Bell's Palsy

A look at a case of Bell's Palsy.

By Marven Ewen, MD
Medical Director

The patient was 34-years-old and well into her third pregnancy. She came to the ER concerned that she was having a stroke. Her pregnancy and general health had been unremarkable until she awoke this morning. Something didn’t seem right about the right side of her face. Looking in the mirror, she realized she had a lopsided smile. The right side of her face didn’t seem to be working.

Upon further questioning, she admitted to having some discomfort in her right ear area for the last few days, along with more sensitivity to certain sounds in the environment. She denied any rashes, fevers, tick bites, headaches or trauma.

Understandably, in a panic she had rushed to the ED. Her vital signs were normal except on initial presentation, a slightly elevated heart rate was present consistent with anxiety and advanced term of pregnancy. Otherwise her pulse rhythm and quality were normal. She had an obvious weakness of her right face; unable to raise the right side of her mouth or completely close the right eye. Importantly, she also had a decreased ability to raise the right eyebrow. She had no other neurologic abnormalities. There were also no signs of a rash in or around the ear.

Bell’s Palsy is a unilateral facial paralysis due to inflammation of the 7th cranial nerve on the affected side. Incidence is about 30/100,000. For some reason, it seems to be more common in pregnancy but can occur in either gender at any time. It may be associated with herpes simplex or herpes zoster infection, but often the cause is not found. 

It typically comes on over a few hours to days, and may continue to worsen for up to 3 weeks before beginning a slow course of resolution. The paralysis is often preceded by a few days of ear pain or altered sensation to sound.

It can be easily confused with an acute stroke by the general public. The onset is not as rapid as a stroke, but of course if one wakes up with it, then whether symptoms came on over a few hours or instantly can not be known. The key difference between Bell’s Palsy and stroke is the unilateral paralysis of the face most often includes the forehead in the case of Bell’s Palsy. 

In the case of a stroke, the forehead is spared due to bilateral origin of innervation. Also, other than the unilateral facial paralysis, decreased tearing and possible loss of taste on the affected side of the tongue, there are no other neurologic abnormalities. 

With some reassurance and explanation, I was able to calm the patient. The prognosis was good as she presented early and had only moderate weakness. With treatment she would most likely see some improvement in a few weeks. I prescribed Prednisone and an antiviral medication. Also she was directed to use an ophthalmic lubricant regularly in her right eye to protect the cornea from drying out. She was directed to be rechecked by her primary MD in 3 weeks as patients that continue to worsen will need further evaluation with imaging or possibly serologic testing for lymes disease.

More from The Allied Times

Hemophilia

HemophiliaThe disorder that causes unstoppable bleeding.By Jenny Ewen, BA, NREMTEditor-In-ChiefA Little Bit of HistoryIn 1837-1901, Queen Victoria of England ruled and was believed to have passed on the traits of hemophilia B to three of her nine children. Her daughters then passed it on to their children, one of whom married Tsar Nicholas of Russia,…

Bell's Palsy

Bell’s PalsyA look at a case of Bell’s Palsy.By Marven Ewen, MDMedical DirectorThe patient was 34-years-old and well into her third pregnancy. She came to the ER concerned that she was having a stroke. Her pregnancy and general health had been unremarkable until she awoke this morning. Something didn’t seem right about the right side…

Celiac Disease

Celiac DiseaseThe most serious reason to request “gluten-free” food.By Jenny Ewen, BA, NREMTEditor-In-ChiefOverviewThere has been a trend towards gluten-free food options over the last decade, but while some people avoid gluten simply for a healthier diet or weight loss, others have to avoid it to the degree that even a crumb of regular bread from…

A Close Shave

A Close ShaveHow shaving can trigger a cardiovascular response.By Marven Ewen, MDMedical DirectorThe day started out fairly quiet in the ER. Pretty good for early Sunday morning. All the usual Saturday night characters had been discharged or admitted. That is when the local EMS service rolled up with an elderly male patient. His story was he…

Progeria

ProgeriaThe accelerated aging disease.By Jenny Ewen, BA, NREMTEditor-In-ChiefOverviewThe concept of accelerated aging sounds like it belongs in movies, but there is a rare and fatal condition that is recognized by its main symptom: accelerated aging in young children. Hutchinson-Gilford Progeria Syndrome (also called Progeria or HGPS) was first written about in England in the nineteenth…

Staying Safe

Staying SafeEMTs save lives – including their own life.By Marven Ewen, MDMedical DirectorI walked into the doorway of the psych interview room. Standing near the partially open door, carefully choosing my words, I made it clear to the patient and his girlfriend that no, we would not be admitting him to the hospital as he…

Are you ready to start saving lives?