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PassMedicine 1747557892336

The document discusses a clinical case of a 56-year-old woman with facial asymmetry and paralysis, leading to a diagnosis of Bell's palsy, which is characterized by acute, unilateral facial nerve paralysis. It outlines the symptoms, management strategies including the use of oral prednisolone, and the prognosis, noting that most patients recover within 3-4 months. Additionally, it highlights the importance of eye care and follow-up for those with persistent symptoms.

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63 views3 pages

PassMedicine 1747557892336

The document discusses a clinical case of a 56-year-old woman with facial asymmetry and paralysis, leading to a diagnosis of Bell's palsy, which is characterized by acute, unilateral facial nerve paralysis. It outlines the symptoms, management strategies including the use of oral prednisolone, and the prognosis, noting that most patients recover within 3-4 months. Additionally, it highlights the importance of eye care and follow-up for those with persistent symptoms.

Uploaded by

مركز نبض عدن الطبي
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd

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Question 3 of 10

A 56-year-old woman presents with facial asymmetry. Whilst brushing her teeth this morning she
noted that the right hand corner of her mouth was drooping. She is generally well but noted some
pain behind her right ear yesterday and says her right eye is becoming dry. On examination she
has a complete paralysis of the facial nerve on the right side, extending from the forehead to the
mouth. Ear, nose and throat examination is normal. Clinical examination of the peripheral nervous
system is normal. What is the most likely diagnosis?

Ramsey-Hunt syndrome 21%

Bell's palsy 76%

Stroke 1%

Multiple sclerosis 0%

Parotid tumour 1%

The pain around the ear raises the possibility of Ramsey-Hunt syndrome but this is actually quite
common in Bell's palsy - some studies suggest it is seen in 50% of patients. The normal ear exam
also goes against this diagnosis.

Discuss (3) Improve

Next question

Bell's palsy

Bell's palsy may be defined as an acute, unilateral, idiopathic, facial nerve paralysis. The aetiology
is unknown although the role of the herpes simplex virus has been investigated previously. The
peak incidence is 20-40 years and the condition is more common in pregnant women.

Features
lower motor neuron facial nerve palsy → forehead affected
in contrast, an upper motor neuron lesion 'spares' the upper face
patients may also notice
post-auricular pain (may precede paralysis)
altered taste
dry eyes
hyperacusis

Management
in the past a variety of treatment options have been proposed including no treatment,
prednisolone only and a combination of antivirals and prednisolone
there is consensus that all patients should receive oral prednisolone within 72 hours of onset
of Bell's palsy
there is an ongoing debate as to the value of adding in antiviral medications
Antiviral treatments alone are not recommended
UpToDate recommends the addition of antivirals for severe facial palsy
eye care is important to prevent exposure keratopathy
prescription of artificial tears and eye lubricants should be considered
If they are unable to close the eye at bedtime, they should tape it closed using
microporous tape

Follow-up
if the paralysis shows no sign of improvement after 3 weeks, refer urgently to ENT
a referral to plastic surgery may be appropriate for patients with more long-standing
weakness e.g. several months

Prognosis
most people with Bell's palsy make a full recovery within 3-4 months
if untreated around 15% of patients have permanent moderate to severe weakness

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Textbooks

High-yield textbook

Extended textbook
Links

Clinical Knowledge Summaries 19 17

Bell's palsy guidelines

Suggest link Report broken link

Media

Bell's palsy

Osmosis - YouTube 11 0

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Score: 66.7%

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