Bell's Palsy

Deviated

Step 1: View clinicals

A 15 year old girl presents with right-sided deviation of her mouth and difficulty closing her left eye for 1 day. She also complains the food dribbles from the left side of her mouth. Her sense of taste is unaffected. There is no history of facial trauma. Her medical history is unremarkable.


Step 2: Order all relevant investigations

Facial nerve biopsy

You realize that a facial nerve biopsy is probably not indicated.

MRI brain

The MRI of the brain shows enhancement of the distal intra-canalicular and labyrinthine segments of the facial nerve.

Electrodiagnostic studies

A nerve conduction study (NCS) and electromyogram (EMG) will be performed tomorrow.

Lumbar Puncture

Appearance: clear Polymorphs: nil Gram stain: negative Glucose: 70 mg/dL (50 - 80) Protein: 20 mg/dl (15 - 60) Culture reports: Available in 3 days


Step 3: Select appropriate management

Corticosteroids
Antiviral treatment
Tarsorrhaphy
Antibiotics


Score: ★★☆