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
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