Morning Distort

By MARTIN A. SAMUELS A 35 year old woman complains of weakness of the right side of her face and pain behind the right ear.  She lives in an urban environment and denies any recent illnesses.  She is not vaccinated against COVID-19 but is COVID negative.  What do you think, I was asked at our Morning Report?  Well, I said, it sounds like a straightforward Bell palsy.  The pain around the ear suggests swelling of the VIIth cranial nerve in the facial canal and the stylomastoid foramen, a very common historical point, I opined; so much so that its absence would make me doubt the diagnosis and make me consider other causes of facial palsy such as sarcoidosis or Borreliosis, though the urban environment argues against that tick born disease.  Then we went around the room, expanding the differential diagnosis (as this exercise is often called) to include tumors of the parotid gland, leptomeningeal metastases and many more.  At one minute before the end of the thirty- minute conference, a photo of the patient was shown.  There was only one problem.  There was no facial weakness, but rather she had a definite Horner syndrome on the right with a smaller pupil and subtle ptosis due to weakness of Muller muscle, a small circular sympathetically innervated muscle that acts as a minor controller of size of the palpebral fissure.  The patient’s pupils were not tested in bright and then dim light, nor was sweating tested because why...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Medical Practice Physicians Martin A. Samuels morning report neurology Source Type: blogs