USMLE Forum Archives - USMLE Step 3 - IM: Neuro, BellS Palsy
IM: Neuro, BellS Palsy
meduploader - 05-14-09 22:45
A 49-year-old man presents to the emergency department with abrupt onset of right facial weakness. He
experienced a respiratory infection 2 weeks ago and has had a dull ache behind the right ear for 2 days.
This morning while shaving, he noticed a drooping of the right side of his face. Neurologic examination
reveals a neuropathy of cranial nerve VII, with complete paralysis of the right upper face and forehead.
Hearing, taste, and sensation are normal, and the other cranial nerves are functioning normally. No rash
or shingles lesions are noted.
Which of the following clinical features seen in this patient suggests a poorer prognosis and would
prompt more aggressive medical treatment (e.g., prednisone and acyclovir)?
meduploader - 05-14-09 22:45
A 49-year-old man presents to the emergency department with abrupt onset of right facial weakness. He
experienced a respiratory infection 2 weeks ago and has had a dull ache behind the right ear for 2 days.
This morning while shaving, he noticed a drooping of the right side of his face. Neurologic examination
reveals a neuropathy of cranial nerve VII, with complete paralysis of the right upper face and forehead.
Hearing, taste, and sensation are normal, and the other cranial nerves are functioning normally. No rash
or shingles lesions are noted.
Which of the following clinical features seen in this patient suggests a poorer prognosis and would
prompt more aggressive medical treatment (e.g., prednisone and acyclovir)?
The correct answer and explanation will be available after you answer.
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#15
Re: IM: Neuro, BellS Palsy conym5 - 04-11-10 08:39 A course of corticosteroids and acyclovir may hasten recovery and is appropriate for patients with clinical features portending a poorer prognosis.
#18
Re: IM: Neuro, BellS Palsy babbu5508 - 05-25-10 03:22 My answer is: d.
Prednisone works as an anti-inflammatory by its effect on immune cells. It acts as an immuno-suppressant, inhibiting the secretion of cytokines. The result is that antibody production is suppressed, and the inflammatory process is slowed and weakened, quickly reducing the inflammation compressing the nerve.
#22
Re: IM: Neuro, BellS Palsy babbu5508 - 09-30-10 15:33 Indicators of poor prognosis in Bell's palsy
Complete facial palsy
No recovery by three weeks
Age over 60 years
Severe pain
Ramsay Hunt syndrome (herpes zoster virus)
Associated conditions—hypertension, diabetes, pregnancy
Severe degeneration of the facial nerve shown by electrophysiological testing
#31
Re: IM: Neuro, BellS Palsy sudha2015 - 03-31-11 00:41 My answer is: d.
while shaving, he noticed a drooping of the right side of his face. Neurologic examination
reveals a neuropathy of cranial nerve VII, with complete paralysis of the right upper face and forehead.
Hearing, taste, and sensation are normal, and the other cranial nerves are functioning normally. No rash
or shingles lesions are noted
#32
Re: IM: Neuro, BellS Palsy babbu5508 - 03-31-11 11:59 In patients presenting with incomplete facial palsy, where the prognosis for recovery is very good, treatment may be unnecessary. Patients presenting with complete paralysis, marked by an inability to close the eyes and mouth on the involved side, are usually treated, some of them with smile surgery. Early treatment (within 3 days after the onset) is necessary for therapy to be effective. Steroids have been shown to be effective at improving recovery while antivirals have not.
#34
Re: IM: Neuro, BellS Palsy humararafiq - 05-17-11 06:20 My answer is: d.
associated with poor prognosis
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