Oct 20, 2010

Bell's Palsy

Oh Me Oh My! Would you look at that! Bell's Palsy, I got's it, don't want it, and truly hope its nothing worse!

What is Bell's Palsy?
Well it is the dysfunction of the 7th Cranial nerve also known as the Facial nerve. While the true cause is unknown for Bell's Palsy, it is is believed to be the inflammation of the Facial nerve as it enters through a small opening beneath the ear. This then seems to compress the nerve and effectively inhibit it from functioning. It is typically associated with a viral infection and can be seen with Upper Respiratory Infections.

How does Bell's Palsy Present?
Well of course every one is different, and presentation also will be different. It presents much like I think a stroke could, Facial paralysis of one side with abnormal smile, inability to raise eye brows evenly and the inability to blink the affected sides eye spontaneously. As for me though it started with a generalized numbness of the left side of my face. It felt as though I had facial swelling around my eye along with pressure behind my left eye, though no trauma had been incurred. I felt that my face was bloated with increasing tingling but it would come and go. I began to notice that I had a metallic taste in my mouth and food tasted strange, actually it lacked taste all together. I shrugged it off thinking it was all associated with my lack of sleep from taking care of my ill Son. Late Thursday night I noticed that I had total tingling sensation on the left side of my face, along with the feeling like I had just been given Novocaine on the left side of my upper jaw.

When did you realize something was wrong?
Let me tell you drinking from a straw (which is invokes childhood joy in me) was impossible! I mean the simple act of a proper seal and suctioning of liquid through a plastic tube felt like 11th grade Chemistry chapter on Organic Chemistry all over again. I mean my son has mastered the dynamics of ratio control needed to suck juice up a straw and I was having extreme difficulties with it. This is when I became scarred but tried so hard to not let on to my Wife. I knew something was wrong, I went upstairs to the bathroom and looked into a mirror for the first time that evening. I took a long hard look at my face wondering what could be wrong. I smiled as to laugh it off and tell myself it was in my head. That's when I realized that my smile was exactly like that in the picture on Wikipedia. I went back down stairs and pointed it out to my wife, I even had my wife preform a modified Cincinnati stroke scale on me much like I would preform to a patient who had a similar complaint in the field. I doubted I was having a stroke simply because my affected area was only in my face and had no other coordination issues of the arms or legs or increase of confusion. I felt confident that I was going to live and still thought it would get better if I got a good nights sleep. It was suggested by my wife about Bell's Palsy just as we fell asleep, who has seen it in her line of work with the elderly.

Course of action?
Well in my case, I woke up Friday morning and found to still be having the symptoms. So I headed to the walk-in, where I was diagnosed and given a course of Steroids and Anti-Viral medication's. A follow up with my Primary Doctor was scheduled a few days later. Now much of the literature I have been reading has conflicting ideas as to the proper course of treatment whether or not the Anti-Viral's are effective. There is even a stance that with out any treatment the affects will begin to return to normal all by itself. Much of the reading has said a return can be expected in a months time. I'm no doctor and am not to familiar with Bell's Palsy to begin with and trust the course of treatment currently.

Insight for EMS
Its sudden onset is startling and can present much like a stroke, working your patients anxiety up. Slurred speech, drooping facial features, drooling and abnormal smile will be noted though no further motor defecates are seen. This can still be the beginning of a stroke and by no means an all inclusive assumption whether or not it is Bell's Palsy versus a stroke. Bell's Palsy is only a diagnosis of exclusion, meaning that after all other possibilities have been ruled out can its diagnosis be made. Further insight into the case will be needed but in the field its best to apply our base knowledge and work up the patient. The condition is not overly "popular" but in no means rare, effecting roughly 20 in 100,000 or 40,000 people annually in the US. So the instance of seeing it in the field will be limited and often miss treated. Though this is not a bad thing, by all means play it safe and assume that it is a stroke until proven other wise. The reverse side is you assume its Bell's Palsy and found to be a stroke or other neurological problem.

As for me?
I am awaiting my secondary follow up with my primary MD to see where I stand and what, if any, the continual course of treatment will be. In this case, time is what is important to reduce the inflammation of the facial nerve. If no significant change is seen in another two weeks or approaching 3 weeks of onset further testing will be done to determine the extent of whats going on. So as long as I do not see any changes for the worse I will sit and wait.

Be Safe
Ambulance Junkie

1 comment:

  1. Hey Junkie!
    Wish you all the best from across the ocean - hope all works out for you and that Bell's Palsy is the worst it gets!
    And thanks for being brave and open enough to keep us in the loop...