1/3. Living with lyme disease.The occurrence of lyme disease is rising steadily in the united states. The majority of health care providers are unfamiliar with this complex syndrome. nurses lack accurate clinical information to provide comprehensive nursing care to these patients. The progression of lyme disease is addressed through three stages. Untreated or poorly managed, lyme disease may become a chronic, debilitating illness. The author's personal story is interwoven and serves to highlight the pathophysiology of the disease and the emotional and physical costs to the patient.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/3. Delayed presentation of traumatic facial nerve (CN VII) paralysis.facial nerve paralysis (Cranial Nerve VII, CN VII) can be a disfiguring disorder with profound impact upon the patient. The etiology of facial nerve paralysis may be congenital, iatrogenic, or result from neoplasm, infection, trauma, or toxic exposure. In the emergency department, the most common cause of unilateral facial paralysis is Bell's palsy, also known as idiopathic facial paralysis (IFP). We report a case of delayed presentation of unilateral facial nerve paralysis 3 days after sustaining a traumatic head injury. Re-evaluation and imaging of this patient revealed a full facial paralysis and temporal bone fracture extending into the facial canal. Because cranial nerve injuries occur in approximately 5-10% of head-injured patients, a good history and physical examination is important to differentiate IFP from another etiology. Newer generation high-resolution computed tomography (CT) scans are commonly demonstrating these fractures. An understanding of this complication, appropriate patient follow-up, and early involvement of the Otolaryngologist is important in management of these patients. The mechanism as well as the timing of facial nerve paralysis will determine the proper evaluation, consultation, and management for the patient. patients with total or immediate paralysis as well as those with poorly prognostic audiogram results are good candidates for surgical repair.- - - - - - - - - - ranking = 5.3558592049638keywords = physical examination, physical (Clic here for more details about this article) |
3/3. Bilateral facial paralysis: case presentation and discussion of differential diagnosis.Bilateral facial paralysis is a rare condition and therefore represents a diagnostic challenge. We report the case of a 34-year-old healthy woman with sequential bilateral facial paralysis as a sole manifestation of sarcoidosis. She initially presented with an isolated left sided Bell's palsy without any symptoms to suggest alternative diagnoses. Within a month there was progression to peripheral facial paresis on the contra lateral side, prompting a diagnosis of lyme disease. Her physical examination and chest x-ray did not reveal any clinical evidence of sarcoidosis. After failing to respond to an empiric trial of intravenous ceftriaxone for a presumptive diagnosis of lyme disease, computed tomography scan of the chest was ordered which demonstrated bilateral hilar lymphadenopathy. Bronchoscopic biopsy confirmed a diagnosis of sarcoidosis. The patient then made a complete recovery on steroid therapy. We discuss the differential diagnosis of facial diplegia and focus on the clinical presentation, diagnosis and treatment of neurosarcoidosis.- - - - - - - - - - ranking = 5.3558592049638keywords = physical examination, physical (Clic here for more details about this article) |