Bell's palsy causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]

Overview

The exact cause of Bell’s palsy is unknown but there are some evidences which implies Bell’s palsy may be caused by: herpes simplex virus reactivation, herpes Zoster, cytomegalovirus, epstein Barr virus, rubella virus, mumps, influenza B, coxsackievirus, Rickettsial infection, borrelia burgdorferi, acute HIV infection, ischemic mononeuropathy, diabetes mellitus, thyroid disorders and compression of the facial nerve.

Causes

Life-threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. There are no life-threatening causes of Bells palsy.

Common Causes

The exact cause of Bell’s palsy is unknown but there are some evidences which implies Bell’s palsy may be caused by:

Viral infections:
- Herpes simplex virus reactivation^[1]
- Herpes Zoster^[2]
- Cytomegalovirus^[3]
- Epstein Barr virus^[4]
- Rubella virus^[5]
- Mumps^[6]
- Influenza B^[7]
- Coxsackievirus^[8]
- Rickettsial infection ^[9]
- Borrelia burgdorferi^[10]
- Acute HIV infection^[11]
Ischemic mononeuropathy^[12]
Diabetes mellitus^[13]
Thyroid disorders^[14]
Compression of the facial nerve^[15]

Causes by Organ System

Cardiovascular	Ischemic mononeuropathy
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	Diabetes mellitus, Thyroid disorders
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	Inactivated intranasal influenza vaccine
Infectious Disease	Acute HIV infection, Adenovirus, Coxsackievirus, Cytomegalovirus, Epstein-Barr virus, Herpes simplex virus, Herpes zoster, Inactivated intranasal influenza vaccine, Influenza B, Mumps, Rickettsial infection, Rubella, Varicella-zoster virus, Borrelia burgdorferi
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	Compression of the facial nerve, Facial nerve inflammation, Ischemic mononeuropathy, Tumors of the facial nerve
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	Tumors of the facial nerve
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	Inactivated intranasal influenza vaccine
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Compression of the facial nerve, Facial nerve inflammation, Idiopathic

Causes in Alphabetical Order

Causes by Etiology

Infectious Causes

Herpes simplex virus reactivation is the most likely cause of Bell’s Palsy.
Herpes Zoster may be the second most common viral infection.
Cytomegalovirus
Epstein Barr virus
Adenovirus
Rubella virus
Mumps
Influenza B
Coxsackievirus
Rickettsial infection
Ehrlichiosis
Borrelia burgdorferi
Acute HIV infection

Non-Infectious Causes

Facial nerve inflammation
Tumors and compression of the facial nerve
Ischemic mononeuropathy

References

↑ Furuta Y, Fukuda S, Chida E, Takasu T, Ohtani F, Inuyama Y; et al. (1998). “Reactivation of herpes simplex virus type 1 in patients with Bell’s palsy”. J Med Virol. 54 (3): 162–6. PMID 9515763.
↑ Morrow MJ (2000). “Bell’s Palsy and Herpes Zoster Oticus”. Curr Treat Options Neurol. 2 (5): 407–416. PMID 11096766.
↑ Walters BN, Redman CW (1984). “Bell’s palsy and cytomegalovirus mononucleosis in pregnancy”. J R Soc Med. 77 (5): 429–30. PMC 1439928. PMID 6327983.
↑ Maeda S, Tsuda H, Haruki S, Mitsuto I (1999). “Atypical Epstein-Barr virus infection associated with Gianotti-Crosti syndrome and Bell’s palsy”. Pediatr Int. 41 (3): 315–7. PMID 10365586.
↑ Jamal GA, Al-Husaini A (1983). “Bell’s palsy and infection with rubella virus”. J Neurol Neurosurg Psychiatry. 46 (7): 678–80. PMC 1027493. PMID 6886708.
↑ Kondo K, Kanaya K, Baba S, Yamasoba T (2014). “Mumps, cervical zoster, and facial paralysis: coincidence or association?”. Case Rep Otolaryngol. 2014: 289687. doi:10.1155/2014/289687. PMC 3933221. PMID 24653846.
↑ Wijnans L, Dodd CN, Weibel D, Sturkenboom M (2017). “Bell’s palsy and influenza(H1N1)pdm09 containing vaccines: A self-controlled case series”. PLoS One. 12 (5): e0175539. doi:10.1371/journal.pone.0175539. PMC 5414992. PMID 28467420.
↑ McFarlin A, Peckler B (2008). “An unusual presentation of Bell’s palsy: A case report and review of literature”. J Emerg Trauma Shock. 1 (1): 50–2. doi:10.4103/0974-2700.40574. PMC 2700557. PMID 19561942.
↑ Bitsori M, Galanakis E, Papadakis CE, Sbyrakis S (2001). “Facial nerve palsy associated with Rickettsia conorii infection”. Arch Dis Child. 85 (1): 54–5. PMC 1718833. PMID 11420202.
↑ Schmutzhard E, Stanek G (1985). “Borrelia burgdorferi, a possible cause of Bell’s palsy?”. Clin Neurol Neurosurg. 87 (4): 255–7. PMID 3912092.
↑ Brown MM, Thompson A, Goh BT, Forster GE, Swash M (1988). “Bell’s palsy and HIV infection”. J Neurol Neurosurg Psychiatry. 51 (3): 425–6. PMC 1032872. PMID 3361335.
↑ Fahimi J, Navi BB, Kamel H (2014). “Potential misdiagnoses of Bell’s palsy in the emergency department”. Ann Emerg Med. 63 (4): 428–34. doi:10.1016/j.annemergmed.2013.06.022. PMC 3940662. PMID 23891413.
↑ Pecket P, Schattner A (1982). “Concurrent Bell’s palsy and diabetes mellitus: a diabetic mononeuropathy?”. J Neurol Neurosurg Psychiatry. 45 (7): 652–5. PMC 491483. PMID 7119834.
↑ Cox NH, Chew D, Williams JG, Morris AI (1985). “Bell’s Palsy associated with hypothyroidism”. Br J Clin Pract. 39 (4): 158–9. PMID 4015946.
↑ Gussen R (1977). “Pathogenesis of Bell’s palsy. Retrograde epineurial edema and postedematous fibrous compression neuropathy of the facial nerve”. Ann Otol Rhinol Laryngol. 86 (4 Pt 1): 549–58. doi:10.1177/000348947708600416. PMID 889228.

