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    Case Presentation: by Michael Armstrong

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    Wirawan Amirul Bahri
    A 39-year-old Hispanic female presented with numbness on the right side of her face, blurry vision in her right eye, and inability to close her right eye over the past 2 days. She reports tearing, drooling, difficulty eating and drinking from her right side. On exam, she has right-sided facial droop and ptosis of the right eye. A differential diagnosis of Bell's palsy, TIA, Ramsay Hunt syndrome, and others is considered. Bell's palsy is described as the leading diagnosis, being an idiopathic, unilateral facial paralysis of unknown etiology that generally resolves within 3 months.

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    Case Presentation: by Michael Armstrong

    Uploaded by

    Wirawan Amirul Bahri
    124 views21 pages
    A 39-year-old Hispanic female presented with numbness on the right side of her face, blurry vision in her right eye, and inability to close her right eye over the past 2 days. She reports tearing, drooling, difficulty eating and drinking from her right side. On exam, she has right-sided facial droop and ptosis of the right eye. A differential diagnosis of Bell's palsy, TIA, Ramsay Hunt syndrome, and others is considered. Bell's palsy is described as the leading diagnosis, being an idiopathic, unilateral facial paralysis of unknown etiology that generally resolves within 3 months.

    Original Description:

    bells palsy

    Original Title

    Bell’s Palsy

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    A 39-year-old Hispanic female presented with numbness on the right side of her face, blurry vision in her right eye, and inability to close her right eye over the past 2 days. She reports tearing, drooling, difficulty eating and drinking from her right side. On exam, she has right-sided facial droop and ptosis of the right eye. A differential diagnosis of Bell's palsy, TIA, Ramsay Hunt syndrome, and others is considered. Bell's palsy is described as the leading diagnosis, being an idiopathic, unilateral facial paralysis of unknown etiology that generally resolves within 3 months.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    124 views21 pages

    Case Presentation: by Michael Armstrong

    Uploaded by

    Wirawan Amirul Bahri
    A 39-year-old Hispanic female presented with numbness on the right side of her face, blurry vision in her right eye, and inability to close her right eye over the past 2 days. She reports tearing, drooling, difficulty eating and drinking from her right side. On exam, she has right-sided facial droop and ptosis of the right eye. A differential diagnosis of Bell's palsy, TIA, Ramsay Hunt syndrome, and others is considered. Bell's palsy is described as the leading diagnosis, being an idiopathic, unilateral facial paralysis of unknown etiology that generally resolves within 3 months.

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    Case Presentation

    by Michael Armstrong

    Chief Complaint
    My face is numb on the right side, my

    vision is blurry, and I cant close my


    right eye.

    History of present illness


    Patient is a 39 y/o Hispanic female

    with a 2 day complaint of numbness to


    the right side of her face following an
    aching pain in the right posterior
    auricular space. The numbness has
    progressed to the point where the
    patient has blurred vision and can no
    longer close her right eye.

    HPI cont.
    The patient states her right eye tears a

    lot and she drools from the right side of


    her mouth. She also admits to having
    difficulty eating and drinking even
    with a straw. She states Motrin has
    helped with the pain. She denies
    weakness to her extremities, loss of
    consciousness, or head trauma.

    Past Medical History


    Hypothyroidism
    Sarciodosis

    Medications
    Synthroid

    Allergies
    NKDA
    NKFA

    Vital Signs
    BP

    166/102
    HR
    84
    RR
    16
    Temp 98.0
    Ht
    68 inches
    Wt
    204 lbs

    Physical Exam
    Gen: Pt. A/O x 3 w/ Rt. side facial droop
    HEENT: NC/AT, PERRLA, + red reflex b/l,
    EOM intact, ptosis of rt. eye, + light reflex
    b/l, disc margins sharp, no A-V nicking,
    TMs and canals clr., good acuity b/l, nares
    patent, septum midline, MMM&P, pharynx
    clr., MMM&P, throat supple, trachea
    midline, no lymphadenopathy.

    Physical Exam
    Thorax: Symmetrical w/ equal expansion,
    breath sounds vesicular and CTA b/l.
    CVA: Normal S1,S2 w/ no murmurs, rubs,
    or gallops. No JVD.
    EXT: No edema. Good pulses x 4 extrem.

    Neurological

    Mental Status: Alert and oriented


    Cranial Nerves: I VI intact
    VII rt. side sens/mtr deficit
    VIII XII intact
    Motor: Strength 5/5 throughout. Gait normal.
    Sensory: Romberg neg., pinprick, light touch,
    position, vibration, and stereognosis intact.
    Reflexes: Bi, tri, sup, abd, knee, ankle, & pl 2+

    R/O Bells Palsy


    CT of the head
    Lyme titers

    Differential Diagnosis
    TIA
    Ramsay Hunt Syndrome
    Acoustic Neuromas
    Heerfordts Syndrome
    Melkersson-Rosenthal Syndrome

    Bells Palsy
    Described by Sir Charles Bell in the

    19th century.
    Idiopathic form of facial paralysis
    resulting from inflammation of the
    facial nerve.

    Epidemiology
    40,000 to 50,000 Americans annually.
    May occur at any age.
    More common amongst pregnant

    women and those suffering from


    diabetes, influenza, common cold, or
    some other upper respiratory ailment.
    Occurs more often in spring or fall.

    Pathophysiology
    Etiology unknown
    Some research leans towards herpes

    virus as a cause
    Sarcoidosis and Lymes Disease also
    potential causes

    Signs and Symptoms


    Unilateral facial
    paralysis
    Inability to close
    the eye
    Absence of the
    nasolabial fold
    May be loss of taste
    on anterior tongue

    Pain behind the ear


    Tearing
    Drooling
    Hyperacusis
    Sag of the eyebrow

    Diagnosis
    Based on clinical findings
    Imaging studies used to rule out other

    pathology
    Lyme titers, PCR testing may indicate
    cause

    Treatment
    Corticosteroids (efficacy not proven)
    Analgesics
    Lubricating eye drops
    Taping eye closed at night
    Massage of the weakened muscles

    Prognosis
    Generally very good
    Most patients get significantly better in

    about 2 weeks even without treatment


    80-85% recover completely within 3
    months
    10% have permanent disfigurement or
    other long term sequelae

    References
    National Institute of Neurological Disorders
    and Stroke (online)
    National Institute of Dental and
    Craniofacial Research (online)
    Merck Manual (online)
    Harrisons Principals of Internal Medicine

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