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Causes and Risk Factors of Bell's Palsy The cause of the nerve irritation associated with Bell's palsy is unknown. Anecdotally, exposure to cold is a frequently cited cause -- for example, driving with a car window open in frigid weather, or sleeping with the window open on a chilly night. This association remains speculative. Some evidence suggests that the cause is inflammation of cranial nerve VII triggered by a viral infection, perhaps in the herpes family. The risk increases through the first 30 years of life, remains steady until approximately 70 years, then increases further. People with diabetes or high blood pressure, as well as pregnant women, are at slightly greater risk, but most patients are ordinary people with no known predisposing factors. Some cases have recently been reported after administration of intranasal influenza vaccine. Symptoms of Bell's Palsy The classic presentation of Bell's palsy is weakness on one side of the face. The potential range of weakness is wide -- it may range from difficulty blinking all the way to a complete paralysis on one side of the face with an inability to close the eye. Onset usually occurs acutely, but the weakness may worsen for 24 to 48 hours before stabilizing. The first awareness of the problem may involve drooling after brushing the teeth or when drinking, an asymmetrical appearance of the mouth noticed in the mirror, an inability to whistle, or excessive tearing in one eye. A man may say that he was unable to blow ...