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What is not?

 Impossible is not a fact, its an opinion 

Bells Palsy-Idiopathic Facial nerve palsy

May 22, 2010 by drsalman

Case Sheet

A 40 year old female presenting to the office with weakness of left side of face.Pateint noted weakness when she woke up in the morning.Pateint says her toungue moves to one side whenver she protudesit.She cannot close her left eye.It seems to her that she is hearing more on left side.

    On examination leftside nasolabialfurrow is less prominent.Pateint cannot hold air in mouth and cannot retract angle of mouth on left sideThe is decrease taste sensation in left ant tougue.Angle of muth is drawn to right side.

 

Case Discussion: 

 Frowning of face is best test to differentiate Bells palsy from UMNL facial palsy

Rules: 

Weakness of left side of face 30

Decreased frowning on affected side 60

Decreased nasolabial fold 30

Hyperacusis on affected side 20

Decreased taste sensatio on affected side 20

Decreased lacrimation 20

H/O Herpes Zoster 10

H/O DM 10

H/O HTN 10

Weakness of limb -20

If Diagnosis Bells palsy then give Predisolone + Acylovir

If Diagnosis Bells Palsy then advice  Physiotherapy

Questions: 

What is the diagnosis?

What is the best next step in managing this patient?

How do you differentiate it with UMNL??

 

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