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[pmid9515763-1] Furuta Y, Fukuda S, Chida E, Takasu T, Ohtani F, Inuyama Y; et al. (1998). “Reactivation of herpes simplex virus type 1 in patients with Bell’s palsy”. J Med Virol. 54 (3): 162–6. PMID 9515763.

[pmid11096766-2] Morrow MJ (2000). “Bell’s Palsy and Herpes Zoster Oticus”. Curr Treat Options Neurol. 2 (5): 407–416. PMID 11096766.

[pmid6327983-3] Walters BN, Redman CW (1984). “Bell’s palsy and cytomegalovirus mononucleosis in pregnancy”. J R Soc Med. 77 (5): 429–30. PMC 1439928. PMID 6327983.

[pmid10365586-4] Maeda S, Tsuda H, Haruki S, Mitsuto I (1999). “Atypical Epstein-Barr virus infection associated with Gianotti-Crosti syndrome and Bell’s palsy”. Pediatr Int. 41 (3): 315–7. PMID 10365586.

[pmid6886708-5] Jamal GA, Al-Husaini A (1983). “Bell’s palsy and infection with rubella virus”. J Neurol Neurosurg Psychiatry. 46 (7): 678–80. PMC 1027493. PMID 6886708.

[pmid24653846-6] Kondo K, Kanaya K, Baba S, Yamasoba T (2014). “Mumps, cervical zoster, and facial paralysis: coincidence or association?”. Case Rep Otolaryngol. 2014: 289687. doi:10.1155/2014/289687. PMC 3933221. PMID 24653846.

[pmid28467420-7] Wijnans L, Dodd CN, Weibel D, Sturkenboom M (2017). “Bell’s palsy and influenza(H1N1)pdm09 containing vaccines: A self-controlled case series”. PLoS One. 12 (5): e0175539. doi:10.1371/journal.pone.0175539. PMC 5414992. PMID 28467420.

[pmid19561942-8] McFarlin A, Peckler B (2008). “An unusual presentation of Bell’s palsy: A case report and review of literature”. J Emerg Trauma Shock. 1 (1): 50–2. doi:10.4103/0974-2700.40574. PMC 2700557. PMID 19561942.

[pmid11420202-9] Bitsori M, Galanakis E, Papadakis CE, Sbyrakis S (2001). “Facial nerve palsy associated with Rickettsia conorii infection”. Arch Dis Child. 85 (1): 54–5. PMC 1718833. PMID 11420202.

[pmid3912092-10] Schmutzhard E, Stanek G (1985). “Borrelia burgdorferi, a possible cause of Bell’s palsy?”. Clin Neurol Neurosurg. 87 (4): 255–7. PMID 3912092.

[pmid3361335-11] Brown MM, Thompson A, Goh BT, Forster GE, Swash M (1988). “Bell’s palsy and HIV infection”. J Neurol Neurosurg Psychiatry. 51 (3): 425–6. PMC 1032872. PMID 3361335.

[pmid23891413-12] Fahimi J, Navi BB, Kamel H (2014). “Potential misdiagnoses of Bell’s palsy in the emergency department”. Ann Emerg Med. 63 (4): 428–34. doi:10.1016/j.annemergmed.2013.06.022. PMC 3940662. PMID 23891413.

[pmid7119834-13] Pecket P, Schattner A (1982). “Concurrent Bell’s palsy and diabetes mellitus: a diabetic mononeuropathy?”. J Neurol Neurosurg Psychiatry. 45 (7): 652–5. PMC 491483. PMID 7119834.

[pmid4015946-14] Cox NH, Chew D, Williams JG, Morris AI (1985). “Bell’s Palsy associated with hypothyroidism”. Br J Clin Pract. 39 (4): 158–9. PMID 4015946.

[pmid889228-15] Gussen R (1977). “Pathogenesis of Bell’s palsy. Retrograde epineurial edema and postedematous fibrous compression neuropathy of the facial nerve”. Ann Otol Rhinol Laryngol. 86 (4 Pt 1): 549–58. doi:10.1177/000348947708600416. PMID 889228.

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