Chapter 35: Neurologic Disorders

BELL’S PALSY

Population

• – Adults with Bell’s palsy.

Recommendation

AAN 2012

• – For patients with recent-onset Bell’s palsy (<72 h of symptoms):

  • Give steroids (prednisone 1 mg/kg PO daily × 7 d) to increase the probability of facial nerve recovery.

  • Consider antivirals (eg, acyclovir or valacyclovir) × 7 d.

Source

• – https://n.neurology.org/content/79/22/2209.short

Comment

1. Antivirals are thought to have a marginal effect on facial nerve recovery when added to steroids.

Population

• – Adult and children with Bell’s palsy.

Recommendations

AAO 2013

• – Do not routinely obtain lab studies, diagnostic imaging, or electrodiagnostic testing for Bell’s palsy. Consider Lyme disease (neuroborreliosis) testing in children <15 y.

• – Do not routinely obtain diagnostic imaging for straightforward Bell’s palsy.

• – If presenting within 72 h of symptoms, give steroids with or without antiviral medications to patients 16 y and older.

• – Do not use antiviral monotherapy.

• – Arrange eye protection for patients with incomplete eye closure.

• – Do not use physical therapy or acupuncture for Bell’s palsy.

Source

• – https://pubmed.ncbi.nlm.nih.gov/24189771/

Comment

1. 2019 Cochrane analysis found no benefit from adding antivirals to corticosteroids vs. corticosteroid monotherapy (https://doi.org/10.1002/14651858.CD001869.pub9)

CONCUSSIONS

Population

• – Children and young adults.

Recommendations

CDC 2016, ACEP 2016

• – Obtain noncontrast CT indicated for loss of consciousness or post-traumatic amnesia. There is no evidence to prefer MRI over CT.

• – Educate all patients about concussions and postconcussive syndrome. Use tools such as the Acute Concussion Evaluation (ACE) care plan developed by Gioia and Collins to guide follow-up management.

Sources

• – https://www.cdc.gov/traumaticbraininjury/pdf/tbi_clinicians_factsheet-a.pdf

• – https://www.cdc.gov/headsup/pdfs/providers/ACE_care_plan_returning_to_work-a.pdf

AAN 2013

• – Use standardized sideline assessment tools to assess athletes with suspected concussions.

• – Immediately remove from play any athlete with a suspected concussion.

• – Do not permit an athlete to return to play until he/she has been cleared to play by a licensed health care professional.

Source

• – https://www.aan.com/Guidelines/home/GuidelineDetail/582

DELIRIUM

Population

• – Adults age ≥18 y in the hospital or in long-term care facilities.

Recommendations

NICE 2019

• – Perform a short Confusion Assessment Method (CAM) screen to confirm the diagnosis of delirium.

• – Include the following when managing delirium:

  • Treat the underlying ...