is early, very high dose antiviral medication and high dose steroids, continuing both until at least the 21st day after disorder onset. While the published literature suggests that middle fossa facial nerve decompression is effective for Bells palsy, the question of adequacy of benefit from surgery has not been proven in Ramsay Hunt syndrome. Nevertheless, since nerve swelling seems to be the in-common issue that causes poor quality recovery, many think surgery is indicated for severe Ramsay Hunt facial paralysis.
In summary, Bells palsy can be a quite disfiguring disorder, but fortunately, for the vast majority, high quality recovery occurs within weeks. For those with delayed recovery, satisfactory function is highly likely but some degree of impairment, generally not severe, may remain. For those whose prognosis for a poor quality recovery seems high, surgery is a possibility. When facial paralysis features do not fit well with the classic features of Bells palsy or Ramsay Hunt syndrome, a careful evaluation for other causes is essential, as other very serious issues may exist for which other specific management is appropriate.
What Causes Ramsay Hunt Syndrome
Ramsay Hunt syndrome occurs when the varicella-zoster virus reactivates in the facial nerve, which is the cranial nerve that affects your face, tongue and inner ear. The varicella-zoster virus is the same virus that causes chickenpox and shingles.
If you had chickenpox as a child, the virus can remain inactive in your nerves for years. Shingles occurs when the previously dormant varicella-zoster virus reactivates. The virus travels down your nerve fibers into your skin, causing painful sores. The virus sometimes develops into Ramsay Hunt syndrome, affecting your facial nerve. Researchers aren’t sure why the virus sometimes involves the facial nerve.
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Who Should Not Get Shingrix
You should not get Shingrix if you:
- Have ever had a severe allergic reaction to any component of the vaccine or after a dose of Shingrix.
- Currently have shingles.
- Currently are pregnant. Women who are pregnant should wait to get Shingrix.
If you have a minor illness, such as a cold, you may get Shingrix. But if you have a moderate or severe illness, with or without fever, you should usually wait until you recover before getting the vaccine.
Whats An Erythematous Vesicular Rash What Does It Mean
This rash is like Supreme Court Justice Potter Stewarts famous definition of obscenityyou know it when you see it. In this case, you definitely know it when you feel it because of the extreme pain. Erythematous vesicular rash affects skin as well as mucous membranes, such as the lining of the mouth. It is characterized by
large, symmetrical red blotches appear all over the skin in a circular pattern. On mucous membranes, it begins as blisters and progresses to ulcers.
The problem with this rash is that it can be caused by a variety of things that have nothing to do with Ramsay Hunt or infection of any kind. For example, it can be misdiagnosed as a kissing bug bite , based on the presence of vesicular rash by the lip. Even more of a problem is that RHS/2 can occur without any rash anywhere, a situation referred to as sine herpete in the medical literature.
The presence or absence of facial erythematous vesicular rash is not diagnostic for RHS/2, though its presence surely should gain the attention of the physician and its absence in the presence of facial paralysis should not rule out RHS/2.
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What Does Recovery From Ramsay Hunt Syndrome Look Like
For the majority of patients with Ramsay Hunt syndrome , they will have minimal if any permanent facial asymmetry. This is typically seen in patients who recover within the first few weeks or month, after developing Ramsay Hunt syndrome.
However, in the other 20-25% of patients, who take longer to recover, patients may have more noticeable facial asymmetry, such as:
- Asymmetrical smiling
When To Call A Professional
If you have been diagnosed with Bell’s palsy, call your doctor immediately if your eye starts hurting or feels irritated. Call if your arms or legs feel weak, your vision changes, you get dizzy, have trouble swallowing, or get a headache that keeps getting worse. Contact your doctor promptly if any symptoms get worse.
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Who Should Get Shingrix
Adults 50 years and older should get two doses of Shingrix, separated by 2 to 6 months. Adults 19 years and older who have or will have weakened immune systems because of disease or therapy should also get two doses of Shingrix. If needed, people with weakened immune systems can get the second dose 1 to 2 months after the first.
You should get Shingrix even if in the past you:
- Received varicella vaccine
There is no maximum age for getting Shingrix.
If you had shingles in the past, Shingrix can help prevent future occurrences of the disease. There is no specific length of time that you need to wait after having shingles before you can receive Shingrix, but generally you should make sure the shingles rash has gone away before getting vaccinated.
Chickenpox and shingles are related because they are caused by the same virus . After a person recovers from chickenpox, the virus stays dormant in the body. It can reactivate years later and cause shingles.
Shingrix is available in doctors offices and pharmacies.
If you have questions about Shingrix, talk with your healthcare provider.
* A shingles vaccine called zoster vaccine live is no longer available for use in the United States, as of November 18, 2020. If you had Zostavax in the past, you should still get Shingrix. Talk to your healthcare provider to determine the best time to get Shingrix.
