Bell’s palsy is the abrupt paralysis of the facial nerve (cranial nerve 7, CN7), resulting in an inability to control facial muscles on the affected side. A common condition, Bell’s palsy has an annual incidence of 11-40 cases per 100 ,000 population. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement, psychological trauma, and facial pain.
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
Top medicine articles for November/December 2012
Here are my suggestions for some of the top articles in medicine for November/December 2012:The Smartphone in Medicine: A Review of Current and Potential Use Among Physicians and Students http://buff.ly/THrvOA
Shocking News: Intraaortic Balloon Pumps May Not Help in Myocardial Infarction with Cardiogenic Shock http://buff.ly/QVzggF
What Your Breath Reveals: Each Patient Has a Unique Breath 'Fingerprint' That Doctors Could Use to Diagnose http://buff.ly/Ravmkd
Rilonacept for Colchicine-Resistant or -Intolerant Familial Mediterranean Fever http://buff.ly/QWJV76
Lowering LDL levels with statin reduces major vascular events regardless of baseline risk http://buff.ly/QWKuxU
Radical prostatectomy and observation did not differ for mortality in localized prostate cancer http://buff.ly/QWLbqM
The Mini-Cog had sensitivity similar to the longer 3MS for detecting cognitive impairment or dementia http://buff.ly/PQkDwL
Risk stratification schemes predict ischemic stroke and bleeding in AF - CHA2DS2-VASc score had 100% sensitivity but only 6% specificty http://buff.ly/QWLu4Z
Deep-Brain Stimulation for Parkinson’s Disease - NEJM summary http://buff.ly/QWNIkR
Update on the management of chronic kidney disease - AFP 2012 http://buff.ly/PQlEol
Chronic fatigue syndrome: diagnosis and treatment - 2012 update from AFP http://buff.ly/QWOePV
Diagnosis and treatment of acne - 2012 AFP update http://buff.ly/QWOmit
Why Some Physician Practices Are Wildly Successful - Medscape http://buff.ly/RFD3Nc
"End-run" lawsuits can blindside physicians. Administrative claims against doctors are likely to rise under the Affordable Care Act - amednews http://buff.ly/S6KU9a
Patients who read doctor notes feel more in control of their health http://buff.ly/RgGPPg
Older patients join crowd consulting "Dr. Internet" http://buff.ly/PNeD7Y
Doctors follow own advice for healthy living http://buff.ly/QYHPDY
The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.
Best of Medical Blogs - weekly review and blog carnival
The “Best of Medical Blogs - weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.Medical care is not the same as customer service
From the cardiologist Dr. John M: “Just say no to linking patient satisfaction with dollars. On a list of well-meaning but really dumb reform ideas, linking compensation of hospitals (or doctors) to patient satisfaction scores ranks near the top. Let me tell you why I think this way. It involves an important baddie—overtreatment. Medical care is not the same as customer service.” http://buff.ly/Vbyjig
Dr. Wes: Like food, we need a slow movement in medicine: Basic. Organic. Local. Personal. Real. http://buff.ly/V0XHXP
Every day is an adventure at Unity Farm
From a Boston hospital CIO who has branched out into farming: "Every day is an adventure at Unity Farm. You never know what interpersonal dynamics will develop with the alpacas, llama, guineas, chickens, and dogs. You never know who will squabble, who will have an injury/illness, and who will develop new behaviors. If it wasn't for the rigors of being a CIO, I could spent the day watching the events of the barnyard - far more interesting than Fox News or CNN." http://bit.ly/UllxPp
The message might be disturbing to you. Maybe we aren't born to run? From the cardiologist Dr. John M: http://buff.ly/YvIu7B
Green tea may be a 'brain booster' - NHS blog reviews the evidence http://buff.ly/YzA6nq
Dr. Wes: Politics in Major Medical Journals http://buff.ly/V58IHB
Recipe for health: cheap, nutritious beans - from Harvard health blog: http://buff.ly/Yyj216
The longevity of a rock singer
Here is Ian Gillan (age 67) from Deep Purple in a recent interview:
You have been screaming rock music for over 40 years. How do you do it?
I think it’s quite natural, I do a lot of it, and so I keep myself fairly fit. My mates who were singers they quit to enjoy their success or raise families and they didn’t continue. Then they tried to come back years later but it was very difficult because vocal cords, unlike guitar strings, are unforgiving, you can’t change them. So I think I’ve been singing all my life, and therefore I’m pretty much fit, so to speak. Most things are within my scope, I sing pretty naturally so it’s not a strain, never has been.
