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  #1  
Old 08-01-2013
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Question Child with facial weakness after viral illness!

Two weeks after a viral illness, a 9 year old boy presents to the clinic with a complaint of several days of weakness of his mouth. In addition to the drooping of the left side of his mouth, you note he is unable to completely shut his left eye and frown his forehead. His smile is asymmetric, but his examination is otherwise normal. Which of the following is the most likely diagnosis?

A. Guillain-Barre
B. Botulism
C. CVA
D. Medulloblastoma
E. Central Facial Palsy
F. Bells Palsy
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  #2  
Old 08-01-2013
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Id pick F!
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Old 08-01-2013
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Id pick F!
Explain why!
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1.- Two weeks after a viral illness, a 9 year old boy presents to the clinic with a complaint of several days of weakness of his mouth. In addition to the drooping of the left side of his mouth, you note he is unable to completely shut his left eye and frown his forehead. His smile is asymmetric, but his examination is otherwise normal. Which of the following is the most likely diagnosis?

A. Guillain-Barre
B. Botulism.
C. CVA.
D. Medulloblastoma.
E. Central Facial Palsy.
F. Bells Palsy.
Guillain barre - Ascending paralysis plus absent reflexes after a C.Jejuni infectious diarrhea .

Botulism - Descending paralysis after some can food, or honey.

CVA - would have more problem than just a facial n palsy.

Medulloblastoma - would have cerebellar problem aswell - esp cerebellar vermis problems.

Central palsy - Would only have downward slanting of corner of mouth. in this case there is also problems of shutting eyelids and forehead problems.

Bells palsy - typical after viral infection and also peripheral facial nerve palsy.
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Explain why!
Please post the answer for ppl to see! thanks
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Old 08-01-2013
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Correct Answer

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Please post the answer for ppl to see! thanks
Im waiting for more people to reply, specially Kais_MD he wanted Peds and Ob/GYN questions, which I will be posting from time to time. Ill give it a couple of hours before posting the answer with explanations, I will tell you though, your reasoning is excellent
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Old 08-01-2013
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this is typical for bell's palsy..go with F
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ofcourse bells palsy with the history of the viral illness and both the lower and the upper face being involved in this case....treatment would be conservative like eye drops and patch over night with prednisone and it will resolves eventually.....

cmon XpaezX something harder lol
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The answer is F.
Bell's Palsy is an acute, unilateral facial nerve palsy that begins about 14 days after a viral infection. Although the exact pathophysiology is unknown, reactivation of herpes simplex or Varicella-zoster virus seems to be the most common cause;. On the affected side, the upper and lower face are paretic, the mouth drops and the patient cannot close the eye. Treatment consists of moisture on the affected eye to prevent keratitis. Complete resolution occurs in about 85% of cases.

It is funny how NO ONE from you as explained why this is peripheral and not central, dont come here saying because of the symptoms, but give an actual reasoning as to why.

This question is easy but it will be asked on the step, probably not as a diagnosis type but more like management or by explaining the pathophysiology.

Until you tell me the exact mechanism I wont consider this question as correct , explain everything.
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The answer is F.
Bell's Palsy is an acute, unilateral facial nerve palsy that begins about 14 days after a viral infection. Although the exact pathophysiology is unknown, reactivation of herpes simplex or Varicella-zoster virus seems to be the most common cause;. On the affected side, the upper and lower face are paretic, the mouth drops and the patient cannot close the eye. Treatment consists of moisture on the affected eye to prevent keratitis. Complete resolution occurs in about 85% of cases.

It is funny how NO ONE from you as explained why this is peripheral and not central, dont come here saying because of the symptoms, but give an actual reasoning as to why.

This question is easy but it will be asked on the step, probably not as a diagnosis type but more like management or by explaining the pathophysiology.

Until you tell me the exact mechanism I wont consider this question as correct , explain everything.
its because of damage to the facial nerves which in turn causes parlaysis of the muscles its associated with. The reason this happens is because of idiopathic inflammation which compresses the nerve when it passes through the temporal bone. So we just have to wait for the inflammation to come down and thats why prednisone is given so it can help ease the inflammation. All the functions are restored once the compression is relieved
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Idea!

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Originally Posted by Kais_MD View Post
its because of damage to the facial nerves which in turn causes parlaysis of the muscles its associated with. The reason this happens is because of idiopathic inflammation which compresses the nerve when it passes through the temporal bone. So we just have to wait for the inflammation to come down and thats why prednisone is given so it can help ease the inflammation. All the functions are restored once the compression is relieved
The reason as to why this is peripheral and not central lies in the basic principle of anatomy, when you have a central insult to the facial ganglion you will be able to frown the forehead because 20% of the forehead muscle innervation, specifically the corrugator supercillii muscle (aka the frowning muscle) comes from the contralateral side, whereas a damage the peripheral facial nerve will cause a complete loss of the frowning ability because the peripheral nerve obviously comes from one (and affected) side only.

Inflammation and all that is cool but the actual differentiation between central and peripheral facial palsy is this one, this is asked on step 3, step 2 ck, Neurology/neurosurgery boards, Internal medicine boards etc, the reason is simple, if you miss a central cause of facial palsy (tumor, stroke) you will be liable.

I will post another question later
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Originally Posted by XpaezX View Post
The reason as to why this is peripheral and not central lies in the basic principle of anatomy, when you have a central insult to the facial ganglion you will be able to frown the forehead because 20% of the forehead muscle innervation, specifically the corrugator supercillii muscle (aka the frowning muscle) comes from the contralateral side, whereas a damage the peripheral facial nerve will cause a complete loss of the frowning ability because the peripheral nerve obviously comes from one (and affected) side only.

Inflammation and all that is cool but the actual differentiation between central and peripheral facial palsy is this one, this is asked on step 3, step 2 ck, Neurology/neurosurgery boards, Internal medicine boards etc, the reason is simple, if you miss a central cause of facial palsy (tumor, stroke) you will be liable.

I will post another question later
i will give you that one even though i knew lol...Central vs peripheral and their presentations. Good one
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Old 01-06-2014
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only BOTULISM, GBS & BELLS PALSY are peripheral palsies in the options.
botulism has a history, GBS is an ascending infection.
So Bells palsy is the answer, post viral infection, possibly varicella zoster or EBV.
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