How Is Bell’s Palsy Managed Or Treated
Bells palsy improves without treatment. Still, your healthcare provider may recommend one or more of these therapies for symptom relief and a faster recovery:
- Oral corticosteroids, such as prednisone, decrease nerve swelling and may help you regain facial movement faster. This treatment is most effective when you start it within 48 hours of noticing symptoms.
- Antiviral medications, such as acyclovir for herpes, may speed recovery, although it’s unclear how much benefit they provide. This treatment works best when combined with oral corticosteroids.
- Eye care is very important. Eyedrops, including artificial tears, soothe dry, irritated eyes. If your eyelid wont close, you may need to wear an eye patch to protect the eye from irritants and injuries.
- Functional facial plastic surgery procedures are options for people who don’t recover to help correct facial asymmetry and assist with eyelid closure.
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How Long Does Bell’s Palsy Last
Approximately 80 percent of people who have Bell’s palsy start to improve within 3 weeks, and make a full recovery within 23 months. However, about 510 percent of people have some slight weakness which remains forever. Rarely, there may be little or no improvement.
Living with Bell’s palsy can make you feel depressed, stressed or anxious. Speak to a GP if it’s affecting your mental health.
How Does Varicella Zoster Virus Injure The Facial Nerve
The virus itself does not attack the nerve. The activation of the virus leads to inflammation around the facial nerve. The inflammation causes the surrounding tissues to swell and compress the facial nerve.
Our facial nerve on the way to the muscles passes through a very narrow bone channel in the pyramid of the temporal bone . Since the space inside the channel is limited, the facial nerve becomes easily susceptible to compression.
The resulting compression disrupts the supply of oxygen, water, glucose, and other nutrients to the nerve fibers. Without these nutrients, the facial nerve fibres sustain damage. The longer the compression remains, the bigger is the damage to the facial nerve.
Why does the recovery after Ramsay Hunt Syndrome take so long?
Shingles, or varicella zoster virus, usually require at least a few days or even a week to be treated. This causes the facial nerve to remain compressed for a longer time, leading to deeper damage. The bigger the damage to the facial nerve, the more time it will require for regeneration.
This is why in most cases, Ramsay Hunt Syndrome usually follows a long recovery scenario and takes a long time until the first improvements become visible. In most cases, it also results in unwanted complications such as synkinesis, asymmetric smile, facial pains and tensions.
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How Is It Treated
For individuals with new-onset Bells palsy, steroids are highly likely to be effective and can increase the probability of recovery of facial nerve function. In most instances, oral steroids should be started within 72 hours of symptom onset if possible, to increase the probability of good facial functional recovery. Some individuals with co-existing conditions may not respond well to or be able to take steroid drugs. Antiviral agents might increase the probability of recovery of facial function, although their benefit has not been clearly established. Analgesics such as aspirin, acetaminophen, or ibuprofen may relieve pain. Because of possible drug interactions, individuals taking prescription medicines should always talk to their doctors before taking any over-the-counter drugs.
Another important factor in treatment is eye protection. Bell’s palsy can interrupt the eyelid’s natural blinking ability, leaving the eye exposed to irritation and drying. Keeping the eye moist and protecting it from debris and injury, especially at night, is important. Lubricating eye drops, such as artificial tears or eye ointments or gels, and eye patches are also effective.
Other therapies such as physical therapy, facial massage, or acupuncture may provide a potential small improvement in facial nerve function and pain.
What Is The Long
The outlook for people with Bells palsy is usually good. Recovery time can vary depending on the severity of nerve damage.
If the nerve damage is mild, you may start seeing an improvement within 2 to 3 weeks of the initial onset of symptoms. If the nerve damage is more severe, it could take 3 to 6 months to start noticing an improvement. In rare cases, symptoms may continue to return or may be permanent.
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What Are The Symptoms Of Bells Palsy
Symptoms of Bells palsy tend to come on suddenly and reach peak severity within 48 to 72 hours. Some people develop mild symptoms. Others experience total paralysis.
Symptoms start to gradually improve in three weeks. Up to 80% of people fully recover and show no signs of Bells palsy within three months.
In addition to facial drooping, signs of Bells palsy include:
- Difficulty speaking, eating or drinking.
Signs And Symptoms Of Bells Palsy
Bell’s palsy causes sudden weakness in your facial muscles. This makes half of your face appear to droop. Your smile is one-sided, and your eye on that side resists closing.
Bell’s palsy, also known as facial palsy, can occur at any age. The exact cause is unknown, but it’s believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face. It may be a reaction that occurs after a viral infection.
For most people, Bell’s palsy is temporary. Symptoms usually start to improve within a few weeks, with complete recovery in about six months. A small number of people continue to have some Bell’s palsy symptoms for life. Rarely, Bell’s palsy can recur.
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Ramsay Hunt Syndrome Vs Bells Palsy: Facts On Facial Paralysis Disorders
3 min. read
Disponible en Español
When singer Justin Bieber announced recently that he has Ramsay Hunt Syndrome, a rare condition that has paralyzed half his face, the news raised interest and questions across the nation about this disorder linked to the varicella virus, which causes chicken pox and shingles.
