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Imagine that you are a healthy 40 year old person and one day you wake up with the left side of your face feeling numb and heavy.  You notice, as you eat breakfast, that your tongue is numb and you have lost taste on the left side of your tongue. You answer the phone and your left ear is really sensitive to the sound of the ring and your mother’s voice on the other end of the phone. As you eat, liquids drip out of the side of your mouth. You look in the mirror and you see that your face is drooping on the left and you cannot close your eye on the left. You call your mother again and she thinks you might be having a stroke. She comes over to take you to the urgent care.

Once at the urgent care, the staff quickly admit you and have you assessed. The provider takes a thorough history including whether you are pregnant, or diabetic, or had any tick bites. On the physical exam, the provider notes that your left eye is more open than the right, the left corner of your mouth droops; you cannot raise your eyebrow, or close your eyelid. You cannot elevate your mouth into a smile or pucker. Your blood pressure is normal.

The provider reassures you that this is not a stroke but you have Bell’s Palsy. It is the most common cause of one-sided facial paralysis in the US. It is most prevalent between ages 15 and 45. In most cases the cause is unknown, although herpes simplex is often suspected. Herpes zoster, or “shingles” can cause Bell’s palsy if it is in the ear canal. The history of a tick bite is important because Lyme disease can present itself as Bell’s palsy.

Bell’s palsy is a clinical diagnosis. It can be diagnosed with you medical history and neurological examination. Laboratory tests are not necessary unless the history points to other causes such as Lyme disease.

Treatment is aimed at settling the inflammation and protecting the cornea if the eyelid will not close. The prognosis is usually good and the good news is that you are not having a stroke. To avoid corneal drying, the eye may need to be patched. Lacri-Lube ophthalmic ointment at night and artificial tears during the day help prevent excessive drying. The provider will commonly prescribe a short course of oral prednisone and an antiviral medication, such as, acyclovir.

Most patients recover fully. Recovery begins within 3 weeks and can take 3 to 6 months to fully recover. If the diagnosis is in question then you will be referred to a neurologist.

Melvin Lee MD
Chief Medical Officer, FastMed Urgent Care

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