Bell's Palsy

HISTORY:

Facial ‍weaknessparalysisdrooping on the ‍rightleft for ‍ ‍hoursdays

Onset: ‍gradualsudden

‍facial pain

‍facial numbness

‍drooling

‍change in taste

‍tearing

‍phonophobia

‍tinnitus

‍jaw pain

‍headache

‍extremity weakness

‍difficulty walking

‍difficulty with speech

‍aphasia

‍fever



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumaticnormal scalprashlesion

Ears: -R: ‍normal, -L: ‍normal

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Neurologic:

- Mental status: ‍alert, oriented in ‍3 spheres, speech ‍clear

- Cranial nerves: ‍all normal

- Strength: upper extremities -R ‍543210/5 ‍, -L ‍543210/5 ‍

lower extremities -R ‍543210/5 ‍, -L ‍543210/5 ‍

- Sensation: upper extremities -R ‍normal, -L ‍normal, ‍fine touch

lower extremities -R ‍normal, -L ‍normal

- Reflexes: triceps -R ‍4+ (clonus)3+2+1+0+, -L ‍4+ (clonus)3+2+1+0+, biceps -R ‍4+ (clonus)3+2+1+0+, -L ‍4+ (clonus)3+2+1+0+, brachioradialis -R ‍4+ (clonus)3+2+1+0+, -L ‍4+ (clonus)3+2+1+0+

patellar -R ‍4+ (clonus)3+2+1+0+, -L ‍4+ (clonus)3+2+1+0+, achilles -R ‍4+ (clonus)3+2+1+0+, -L ‍4+ (clonus)3+2+1+0+, plantar -R ‍flexionextension, -L ‍flexionextension

- Cerebellar function: ‍normal, finger-nose ‍normalimpaired, rapid alternating movements ‍normalimpaired, heel-knee ‍normalimpaired, Romberg ‍negative, Dix-Hallpike ‍negative, ‍

- Gait: ‍steadyunsteady, tandem walking ‍normalimpaired, heel and toe walking ‍normalimpaired



ASSESSMENT:

‍Bell's palsy ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍creatinine, ‍electrolytes, ‍glucose, ‍CRP, ‍coagulation profile, ‍Lyme serology

- CT scan of the brain

- MRI of the brain

- Advise that there is no signs of stroke, that condition is benign, and that most cases resolve spontaneously within a few months

- ‍Corticosteroids

- ‍Antivirals

- Eye care: artificial tears during the day, ointment at night, eye patch at night

- Facial exercises

- Referral to ENT specialist within 10 days

- Referral to neurologist if central cause not ruled out

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen, if new symptoms develop such as vision changes or severe headache, or if symptoms do not improve with treatment

- Go to ER if difficulty swallowing, difficulty breathing, or severe headache occurs