Adding to the mystery behind Ramsay Hunt is its symptomatic similarity to Bells Palsy, a more common cause of facial paralysis. In both cases, most patients start recovering within days or weeks with appropriate treatment.
Svetlana Faktorovich, M.D., a neurologist with Marcus Neuroscience Institute, established at Boca Raton Regional Hospital.
Ramsay Hunt Syndrome is a rare condition where the varicella virus, the virus that causes chicken pox and shingles, infects the inner ear, resulting in the spread of infection to the nearby nerves. This occurs due to varicella reactivation in those that have had chickenpox or shingles in the past, and after the virus sits quietly in the body for some time.
Svetlana Faktorovich, M.D., a neurologist with , part of Baptist Health, said she rarely sees cases of RHS, which accounts for 10 percent to 12 percent of all facial nerve disorders.
Bells Palsy is a much more common cause of facial paralysis, accounting for the majority of cases with spontaneous facial paralysis.
What are the primary differences between Ramsay Hunt and Bells Palsy?
More on Ramsay Hunt Syndrome
How is Ramsay Hunt treated?
Enhancing Healthcare Team Outcomes
Ramsay Hunt syndrome affects patients in a myriad of ways, with pain, paralysis, cochleovestibular symptoms, and behavioral health concerns all occurring commonly in the acute period. While most patients do recover the majority of their premorbid function when managed appropriately, long-term pain, facial dysfunction, scarring, and behavioral health concerns may all persist. For this reason, optimal patient outcomes occur when healthcare teams include members with expertise across a broad range of specialties. In the short term, primary care, otolaryngology, neurology, ophthalmology, and psychology/psychiatry are often required. In the long-term, facial plastic surgery or otolaryngology, pain management, ophthalmology, speech or physical therapy, and psychology/psychiatry may be needed. Patients who develop synkinesis may require regular visits over the course of many years with a physician or nurse who can administer botulinum toxin injections it is critical to surround these patients with an experienced interprofessional team early on in the treatment process in order to provide the care and support they need to maximize their quality of life outcomes.
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What Are The Possible Side Effects Of Shingrix
Studies show that Shingrix is safe. The vaccine helps your body create a strong defense against shingles. As a result, you are likely to have temporary side effects from getting the shots. The side effects might affect your ability to do normal daily activities for 2 to 3 days.
Most people got a sore arm with mild or moderate pain after getting Shingrix, and some also had redness and swelling where they got the shot. Some people felt tired, had muscle pain, a headache, shivering, fever, stomach pain, or nausea. Some people who got Shingrix experienced side effects that prevented them from doing regular activities. Symptoms went away on their own in about 2 to 3 days. Side effects were more common in younger people.
You might have a reaction to the first or second dose of Shingrix, or both doses. If you experience side effects, you may choose to take over-the-counter pain medicine such as ibuprofen or acetaminophen.
Guillain-Barré syndrome , a serious nervous system disorder, has been reported very rarely after Shingrix. There is also a very small increased risk of GBS after having shingles.
If you experience side effects from Shingrix, you should report them to the Vaccine Adverse Event Reporting System . Your doctor might file this report, or you can do it yourself through the VAERS websiteexternal icon, or by calling 1-800-822-7967.
If you have any questions about side effects from Shingrix, talk with your doctor.
Bell’s Palsy: Treatment Guidelines
Article notesCopyright and License informationDisclaimerFor correspondence: Dr. J K. Murthy,Copyright
The most common cause of acute onset unilateral peripheral facial weakness is Bell’s palsy. The incidence of Bell’s palsy is 20-30 cases for 100,000 and accounts for 60-70% of all cases of unilateral peripheral facial palsy. Either sex is affected equally and may occur at any age, the median age is 40 years. The incidence is lowest under 10 years of age and highest in people over the age of 70. Left and right sides are affected equally.
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Bells Palsy And Ramsay Hunt Syndrome
The incidence of Bells palsy is generally about 20-22 per 100,000 population per year. The rate is highest in pregnant women, a bit over 40 per 100,000 pregnant women per year. The lowest incidence is in children and the best prognosis is in children. About 70% of folks who get Bells palsy develop a rapid onset, single sided facial paralysis. About 30% develop diffuse facial weakness on a single side which usually recovers completely within 1-3 weeks. Rarely, does acute viral facial paralysis develop on both sides simultaneously. For a bit over 70%, recovery is back to normal within a month. About half of those who take longer than a month to recover return to completely normal ,and about half have at least some permanent side effects, but, generally, less than 5% have readily noticeable long term facial weakness with other signs of dysfunctional movement. The poorest prognosis applies to the elderly and long term diabetics but all experience at least some recovery of function, almost always quite functional. The repeat facial palsy rate, same or opposite side, is about 6-7% and about 7-10% have a family history of a similar problem. If a repeat Bells palsy occurs, the odds of a third recurrence nearly doubles to about 12-15% and if a third palsy occurs, the odds of a fourth palsy exceeds a 20% risk.