A 60-year-old woman presents 18 hours after onset of complete right-sided lower motor neuron facial palsy. Ear examination, otoscopy and neurological screening are otherwise normal. What is the most appropriate initial management?

• A Observation with physiotherapy, as most cases recover spontaneously
• B Oral acyclovir as monotherapy
• C Facial nerve decompression surgery within one week
• D Oral prednisolone commenced within 72 hours of onset ✓

Explanation

Early corticosteroids improve the probability of full recovery in Bell's palsy when started within 72 hours of onset, typically prednisolone 1 mg/kg per day for 5 days followed by a taper. Antivirals add marginal benefit and are never monotherapy. Decompression is reserved for the rare case showing progressive degeneration on serial electrophysiology despite medical therapy. Observation alone forfeits the proven benefit of early steroids even though spontaneous recovery is common.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.