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Bells Palsy connection to the pons

Hi
I am recovery from bells palsy.  It's been four weeks from the initial onset and my face is almost back to normal.  I'm very thankful.  I'm a believer that the strong dose of steroids has worked.  This was the second time I have had bells palsy.  The other time was when I was 16.  Both times it was on the same side of the face (right) and the paralysis of the right side of the face was identical.  Both times it took about a month to recover.  I have always believed that the reason I had bells palsy was because the VII cranial nerve was inflamed.  How it became inflamed I didn't know - nor did the Dr's ... but as long as it went away and I looked like myself again,  I didn't really care. Recently I learned that I have "a small focus of FLAIR hyperintensities within the left pons".  Does this mean there is a lesion in the pons?  And if so, does anyone know if a lesion in the pons can affect the VII cranial nerve? thank-you for any information you can provide.
4 Responses
987762 tn?1331027953
COMMUNITY LEADER
Hi Jenny,

The pon's is the top part of the brain stem, yes the Pon's is involved in facial  nerves (trigeminal nerve, abducens nerve, facial nerve, vestibulocochlear nerve), cranial nerves V, VI, VII and VIII are at the border of the pons.

There is a 'potential' explanation but keep in mind that they often don't know exactly what causes bells palsy, there's a high association to herpes simplex and diabetes as well as other's......lesion-symptom mapping is very difficult to get absolutely 100% right!

Having a Pon's lesion and periventricular lesions will definitely limit the list of potential medical explanations in your age group, MS unfortunately will be on your list but deep breath cause it still may not be MS...

Hope that helps.......JJ    

  

  
1 Comments
Thanks.  I hadn't even noticed the line on the MRI report about the hyperintensities in the pons until I pulled it out again the other day to reread (cause I, seeing a neurologist in a week). I'm new to all of this and just learning what hyperintensities are and even some basic parts of the brain. To be honest, before 2 weeks ago the only thing I associated with Mcdonald was the drive through where I can order a Bic Mac.  This has been helpful.  I feel a little more prepared to be able to ask the neurologist some questions at least when I meet with him.  Also it is putting things into perspective that there are no simple answers, its all very complicated and it may take months or years to understand the full picture.
Avatar universal
Hi. This is more a question for anyone knowledgeable than an informed comment, but here goes------

You mention that your Bell's Palsy has occurred both times on the right. Also that your MRI shows a small lesion in the left pons. I know that outside the brain, functions etc., are controlled by nerves on the opposite side, to be crude about a much more complicated issue. But in the brain or head itself, I don't think the 'opposite effect' applies. If this is true, then the left pons lesion would not be the cause of the right side palsy. Not to say you do or don't have MS nonetheless, as I certainly don't know, but just suggesting the BP may be an extra issue of unknown causation.

On the other hand, my idea may be totally wrong. Could you ask your neuro about this?

Best of luck.
1 Comments
Thank-you.  Good point.  I will ask the neurologist.  Like you said, it may just be an extra - unrelated issue.  
987762 tn?1331027953
COMMUNITY LEADER
hmmmm would you like fry's with that :D there's often no simple answer that's for sure.....i can't accurately answer ess's opposite effect, i was thinking along similar lines whilst i was posting. When it comes to the Pon's i'm not 100% sure the opposite applies either, it's a central location, it's quite small compared to other parts of the brain approx 2.5 cm long, it's basically the bridge between various parts of the nervous system.

I'm more use to research that's separated the Pon's into upper, mid or lower areas but I still couldn't find anything research related that isolated the Pon's lesion specifics to which side of the face would likely be affected, which was surprising. The best I could come up with was a Pon's lesion was a 'potential' explanation but there was lot's of factors that effects IF it could be the more likely than any other potential, so it's a maybe yes, maybe no which is as clear as mud..

Bell's palsy is associated with lower motor neural track but upper motor neuron facial palsy causes slightly different signs, so the question i've got in my head is could you actually raise both your eyebrows or was the entire right side including the right eyebrow palsy?

Tutorials explaining the differences between umn and lmn look to me like there is an opposite going on with facial palsy but at this stage i'm starting to get too loopy lala :D so i could be a tad backwards lol

check out https://www.youtube.com/watch?v=5T4G27xkckE to get an easy easy understanding of umn vs lmn to get an idea..

Hope that helps and not confuses you more.....JJ
  



  

Avatar universal
I'm still curious about how all this works, even though I lack even a basic understanding of cranial nerves. But according to Wikipedia, that paragon of accuracy :-)

"Lesions of the facial nerve (VII) may manifest as facial palsy. This is where a person is unable to move the muscles on one or both sides of their face. A very common and generally temporarily facial palsy is known as Bell's palsy. Bell's Palsy is the result of an idiopathic (unknown), unilateral lower motor neuron lesion of the facial nerve and is characterized by an inability to move the ipsilateral muscles of facial expression, including elevation of the eyebrow and furrowing of the forehead. Patients with Bell's palsy often have a drooping mouth on the affected side and often have trouble chewing because the buccinator muscle is affected."

The significant word above is 'ipsilateral,' which I learned means 'same-sided.' If, and this is a big if, I have this right, then a lesion on the left pons would not be the cause of right Bell's Palsy. However, some cranial nerves apparently do affect the opposite side, and the nerves leave the brain and the skull at various points. All this is beyond my ken.

I do plan to ask my neuro about this idea generally because of my history of trigeminal neuralgia, which has been on the right. I have at least one pons lesion, but the radiologist's language is fuzzy, something about 'right more than left,' which hardly clarifies things for this question. In any case, no pons lesion has ever enhanced on my MRIs (nor has any lesion anywhere), yet I have a brain full of lesions and definite MS.

Bottom line for me: Go figure.
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