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

“The corticosteroids gave me a ‘moon face’ and I’ve gained some weight, but I’m praying the meds will do the trick. I do wear a patch on my eye at night and use the artificial tears. During the day I just use plain eye wash every now and then. I took a leave of absence for the rest of summer school because I don’t want to freak out my nine-year-old pupils! I still get the creeps when I look in the mirror. Fingers crossed I’ll be pretty much OK by the time school starts again in the fall. If not, I may decide to take the whole year off from teaching. My husband has a good job and we have been better than most at saving for retirement. Writing a children’s book has always been on my Bucket List. Maybe if I had free time, I would finally do it! This could be a blessing in disguise. Other people have problems that are much worse than mine, and of course I could keep teaching if I really needed the money. Still, the idea of a sabbatical year is sounding more and more appealing. We shall see!”

Come back to ThirdAge.com next Thursday when we’ll introduce a new medical riddle!

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.