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Rose Tyler (Symptoms (Slightly blurred vision, Burning sensation right eye…
Rose Tyler
Symptoms
Slightly blurred vision
Burning sensation right eye
Cannot move right face well
Right side of face feels heavy
Acute onset (two days)
Signs
Right eye tearing
Lower lid lag
Weakness of right side of face
House-Brackmann V/VI
Loss of forehead wrinkles
Loss of nasolabial fold
PMH/PSH
Tonsillectomy, childhood
Adenoidectomy, childhood
Third molar extractions
Labs
Negative Lyme titer - not Lyme
Normal ACE - not sarcoidosis
EMG/ENoG - facial nerve problem
Diagnosis
Bell's palsy
Herpes
Treatment
Lacrilube
Prednisone
Physical therapy
Acyclovir
sero-negative Lyme disease still possible?
Course
Full recovery by three months
Severe synkinesis
Treated with Botox
Social History
Camped in Wisconsin
Otherwise unremarkable