Emergency medicine residents and medical students on emergency medicine rotations.
This oral board review case tests the resident’s ability to differentiate between benign and life-threatening causes of acute facial paralysis. Bell’s Palsy is a peripheral facial nerve palsy with a prevalence of 15-40 per 100,000.1The diagnosis is mainly clinical, based on focused history and thorough neurologic examination, particularly of the cranial nerves. The etiology is unknown; viral reactivation is suspected to be the culprit in the majority of cases and is the target of current therapy, although alternate etiologies of peripheral facial paralysis should be ruled out. The primary objective of the emergency physician is to rule out life-threatening and function-threatening etiologies of facial nerve paralysis (eg, cerebrovascular accident), initiate conservative management, and coordinate appropriate follow-up.
At the end of this oral boards session, examinees will: 1) Demonstrate ability to perform a thorough neurologic examination including full cranial nerve exam, National Institutes of Health (NIH) stroke scale assessment, strength and sensation and reflex testing, pronator drift, speech repetition. 2) Differentiate between Bell’s Palsy and acute stroke with facial paralysis. 3) List appropriate laboratory testing for a case of peripheral facial nerve paralysis (basic metabolic panel [BMP]; complete blood count [CBC]; coagulation studies if considering lumbar puncture; human immunodeficiency virus (HIV) test if high-risk by history, or if bilateral; Lyme titer if in endemic area, or if bilateral). 4) Select appropriate treatments (steroids, eye lubricant and patch, PCP referral) for peripheral facial nerve paralysis.
Oral boards case
Paralysis, Bell’s palsy, facial nerve paralysis, Lyme disease, viral syndrome, neurologic emergency.