Bell’s Palsy: The Daily PANCE Blueprint

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Bell's Palsy: The Daily PANCE Blueprint

A 50-year-old male with a history of hypertension presents to your clinic complaining of acute onset of weakness on the right side of his face that has lasted the past few days. He said he had gone hiking about a month ago up in Vermont. On physical exam, you note unilateral weakness of the right side of his face with loss of the right nasolabial fold. The right eye does not completely close. Which of the following is the most likely diagnosis?

A. Amyotrophic lateral sclerosis
B. Transient ischemic attack
C. Cranial nerve V palsy
D. Myasthenia gravis
E. Bell's palsy

Answer and topic summary

The answer is E. Bell’s palsy

Bell’s palsy (aka facial nerve palsy) is the most common type of peripheral facial paralysis. Onset is usually acute. Clinical features include eyebrow sagging, inability to close the eye, drooping on one corner of the mouth, and disappearance of the nasolabial fold. MRI of the brain with gadolinium with sequence to assess the facial nerve is the preferred diagnostic test. Electrodiagnostic tests are rarely needed. A work-up for an underlying disorder should be done, as many things can cause Bell’s Palsy (e.g., Herpes simplex, herpes zoster, Lyme disease, COVID, or autoimmune diseases). About 60% of cases recover without treatment.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Neurology ⇒ Cranial Nerve Palsies => Bell's Palsy

Also found on PAEA Family Medicine, Internal Medicine, Emergency Medicine, and Pediatric Rotation EOR topic list

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