# Acute Facial Palsy: ED Assessment & Management Guide
> Clinical guide for evaluating acute facial palsy in the ER, covering UMN vs LMN signs, Bell's palsy, Ramsay Hunt syndrome, and prednisolone dosing.

Tags: bell's-palsy, emergency-medicine, neurology, ramsay-hunt-syndrome, clinical-guidelines, facial-nerve, medical-education
## Acute Facial Palsy Assessment
- **Definition**: Sudden onset weakness due to CN VII dysfunction. Bell's Palsy accounts for 75% of cases.
- **Learning Objectives**: Differentiate UMN vs LMN palsy, apply House-Brackmann scale, and exclude differentials like stroke.

## Differential Diagnosis
- **Bell's Palsy**: Idiopathic LMN palsy, 75% spontaneous recovery.
- **Stroke/TIA**: UMN signs, forehead sparing - requires urgent CT/MRI.
- **Ramsay Hunt Syndrome**: VZV reactivation, painful vesicles in ear canal, hearing loss.
- **Others**: Lyme disease, Parotid tumor, Otitis media.

## Clinical Examination
- **Key Test**: Forehead wrinkling and eye closure. If wrinkles are visible on the paralyzed side, suspect a central (UMN) lesion.
- **House-Brackmann Scale**: Grade I (Normal) to Grade VI (Total paralysis).

## ED Management of Bell's Palsy
- **Steroids**: Prednisolone 50mg OD for 10 days (start within 72h).
- **Eye Care**: Essential to prevent keratitis; use lubricating drops, ointment, and tape eye closed at night.
- **Antivirals**: Not routine for Bell's; only for Ramsay Hunt (Aciclovir 800mg 5x/day).

## Prognosis and Safety Netting
- **Outcomes**: 85% near-complete recovery with treatment.
- **Red Flags**: Bilateral palsy, progressive palsy >72h, parotid mass, or systemic features.
- **Follow-up**: GP review in 1 week; ENT if no improvement at 4 weeks.
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