Bell’s palsy Health Dictionary

The term used to describe a group of conditions characterised by varying degrees of paralysis and originating in infancy or early childhood. In some 80 per cent of cases this takes the form of spastic paralysis (muscle sti?ness), hence the now obsolete lay description of sufferers as ‘spastics’. The incidence is believed to be around 2 or 2·5 per 1,000 of the childhood community. In the majority of cases the abnormality dates from well before birth: among the factors are some genetic malformation of the brain, a congenital defect of the brain, or some adverse e?ect on the fetal brain as by infection during pregnancy. Among the factors during birth that may be responsible is prolonged lack of oxygen such as can occur during a di?cult labour; this may be the cause in up to 15 per cent of cases. In some 10–15 per cent of cases the condition is acquired after birth, when it may be due to KERNICTERUS, infection of the brain, cerebral thrombosis or embolism, or trauma. Acute illness in infancy, such as meningitis, may result in cerebral palsy.

The disease manifests itself in many ways. It may not be ?nally diagnosed and characterised until the infant is two years old, but may be apparent much earlier – even soon after birth. The child may be spastic or ?accid, or the slow, writhing involuntary movements known as athetosis may be the predominant feature. These involuntary movements often disappear during sleep and may be controlled, or even abolished, in some cases by training the child to relax. The paralysis varies tremendously. It may involve the limbs on one side of the body (hemiplegia), both lower limbs (paraplegia), or all four limbs (DIPLEGIA and QUADRIPLEGIA). Learning disability (with an IQ under 70) is present in around 75 per cent of all children but children with diplegia or athetoid symptoms may have normal or even high intelligence. Associated problems may include hearing or visual disability, behavioural problems and epilepsy.

The outlook for life is good, only the more severely affected cases dying in infancy. Although there is no cure, much can be done to help these disabled children, particularly if the condition is detected at an early stage. Assistance is available from NHS developmental and assessment clinics, supervised by community paediatricians and involving a team approach from experts in education, physiotherapy, occupational therapy and speech training. In this way many of these handicapped children reach adulthood able to lead near-normal lives. Much help in dealing with these children can be obtained from SCOPE (formerly the Spastics Society), and Advice Service Capability Scotland (ASCS).... cerebral palsy

Another name for PARALYSIS. CEREBRAL PALSY involves total or partial paralysis of a limb or limbs due to a perinatal or early infancy brain lesion.... palsy

Bell’s palsy, or idiopathic facial nerve palsy, refers to the isolated paralysis of the facial muscles on one or both sides. It is of unclear cause, though damage to the seventh cranial, or FACIAL NERVE, possibly of viral origin, is thought likely. Occurring in both sexes at any age, it presents with a facial pain on the affected side, followed by an inability to close the eye or smile. The mouth appears to be drawn over to the opposite side, and ?uids may escape from the angle of the mouth. Lines of expression are ?attened and the patient is unable to wrinkle the brow. Rare causes include mastoiditis, LYME DISEASE, and hypertension.

Treatment Oral steroids, if started early, increase the rate of recovery, which occurs in over 90 per cent of patients, usually starting after two or three weeks and complete within three months. Permanent loss of function with facial contractures occurs in about 5 per cent of patients. Recurrence of Bell’s palsy is unusual.... bell’s palsy

Crutch palsy is weakness or paralysis of muscles in the wrist and hand, due to pressure exerted by the CRUTCH head on the nerves that control the affected muscles. It usually occurs because the crutch is too long for the individual, and/or if he or she attempts too much walking. The nerve damage is temporary and symptoms disappear if the crutch is properly used or left aside for a time.... crutch palsy

See BELL’S PALSY.... idiopathic facial nerve palsy

Another name for writer’s cramp (see MUSCLES, DISORDERS OF).... scrivener’s palsy

a psychological method of treating bed-wetting in children and adults. When the subject starts to pass urine it is detected by a pad (or by sheets of metallic mesh) and this sets off a bell (or loud buzzer). The modern form of the apparatus has a small electronic sensor worn under the underclothes and produces a loud bleep. The purpose of the alarm is to waken the subject, who then empties the bladder fully. A process of conditioning leads to the subject learning to be dry. It is effective in about 80% of cases.... bell and pad

the normal outward and upward rotation of the eyes that occurs when the lids are closed, but not during blinking. [Sir C. Bell]... bell’s phenomenon

(Steele–Richardson–Olszewski syndrome) a progressive neurological disorder resulting from degeneration of the motor neurons, basal ganglia, and brainstem. Starting in late middle age, it is characterized by a staring facial expression due to impaired ability to move the eyes up and down, progressing to difficulties in swallowing, speech, balance, and movement and general spasticity. The condition enters the differential diagnosis of *parkinsonism, with which it is often confused in its early stages.... progressive supranuclear palsy

an archaic name for Parkinson’s disease (see parkinsonism).... shaking palsy

Weakness of the facial muscles due to inflammation of or damage to the facial nerve. The condition is usually temporary and affects only one side of the face.

Facial palsy is most often due to Bell’s palsy, which occurs for no known reason. Less commonly, facial palsy is associated with herpes zoster affecting the ear and facial nerve. Facial palsy may also result from surgical damage to this nerve or compression of the nerve by a tumour.

Facial palsy usually comes on suddenly. The eyelid and corner of the mouth droop on one side of the face and there may be pain in the ear on that side. The sense of taste may be impaired or sounds may seem to be unnaturally loud.

In many cases, facial palsy clears up without treatment. Pain can be relieved by taking analgesic drugs, and exercising the facial muscles may aid recovery. In some cases, it may be necessary to tape the eyelid shut at bedtime in order to avoid the risk of corneal abrasion. Bell’s palsy may be treated with corticosteroid drugs to reduce inflammation and speed recovery. Re-routing or grafting of nerve tissue may help people with palsies as a result of injury or a tumour.... facial palsy

weakness or paralysis of the shoulder and arm usually caused by injury to the upper roots of the *brachial plexus during traumatic childbirth. This may happen if, during a difficult delivery, excess traction applied to the head damages the fifth and sixth cervical roots of the spinal cord. The muscles of the shoulder and the flexors of the elbow are paralysed and the arm hangs at the side internally rotated at the shoulder with the forearm pronated (waiter’s-tip deformity). Recovery may be spontaneous, but in some cases nerve grafts or muscle transfers are required. [W. H. Erb (1840–1921), German neurologist]

ERCP (endoscopic retrograde cholangiopancreatography) the technique in which a catheter is passed through a *duodenoscope into the *ampulla of Vater of the common bile duct and injected with a radiopaque medium to outline the pancreatic duct and bile ducts radiologically. Magnetic resonance cholangiopancreatography (MRCP; see cholangiography) is often used to diagnose biliary and pancreatic disease followed by ERCP for diagnostic confirmation and therapeutic intervention. ERCP facilitates the removal of gallstones from the common bile duct, biopsy of lesions, and insertion of biliary *stents. See also papillotomy.... erb’s palsy