Here is Deep Purple with Maybe I'm a Leo, Mainz, Germany, July 2011:
This is the same band 40 years ago, in 1972:
I have been to two concerts of Deep Purple, the last one was in June 2011 and it was quite impressive. The audience age ranged from 5 to 75 and everyone rose to their feet to the sound of Smoke on the Water.
Here is Mick Jagger on staying fit: "You watch what you eat, you exercise, you have a bit of fun. You keep on going forward. Don’t stop. Do what makes you happy. Don’t look at the clouds of tomorrow through the sunshine of today. That’s it."
Why aging rock stars still tour: "Once the lights go down and the crowds roar, something magical happens. All your aches and pains go". -- Rick Parfitt: Status Quo have to keep rocking to pay the bills | Music | Entertainment | Daily Express http://buff.ly/1gxTM5G
References:
Deep Purple but no blues: US legends top Dubai jazz festival line-up | Al Bawaba http://buff.ly/V520RZ
Mick Jagger's new supergroup with Joss Stone and Dave Stewart. DailyMail.
Redefining age 65 - when your job description is "rockstar"
You have been screaming rock music for over 40 years. How do you do it?
I think it’s quite natural, I do a lot of it, and so I keep myself fairly fit. My mates who were singers they quit to enjoy their success or raise families and they didn’t continue. Then they tried to come back years later but it was very difficult because vocal cords, unlike guitar strings, are unforgiving, you can’t change them. So I think I’ve been singing all my life, and therefore I’m pretty much fit, so to speak. Most things are within my scope, I sing pretty naturally so it’s not a strain, never has been.
Here is Deep Purple with Maybe I'm a Leo, Mainz, Germany, July 2011:
This is the same band 40 years ago, in 1972:
I have been to two concerts of Deep Purple, the last one was in June 2011 and it was quite impressive. The audience age ranged from 5 to 75 and everyone rose to their feet to the sound of Smoke on the Water.
Here is Mick Jagger on staying fit: "You watch what you eat, you exercise, you have a bit of fun. You keep on going forward. Don’t stop. Do what makes you happy. Don’t look at the clouds of tomorrow through the sunshine of today. That’s it."
Why aging rock stars still tour: "Once the lights go down and the crowds roar, something magical happens. All your aches and pains go". -- Rick Parfitt: Status Quo have to keep rocking to pay the bills | Music | Entertainment | Daily Express http://buff.ly/1gxTM5G
References:
Deep Purple but no blues: US legends top Dubai jazz festival line-up | Al Bawaba http://buff.ly/V520RZ
Mick Jagger's new supergroup with Joss Stone and Dave Stewart. DailyMail.
Redefining age 65 - when your job description is "rockstar"
Top medicine articles for November 2012
Here are my suggestions for some of the top articles in medicine for October-November 2012:Medical licensure: State lines pose daunting barriers - amednews. 20% of U.S. physicians hold medical licenses in multiple states http://buff.ly/T90VNP
“There is a much better opportunity to find a smoking gun" through EMR, says malpractice attorney http://buff.ly/PZP8hT
Avocado Sales Are Rising, as Consumers Buy Into the Fruit as a Source of 'Healthy Fats' - WSJ http://buff.ly/P4Cvz3
Will meaningful use spur growth of patient portals? Stage 2 of meaningful use rules require that 5% of a physician’s patients access their records online http://buff.ly/NxtVvs
In New York, Poor Smokers Spend 25% of Income on Cigarettes http://buff.ly/PZRCwN
Facing anti-malaria nets, mosquitoes alter habits by changing their hours of "peak aggression" http://buff.ly/PZRVrc
"Sonic Hedgehog Is Neuroprotective in the Cavernous Nerve with Crush Injury". Not your everyday headline http://buff.ly/PZTmpK
Monthly administration of 100 000 IU of vitamin D did not reduce the incidence or severity of URTIs in healthy adults http://buff.ly/PNdxo8
Venous leg ulcers can be healed with a spray formulation of allogeneic neonatal keratinocytes and fibroblasts http://buff.ly/PNdOaB
Social media is an efficient and effective method for physicians to keep up-to-date http://buff.ly/TEHaxW
The role of aldosterone receptor antagonists in the management of heart failure: An update http://buff.ly/PNgYv7
Immune thrombocytopenia in adults: An update http://buff.ly/PNh6Lb
Vitamin D supplements do not prevent or reduce the severity of colds in adults without a frank vitamin D deficiency http://buff.ly/QNdpIc
Gout Guidelines Issued http://buff.ly/PNkO7E
The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.
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