Facial Weakness Scenario

68 HR, 16 RR, 98% SpO2, 124/76 BP, 37.5 Temp, 4.8 BM. NEWS 0. The patient is FAST positive on face. There are no other deficits noted on the fast test. What other tests exist to pre-hospital clinicians to help diagnose CVA? 

You notice the patient is manually closing his left eye with his hand as he is having difficulty blinking. The inability to blink is a normal presentation associated with a stroke and is commonly documented as a primary sign/symptom?

After this observation you start to assess the patient further before you rush off querying a stroke. The patients face looks similar to what is pictured. 

The patients eyebrow is dropping, eye relaxed and maintained open and left sided mouth drooping to the side. Outside of the stroke differential, what can this presentation relate more to? 

You suspect Bell’s palsy as the patient has no other associated symptoms and seems patient onset has been progressively getting worse over 12 hours rather than suddenly like an acute stroke. What nerve is responsible for the control of the facial muscles concerned here?

It is the Facial nerve responsible for this patients’ symptoms. What number is this within the 12 cranial nerves?

What associated symptoms of stroke, that are not displayed in Bell’s palsy, should be excluded when making a diagnosis?

One quick examination to initially indicate whether a stroke or peripheral Bell’s palsy is to observe if the patient is able lift their eyebrows bilaterally?

You decide to transfer the patient to hospital to eliminate any risk of stroke or TIA event. Returning later, you follow up on the job and the stroke ward staff confirm that the patient had Bell’s palsy. Within the hospital environment, what treatment options are usually recommended for Bell’s palsy?

The treatment of Bell’s palsy with corticosteroids should be started within 72 hours to promote efficient recovery and a better prognosis?

Bell’s palsy is the most common cause of acute facial paralysis?

Recovery rates vary but how long can maximum recovery take with Bell’s palsy?

What are the potential risk factors/triggers for Bell’s palsy?