Acute idiopathic LMN facial nerve palsy; involves forehead (vs UMN stroke).
History taking
- • Unilateral facial droop over hours, hyperacusis, taste change
- • Otalgia, post-auricular pain
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Vesicles in ear (Ramsay Hunt — add aciclovir)
- • Bilateral palsy (Lyme, sarcoid, GBS)
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • CBC, basic metabolic panel as indicated
- • Targeted disease-specific tests
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Prednisolone 60 mg OD × 5 d then taper (start within 72 h)
- • Lubricating eye drops + nocturnal eye taping
- • Add valaciclovir if severe / Ramsay Hunt
Follow-up advice
- • Most recover by 6 months
- • Refer ENT/neurology if no improvement at 3 weeks
Patient counselling
- • Explain diagnosis and natural course in lay terms
- • Red-flag symptoms warranting urgent return
- • Adherence to medications and follow-up
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
