Solve the Medical Riddle: One Side of Her Face Suddenly Drooped and She Couldn’t Smile or Close Her Eye, Fourth Week

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient reported her symptoms to her PCP. The doctor gave her a complete examination using the components of the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendation

The doctor referred Marjorie to a neurologist. The second week, the neurologist did an electromyology (EMG) test and conferred with Marjorie’s doctor. Last week, we let you know what some people had suggested as possible diagnoses. This week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month

The Doctor Reveals the Diagnosis

Congratulations to Kathy M. who guessed that Marjorie might have Bell’s palsy. That’s the correct diagnosis, although fortunately the cause was not Lyme disease in Marjorie’s case. As often happens, the palsy was idiopathic. That means no known cause was ever determined. However, the cold that Marjorie said she had a few weeks earlier might in fact have been a mild case of the flu. The flu virus can precipitate Bell’s palsy.

The neurologist assured Marjorie that the prognosis was excellent, especially since she had come in right away. The earlier the treatment, the better. He prescribed corticosteroids and antiviral medications. However, not everyone ends up 100% back to normal. Only time will tell, which is very scary and frustrating for patients. Nerve inflammation can take months to a year to get better. In the meantime, since Marjorie can’t close her eye completely even at night, it might dry out or she could scratch her cornea so she needs artificial tear ointment at night but not during the day because it clouds vision. A patch is another possibility.

Marjorie hopes she’ll be one of the lucky ones who is totally curedl fairly quickly. Here’s her story: