Bell - S Palsy Dan Lesi BAtang Otak - Blok 5

Bell’s Palsy dan Lesi Batang Otak
Hernawan, MD / Ratih Rizki Indrayani

FK Unsoed / RS Margono Soekarjo
2017
Bell’s Palsy
A. Definition
– Bell palsy, also termed idiopathic facial paralysis

(IFP)
– Unilateral facial paralysis
– Cause Peripheral facial nerve disorders (LMN)
– Without other neurological diseases
B. EPIDEMIOLOGI
The number of new cases of Bell's palsy : 11-40 kasus per 100.000
Age
Peak age:  15-45 years
Highest incidence  >60 tahun
lowest incidence: <10 tahun
Sex
1. Bell palsy appears to affect
the sexes equally
2. most frequently in the third
trimester
C. Etiologi parese n VII perifer
Idiopathic Congenital Acquired

• cold exposure • Congenital • Trauma
• wind, cold AC, anomalies • The process of
(Moebius intracranial (tumor,
or driving a car inflammation,
with the syndrome) 2) bleeding, etc.)
windows • Birth trauma • presses the neck
down, sleeping (intracranial region: Ca NF
in the open, hemorrhage • Infections: HSV, CMV,
sleeping on the .dll.) Herpes zoster
floor • Hereditary: immune,
narrowness of the
cervical canal
D. Pathophysiology
E. DIAGNOSIS
Anamnesis
Symptoms of Bell palsy Early symptoms
1) Acute onset of unilateral upper 1) Weakness of the facial muscles

and lower facial paralysis (over 2) Poor eyelid closure /
a 48-h period) Lagophthalmos
2) Posterior auricular pain 3) Aching of the ear or mastoid
3) Decreased tearing (60%)
4) Hyperacusis 4) Alteration of taste (57%)
5) Taste disturbances 5) Hyperacusis (30%)
6) Otalgia 6) Tingling or numbness of the
cheek/mouth
7) Epiphora
8) Ocular pain
9) Blurred vision
Onset: typically sudden, peak in less than 48 hours

PE
1. Motorik N. VII
- lagoftalmus.
- flattening of the forehead and
nasolabial fold-
- distorted and lateralize to the side
opposite the palsy
2. Ocular examination
- refleks kornea (-)
- Bell phenomenon
- Schirmer
3. Otologic examination : hiperakusis
4. Gustometri : decreased taste
compared with the normal side
Signs And Symptoms Based on the location of lesions
Letak Lesi Kelainan Gangguan Gangguan Hiposekresi Hiposekresi

motorik pengecapan pendengaran saliva lakrimalis
Pons-meatus + + + tuli/hiperakusis + +
akustikus internus
Meatus akustikus + + + + +
internus-ganglion Hiperakusis
genikulatum
Ganglion + + + + –
genikulatum-N. Hiperakusis
Stapedius
N.stapedius-chorda + + + + –
tympani
Chorda tympani + + – + –
Infra chorda + – – – –
tympani-sekitar
foramen
stilomastoideus
1. Imaging
2. Audiometri
PP 3. Lab : DM
F. MANAGEMENT
Antiviral:
1. HSV : Asiklovir 5 x 400 mg 10 hari.
2. VZV : Asiklovir 5 x 800 mg
Medika Steroid/ Prednison

Surgery dosis: 1 mg/kg atau 60 mg/day selama 6
mentosa hari, diikuti penurunan bertahap total
selama 10 hari
Neurotropik
nonmedika
mentosa
1. Protect eye: topical ocular lubrication,

the eyelids by using tape, glasses
2. Massage of muscle weakness
3. Warm compresses side areas
4. Fisioterapi
Kontraktur
Sinkinesia
(gerakan tidak sadar
yg mengikuti gerakan
Sequele sadar)
Symptom
Spasme spontan/
Tic Fasialis
Crocodile tears
syndrome
Prognosis
Almost 80-90% of Patients recover Without

abnormality
House-Brackmann Facial Nerve Grading System
Grade Deskripsi Kerakteristik
I Normal Fungsi wajah normal
II Disfungsi ringan Inspeksi: Sedikit kelemahan dan sedikit synkinesis. Simetri Normal
Istirahat: dahi : moderat sampai baik;
Gerak: mata: menutup sempurna dengan sedikit usaha, mulut:
sedikit asimetri.
III Disfungsi sedang Inspeksi: Perbedaan yang jelas antara 2 sisi. Synkinesis terlihat, tetapi
tidak parah, kontraktur, atau didapatkan hemifacial spasm.
Simetri normal
Istirahat: Dahi: gerakan sedikit sampai sedang;
Gerak: Mata: menutup sempurna dengan usaha, dan mulut:
gerakan sedikit lemah dengan upaya maksimal.
IV Disfungsi cukup Inspeksi: Kelemahan atau asimetri jelas terlihat.

parah Istirahat: Simetri saat istirahat.
Gerak: Dahi: tidak dapat bergerak.
Mata: Penutupan inkomplit,
Mulut: asimetris dengan upaya maksimal.
V Disfungsi berat Inspeksi: Gerakan nyaris tak terlihat.
Istirahat: Asimetri saat istirahat.
Gerak: Dahi: tidak ada gerakan
Mata: penutupan inkomplit,
Mulut: sedikit gerakan
VI Kelumpuhan total. Asimetri jelas terlihat. Tidak ada gerakan.
Brainstem
Lesions
A. DEFINITION
lesions involving the brainstem
hemiplegia alternans
the deficit of the ipsilateral cranial nerve lesions

+
paralysis of half the body side contralateral
B. Etiologi
1. Vascular disorders such as non - hemorrhagic stroke and

hemorrhagic stroke in the brain stem
2. Tumor
3. Inflammatory process
4. Degenerative
C. Clasification
Mesensefalon Pons Medulla Oblongata

a. Sindrom Weber a. Sindrom Foville-Millard a. Sindrom Lateralis/
b. Sindrom Benedict Gubler Wallenberg
b. Tegmentum pontis b. SIndrom Dejerine
kaudale
c. Tegmentum pontis
orale
d. Basis pontis kaudalis
e. Basis pontis bagian
tengah
Mesensefalon : Sindroma Weber dan Benedict
Sindrom Weber
Sindrom Benedict
Pons : Sindroma Millard Gubler
Pons : Sindroma Tegmentum pontis kaudale
Pons : Sindroma Tegmentum pontis orale
Pons : Sindroma Basis pontis bagian tengah
MO : Sindroma Lateralis/ Wallenberg
MO : Sindroma Dejerin
DAFTAR PUSTAKA
– Adel B , Souid Kawthar, Derbel Amine, Ben Youssef Souha, Boughzala Abdellatif. 2014. Idiopathic Facial Paralysis (Bell’s palsy). International Journal of
Dental Sciences and Research, Vol. 2, No. 5A, 1-4
– Akdal G, Kutluk K, Men S, Yaka E. 2010. "Benedikt and "plus-minus lid" syndromes arising from posterior cerebral artery branch occlusion". Journal of
the neurological sciences. 228 (1): 105–107
– Berg, T. 2009. Medical Treatment and Grading of Bell’s palsy. ActaUniversitatis Upsalensis. Digital Comprehensive Summaries of Uppsala
Dissertations from the Faculty of Medicine 460. 47 pp.Uppsala
– Duus P, Baehr M, Frotscher M. Duus. 2010. Topical Diagnosis in Neurology: Anatomy, Physiology, Signs, Symptoms. Ed 4th. EGC, Jakarta.; p198 – 212.
– Eslinger, Amanda. 2013. Cranial Nerve VII Palsy: Pathogenesis and Clinical Finding. The Calgary Guide.
– Eviston, Timothy, Glen C, Peter G, Tessa H, dan Arun V. 2014. Bell's palsy: aetiology, clinical features and multidisciplinary care. The Journal of
Neurology, Neurosurgery, and Psychiatry, No. (42)1:41-49.
– Garg, K.N., Gupta, K., Singh, S., Chaudhary, S. 2012. Bell’s palsy:Aetiology, Classification, Diffrential Diagnosis and Treatment: A Review. Journal of
dentofacial sciences. 1(1): 1-8
– Hadley, R. (2010). "Dejerine-Roussy Syndrome". Clinical Chiropractic. 7 (2): 79–83
– Joyce L, Anisa B, Katia C. 2011. Crash Course: Neurology. United Kingdom.
– Kanerva,M. 2008. Peripheral Facial Palsy: Grading, Etiology, and Melkersson-Rosenthal Syndrome. Otolaryngology-Head and Neck Surgery, in press.
– Kubik, M., Robles, L., Kung, A. 2012. Familial Bell’s palsy: A Case Report and Literature Review. Hindawi Publishing Corporation.
– Kumar, V.,Abbas, A.K., Fausto, N., Aster, J. 2010. Robbins and Cotran Pathologic Basis of Disease. Professional Edition. 8th ed. Saunders. Elsivier, lnc
– Lowis, Handoko dan Maula N. 2012. Bell’s Palsy, Diagnosis and Management in Primary Care. Journal Indonesian Medecine Assoc. 62;32-7
– Mardjono M, Sidharta P. Neurologi Klinis Dasar. Penerbit PT. Dian Rakyat. Jakarta; 2008. h31 – 156.
– Marsk, E. 2012. Bell’s palsy- study design, prognosis and quality of life. Karolinska Institutet. Stockholm.
– Martini, Frederic. 2009. The Special Sistems. In Fundamental Anatomy and Fisiologi Nine Edition. New York: Benjamin Cmmings. Hal: 574-575
– Monkhouse, S. 2006. Cranial Nerves: Functional Anatomy. CambridgeUniversity Press. New York.
– Murthy JM dan Amrit B. 2011. Bell's palsy: Treatment guidelines. Ann Indian Acad Neurol. 14(Suppl1): S70–S72.

Bell - S Palsy Dan Lesi BAtang Otak - Blok 5

Uploaded by

Copyright:

Available Formats

Bell - S Palsy Dan Lesi BAtang Otak - Blok 5

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Bell - S Palsy Dan Lesi BAtang Otak - Blok 5

Uploaded by

Copyright:

Available Formats

Bell’s Palsy dan Lesi Batang Otak

Hernawan, MD / Ratih Rizki Indrayani

– Bell palsy, also termed idiopathic facial paralysis

Idiopathic Congenital Acquired

1) Acute onset of unilateral upper 1) Weakness of the facial muscles

Onset: typically sudden, peak in less than 48 hours

Letak Lesi Kelainan Gangguan Gangguan Hiposekresi Hiposekresi

Medika Steroid/ Prednison

1. Protect eye: topical ocular lubrication,

Almost 80-90% of Patients recover Without

IV Disfungsi cukup Inspeksi: Kelemahan atau asimetri jelas terlihat.

lesions involving the brainstem

the deficit of the ipsilateral cranial nerve lesions

1. Vascular disorders such as non - hemorrhagic stroke and

Mesensefalon Pons Medulla Oblongata

– Hadley, R. (2010). "Dejerine-Roussy Syndrome". Clinical Chiropractic. 7 (2): 79–83

– Joyce L, Anisa B, Katia C. 2011. Crash Course: Neurology. United Kingdom.

You might also like