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1. LMN CN VII palsy; idiopathic or caused by infection, occasionally results in no taste sensation on the anterior 2/3 of tongue, loss of lacrimation, and hyperacusis.

2. Pregeniculate lesions are associated with the loss of taste, salivation, and lacrimation, while more distal lesions spare these functions.

3. Causes - HSV; VZV which P/W vesicles involving the TM & EAC (Ramsay Hunt syndrome); Lyme disease; HIV.

4. Know that if the palsy is preceded by a period of facial twitching, the risk of tumor is higher - urgent imaging required.

5. Patients who begin to improve within 3 weeks will commonly recover completely.

6. A week of prednisone shortens the course and improves function if started within 7 days of clinical onset


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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