[##]-year-old
[male/female] presents with complaint of [right-sided/left-sided] facial
asymmetry with history and exam consistent with Bell's palsy.
Initial considerations in this patient
included Bell's palsy, cerebrovascular accident CVA), transient ischemic attack
(TIA), trigeminal neuralgia, intracranial mass or hemorrhage, tick paralysis
and the Lyme disease, and other infectious and toxicologic etiologies among
others.
Patient presented with [## hours/days] of
facial asymmetry without other associated neurologic deficits. Patient
noted to have complete [right-sided/left-sided] facial droop and weakness in
the distribution of the facial nerve (cranial nerve VII), specifically
including inability to raise the eyebrow or wrinkle her forehead on the
affected side. Patient reported associated [alteration in
taste/hyperacusis/subjective facial numbness with no objective findings on
exam/retroauricular pain]. Patient noted to have otherwise unremarkable
neurologic exam. Patient [reported/denied] prior similar episodes in the
past. Patient denied any preceding trauma. Doubt significant
intracranial process at this time with no indication for acute imaging.
Given onset of symptoms
[within the past 72 hours/greater than 72 from time of presentation] we
discussed plan for discharge [with/without] Prednisone. We also discussed
plan for discharge with [Valacyclovir/Acyclovir] despite limited evidence of
benefit with no significant associated harm. We also discussed covering
the eye overnight and provided patient with lubricating eye-drops on
discharge. We discussed return precautions and recommended follow up with
primary care provider in [time frame], and the patient demonstrated
understanding and agreement.
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