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

By Marie Savard MD

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 proceeded with the examination using the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

The doctor referred Marjorie to a neurologist. The second week, the neurologist did some tests and conferred with Marjorie’s doctor. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“Marjorie’s doctor mentioned the possibility of a brain tumor. Are the doctor and the neurologist still looking for a tumor? My cousin had a tumor called an acoustic neuroma on the nerve that leads from the inner ear to the brain. It was slow growing but eventually my cousin did have facial paralysis that seemed to her to come on suddenly because she hadn’t been aware of the tumor before that. She was told that the chances of facial paralysis with an acoustic neuroma, also known as vestibular schwannoma, were about 4% to 15 %. The tumor wasn’t cancerous, but she had surgery and radiation because pressure from the tumor could have caused hearing loss and balance problems. My guess is that Marjorie might have an acoustic neuroma.”

— Glenda P.

“It’s summer so maybe Marjorie ate some chicken that wasn’t grilled long enough. My husband ate undercooked chicken last year and he got infected with a type of bacteria called campylobacter that led to a condition called Guillain-Barré syndrome. I wasn’t affected because I’m a vegetarian. I didn’t eat the chicken at our barbecue, just the grilled corn on the cob and a three-bean salad. Anyway, my husband did have facial paralysis, but it was on both sides. He also had tingling and paralysis in his arms and legs. Marjorie only has a problem with the left side of her face so she probably doesn’t have Guillain-Barré. I think they should be sure to rule the syndrome out, though. It’s very serious. My husband eventually recovered, but he does still drag his right foot. ”

— Myra R.

“Did Marjorie ever have Botox treatments? My sister went to cheap-o dermatologist who wasn’t really qualified to give Botox injections. The derm gave my sister too much and it spread to her facial nerve. Awful! Thank goodness it did eventually wear off.”

— Diana L.

“Maybe Marjorie has mastoiditis. It’s an infection that spreads from the inner ear to the mastoid bone. We went scuba diving on our vacation last year, and I got a perforated eardrum with cholesteotoma, a benign growth in my middle ear that affected my facial nerve.”

—  Lillian G.

“Marjorie said she hadn’t been exposed to ticks, but my sister who lives on Long Island got Lyme disease from a tick bite she wasn’t even aware of until she had symptoms. It turns out that her dog had tick bites as well. The ticks were in their own backyard! The family lives near a wooded area so my sister suspects that deer come onto their property at night. One of the symptoms of the Lyme disease as it progressed was a type of facial paralysis called Bell’s palsy that sounds like what Marjorie has. Actually, that was pretty much the least of what my sister had to deal with because of Lyme disease. It’s no joke, let me tell you. My sister said the headaches are the worst. She was treated with antibiotics and then the symptoms recurred. She had to start treatment again. I really hope Marjorie doesn’t have Lyme disease!

— Kathy M.

To be continued . . .

Come back to ThirdAge.com next Thursday when the doctor will reveal the actual diagnosis and treatment plan.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.