Any topic (writer’s choice)
Discussion 13.1: Critical Thinking Question (Neurological Disorder)
1. Please Provide a Follow Up Response to your classmate post/discussion noted below
2. Use at least 1 scholarly resource/reference
“For this weeks critical thinking discussion, I am going to talk about Bells palsy. We recently diagnosed a 33-year-old male patient with Bells palsy in the clinic. He had come in for complaints of a watering right eye. On physical examination, his eyelid was incompletely closed, he was unable to furrow or raise his eyebrows, and he had drooping on the right side of his mouth. He had sensation present to his face, he was able to move his tongue, and his sense of taste was intact. He had no vision changes or other neurological deficits. This was my first experience with Bells palsy, according to Ronthal and Greenstein (2020), it is prevalent in adults with the peak incidence occurring in their 40s. Facial paralysis is very alarming, and this was a great learning experience for me to have. The differentials of Bells palsy are all very scary, including tumors, Guillain-Barre, and of course, stroke.
Brief overview of the neurological problem: Bells palsy is an idiopathic facial nerve palsy that causes spontaneous facial paralysis (Ronthal & Greenstein, 2020). It is believed that some cases are caused by viral etiology, such as herpes simplex virus, but over half of all cases have an unknown cause. There is no increase in prevalence in different races or gender, but it seems to occur more often in pregnancy and in diabetic patients (Ronthal & Greenstein, 2020). Bells palsy is thought to be caused by inflammation of the facial nerve at the geniculate ganglion, which can lead to compression and possible ischemia and demyelination; however, the cause of the inflammatory process remains uncertain (Tiemstra & Khatkhate, 2007).
Typically, patients with Bells palsy present with sudden onset, unilateral facial paralysis, including eyebrow sagging, inability to close the eye, the disappearance of the nasolabial fold, and mouth drooping (Ronthal & Greenstein, 2020).
Diagnosis: The diagnosis of Bells palsy is based on criteria including paralysis of the facial muscles, with or without loss of taste on the tongue or altered secretion of the lacrimal and salivary glands (Ronthal & Greenstein, 2020). It is hallmarked by acute onset, sometimes as quickly as within a couple of hours. This patient met all the criteria and had no other neurological deficits. He developed symptoms over the course of 24 hours, and in fact, it was the eye tearing that motivated him to come in. He did not realize he had facial paralysis; he is a single guy and stated that he had not looked in a mirror lately.
Diagnostic testing: CT or MRI imaging is warranted if the physical signs are atypical, if there is progression of symptoms beyond three weeks, or if there is no improvement at four months. There are no laboratory studies for diagnosis; however, there is some evidence that links Lyme disease to Bells palsy, so if the patient had a recent tick bite or is in a high-risk geographical area for Lyme disease, the practitioner should order diagnostic testing for Lyme disease (Tiemstra & Khatkhate, 2007).
Treatment plan: The pharmacologic treatment is short-term oral glucocorticoids. Sometimes antiviral therapy is warranted in cases of severe facial palsy. For this patient, we treated him with Prednisone 60 mg/day for one week. For patients with severe Bells palsy, dual- therapy with valacyclovir 1000 mg TID for one week is indicated.
Referrals: If complete facial function is not achieved by four months, neurology referral may be warranted for further assessment and testing, such as an EMG. Diagnostic imaging would also be warranted in this situation.
Patient education: The course is progressive and self-limiting and usually will peak before three weeks, and usually patients are fully recovered by six months.
Patients diagnosed with Bells palsy need to be assessed for the ability to completely close the eye. All patients should be taught meticulous eye care to prevent corneal injury from the inability to completely close the eyelid. This includes eye drops, artificial tears, and taping the eyelid shut while they are asleep.
Follow-up: Generally, complete resolution of symptoms occurs by two to three months. Any worsening of facial weakness after three weeks or development of any new neurological symptoms such as diplopia, facial numbness, and ataxia should prompt further evaluation and MRI imaging (Ronthal & Greenstein, 2020). Close follow-up is definitely important, especially if symptoms worsen or persist.”
References:
Ronthal, M., & Greenstein, P. (2020). Bells palsy: Pathogenesis, clinical features, and diagnosis in adults. Retrieved from https://www-uptodate-com.proxy.library.maryville.edu/contents/bells-palsy-treatment-and-prognosis-in-adults (Links to an external site.)
Tiemstra, J. D., & Khatkhate, N. (2007, October 1). Bell’s palsy: Diagnosis and management. American Family Physician, 76(7), 997-1002. Retrieved from https://www.aafp.org/afp/2007/1001/p997.html
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