Facial nerve paralysis: Difference between revisions

[[Lyme disease]], an infection caused by ''[[Borrelia burgdorferi]]'' bacteria and spread by [[ticks]], can account for about 25% of cases of facial palsy in areas where Lyme disease is common.<ref name=garro_2018>{{cite journal | vauthors = Garro A, Nigrovic LE | title = Managing Peripheral Facial Palsy | journal = Annals of Emergency Medicine | volume = 71 | issue = 5 | pages = 618–623 | date = May 2018 | pmid = 29110887 | doi = 10.1016/j.annemergmed.2017.08.039 | doi-access = free }}</ref> In the U.S., Lyme is most common in the [[New England]] and [[Mid-Atlantic (United States)|Mid-Atlantic]] states and parts of [[Wisconsin]] and [[Minnesota]], but it is expanding into other areas.<ref name=CDC-Lyme-Data>{{cite web|title=Lyme Disease Data and surveillance |url = https://www.cdc.gov/lyme/datasurveillance/ |website=Lyme Disease |publisher=Centers for Disease Control and Prevention |access-date=12 April 2019}}</ref> The first sign of about 80% of Lyme infections, typically one or two weeks after a tick bite, is usually an [[Erythema migrans|expanding rash]] that may be accompanied by headaches, body aches, fatigue, or fever.<ref name=CDC_Lyme_rashes>{{cite web|title=Lyme disease rashes and look-alikes |url=https://www.cdc.gov/lyme/signs_symptoms/rashes.html |website=Lyme Disease |publisher=Centers for Disease Control and Prevention |access-date=18 April 2019}}</ref> In up to 10-15% of Lyme infections, facial palsy appears several weeks later, and may be the first sign of infection that is noticed, as the Lyme rash typically does not itch and is not painful. Lyme disease is treated with antibiotics.<ref name=wright_2012>{{cite journal | vauthors = Wright WF, Riedel DJ, Talwani R, Gilliam BL | title = Diagnosis and management of Lyme disease | journal = American Family Physician | volume = 85 | issue = 11 | pages = 1086–93 | date = June 2012 | pmid = 22962880 | url = http://www.aafp.org/afp/2012/0601/p1086.html | archive-url = https://web.archive.org/web/20130927081243/http://www.aafp.org/afp/2012/0601/p1086.html| url-status = live | archive-date = 27 September 2013 }}</ref><ref name=NEJM2014>{{cite journal | vauthors = Shapiro ED | title = Clinical practice. Lyme disease | journal = The New England Journal of Medicine | volume = 370 | issue = 18 | pages = 1724–1731 | date = May 2014 | pmid = 24785207 | pmc = 4487875 | doi = 10.1056/NEJMcp1314325 | url = http://portal.mah.harvard.edu/templatesnew/departments/MTA/Lyme/uploaded_documents/NEJMcp1314325.pdf | archive-url = https://web.archive.org/web/20161019142422/http://portal.mah.harvard.edu/templatesnew/departments/MTA/Lyme/uploaded_documents/NEJMcp1314325.pdf | archive-date = 19 October 2016 }}</ref>

Reactivation of [[herpesvaricella zoster]] virus]], as well as being associated with Bell's palsy, may also be a direct cause of facial nerve palsy. Reactivation of latent virus within the [[geniculate ganglion]] is associated with vesicles affecting the ear canal, and termed [[Ramsay Hunt syndrome type II2]].<ref name=HARRISONS2008 /> In addition to facial paralysis, symptoms may include ear pain and vesicles, [[sensorineural hearing loss]], and [[dizziness|vertigo]]. Management includes [[antiviral drug]]s and oral [[steroid]]s.