A forty-nine year old Caucasian male presents to the ER with difficulty eating,

Question

A forty-nine year old Caucasian male presents to the ER with difficulty eating, drinking, and speaking. He is unable to blink or fully close his left eye and reports pain around his left ear. He also reports drooling and says that his food tastes different. He reports his eyes have been tearing. His symptoms started yesterday and seem to have gotten slightly worse today. Past history shows positive for herpes simplex virus 1 (HSV-1) and type 2 diabetes and he reports having high stress levels due to his job. Upon observation you notice dropping of the eyebrow, an absence of wrinkles in the forehead, and an absence of facial expression on the left side of the face. Neurological examination reveals:

-No loss of sensory function to the face

-Weakness of the facial muscles on the left side of the face

-Difficulty recognizing common tastes

-Hyperacusis

1. What is your working diagnosis of this patient?

2. How long is the typical recovery for a patient with this condition?

3. Is there a chance of reoccurrence?

Explanation / Answer

1). The working diagnosis of the patient is Bell's palsy. Bell's Palsy is an acute condition of facial nerve paralysis, which is generally caused due to a viral infection (HSV-I) or due to the Lyme disease. The seventh cranial nerve is the facial nerve, originates in the roots of pons and medulla oblongata and control the expression of facial muscles. Thus, the acute paralysis of the facial nerve (may be due to inflammation) results in the Bells Palsy.

2). The symptoms start to improve in 2-3 weeks, but complete recovery takes 3-6 months.

3). Yes, the affected person may face recurrence because the virus remains dormant in the body. With increasing recurrence, the chances of recovery decreases.

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