2017 Resarch Forum

IM: C-2

Applicant: Aarushi Parekh MD Principal Investigator: Greti Petersen MD

Bell’s palsy: presenting with hemiparesis Aarushi Parekh MD, Ahana Sandhu MD, Greti Petersen, MD

INTRODUCTION

This is the first case report presenting this disease.

PURPOSE A 31year old obese Hispanic female without past medical history has not seen a medical doctor for at least 5 years. She developed left eye twitching, blurred vision in the left eye in, and 40 minutes around lunchtime later felt numbness in the left mouth and tongue with some difficulty chewing without any trouble swallowing. At dinner time, the left tongue was tingling and in the morning she noticed that the left upper and lower face were weak. At about 11 a.m. when driving herself to the ED, she felt her left arm and leg become numb and mildly weak. Upon presentation to the ED, stroke code was called. NIHSS was found to be 5, three for left upper and lower facial weakness, 1 for left leg drift, and 1 for decreased sensation in the left side. She was deemed not a tPA candidate because her symptoms were subacute and had been 24 hours since initiation of symptoms. All imaging of brain and neck were unremarkable. Her lipid panel showed total cholesterol 273 mg/dl and LDL 209 mg/dl. Her liver function test consisted of alkaline phosphate 66 U/L, ALT 86 U/dl, and AST 60 U/L. Her random blood glucose was 200 and hemoglobin A1C 6.5%. Her left arm and leg weakness had resolved by 4-5 pm on the day of presentation to the hospital. The next day in the hospital, she continued to have left upper and lower face weakness, dryness of the left eye, and decreased taste in the left side of the mouth. DISCUSSION There has been a report of patients presenting to Emergency Department who had ischemic stroke being misdiagnosed with Bell’s Palsy. There has also been reports of pontine stroke and pontine hemorrhage being misdiagnosed with Bell’s Palsy. In the future, with a patient presenting with signs mimicking Bell’s palsy, it is important to evaluate for additional cranial neuropathies as well as being cognizant of multiple reports of Bell’s palsy being misdiagnosed. CONCLUSION

Facial palsy should not always be attributed to Bell’s palsy as it is a diagnosis of exclusion.