Bell's palsy and other cranial nerve lesions
Telling Bell's palsy from a central or secondary facial palsy, prednisolone within 72 hours, eye protection, Ramsay Hunt syndrome, and localising multiple cranial neuropathies.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Bell's palsy is an acute idiopathic lower motor neuron facial palsy, maximal within 72 hours, with forehead involvement. It is a diagnosis of exclusion.
- Prednisolone within 72 hours improves the chance of full recovery. Antivirals alone don't work.
- Protect the eye in everyone who can't close it.
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Sources
- Therapeutic Guidelines: Neurology (Bell palsy)AU/NZTherapeutic Guidelines Limited
- Evidence-based guideline update: steroids and antivirals for Bell palsy (Gronseth GS, Paduga R. Neurology 2012;79(22):2209-2213)American Academy of Neurology, 2012 (reaffirmed)
- Clinical practice guideline: Bell's palsy (Baugh RF et al. Otolaryngol Head Neck Surg 2013;149(3 Suppl):S1-S27)American Academy of Otolaryngology-Head and Neck Surgery Foundation, 2013
- Early treatment with prednisolone or acyclovir in Bell's palsy (Sullivan FM et al. NEJM 2007;357:1598-1607)New England Journal of Medicine, 2007
- Prednisolone and valaciclovir in Bell's palsy: a randomised, double-blind, placebo-controlled, multicentre trial (Engström M et al. Lancet Neurology 2008;7(11):993-1000)Lancet Neurology, 2008
- Antiviral treatment for Bell's palsy (idiopathic facial paralysis) (Gagyor I et al. Cochrane Database Syst Rev 2019;CD001869)Cochrane, 2019
- Last updated
- 14 November 2026
What changed
- 14 November 2026 Turnstile bot check on sign-in and signed-out feedback