CASE PRESENTATION

PRINCESS MAE P. PETALLANA

CASE
B.S.
42 year old
Female
Married FACIAL ASYMMETRY
Mother of 2 kids
Filipino
Caibaan Tacloban City
HISTORY OF PRESENT ILLNESS
3 days PTA
Onset of posterior auricular pain
No cough, no colds, no ear discharge, no erythema

Few hours PTA

Still with post-auricular pain
Onset facial asymmetry of left side
No slurring of speech, no headache, no body weakness.
Past Medical History
 Gestational Hypertension
 No previous admissions
 No previous surgical operation

Family History
 Hypertension –Maternal and Paternal Side

Psychosocial History
 Housewife with 2 kids
PHYSICAL EXAMINATION
Patient is a female, mesomorph, conscious, responsive, cooperative,
afebrile and not in cardio-respiratory distress with the following vital
signs:
•BP – 130/90 mmHg
•HR – 94bpm
•RR- 21 cpm
•Temp. – 36.5 C
PHYSICAL EXAMINATION
PERTINENT FINDINGS:
HEENT: Normocephalic, anicteric sclerae, pupils equally reactive to
light and accommodation
Flattening of forehead and nasolabial fold, left.
Poor eyelid closure OS
Auricles symmetrical, no discharges, slight tenderness left posterior
auricular area, no erythema
Pinkish nasal mucosa, nasal septum at midline, no masses, no polyps
OTHER SYSTEM ORGANS WERE UNREMARKABLE
NEUROLOGIC EXAMINATION
Awake, conscious oriented
CN I No anosmia
CN II Pupils 2-3mm in diameter, equally reactive to light and accommodation
CN III, IV, VI Full EOM
CN V with corneal reflex
CN VII Facial paralysis left
CN VIII Responds to verbal stimuli
NEUROLOGIC EXAMINATION
CN IX, X Good gag reflex
CN XI able to shrug shoulders
CN XII unable to protrude tongue, midline
Motor 5/5 in all extremities
Sensory 100% in all extremities
DTR +2 in all extremities
(-) Babinski
LABORATORIES
COMPLETE BLOOD COUNT
BLOOD CHEMISTRY
URINALYSIS
ELECTROLYTES
SALIENT FEATURES
Female
42 y.o.
Posterior Auricular Pain
Facial paralysis, left
Poor eyelid closure OS
No body weakness
No slurring of speech
No change in sensorium
DIFFERENTIAL DIAGNOSIS
NUCLEAR (PERIPHERAL)
Disease Cause Distinguishing Factors
Lyme Disease Spirochet Borrelia burgdorferi History of tick exposure, rash or
arthralgias; exposure to endemic
areas
Otitis Media Bacterial pathogens Gradual onset; ear pain, fever and
conductive hearing loss
Ramsay Hunt Syndrome Herpes zoster virus Pronounced prodrome of pain,
vesicular eruption in ear canal or
pharynx
GBS Autoimmune response More often bilateral
Tumor Cholesteatoma, parotid gland Gradual onset
 DIFFERENTIAL DIAGNOSIS
SUPRANUCLEAR (CENTRAL)

Disease Cause Distinguishing Factors

Multiple Sclerosis Demyelination Additional Neurologic
symptoms
Stroke Ischemia/hemorrhage Extremities on affected side
often involved
Tumor Metastases, primary Gradual onset; mental
brain status changes; history of
cancer
BELL’S PALSY
Acute unilateral facial nerve paresis or
paralysis with onset in less than 72 hours and
without an identifiable cause
BELL’S PALSY
Bell’s palsy is a relatively uncommon condition but one that affects
people across the age and gender spectrum, with incidence ranging
from 11.5 to 53.3 per 100,000 person years in different populations.
The incidence is noted to be highest in the 15- to 45-year-old age
group.
BELL’S PALSY
Facial paresis or paralysis is thought to
result from facial nerve inflammation and
edema. As the facial nerve travels in a
narrow canal within the temporal bone,
swelling may lead to nerve compression
and result in temporary or permanent
nerve damage.
70-80% will recover spontaneously
CLINICAL PRACTICE GUIDELINE: BELL’S PALSY
THANK YOU!