Designed by Mohammad saleh Moallem

1. Clinical manifestations
Mr. Bell
A 35 years old office worker
Case flowchart
Who has a sedentary lifestyle
History & Origin Recurrence of disease Hospitalization Medical Examination Diagnose Treatment
Viral infection
Affect facial nerve
He has a habit of setting AC at
very low temperatures and he
never does exercise after work.
Dry mouth
Excessive drinking
Increased urination
loose weight (2.5 kg in 1 month)
The next morning some
problems appear on him.
Mouth tilted to one side &
felt a pain in his right ear
He was in panic asked the company
for leave and rushed to the hospital
Uncontrolled tearing
Mouth had been tilted to one side
Feeling pain in right ear
Water leakage from right part of mouth
At Emergency department
The result of neurological physical examination:
Right frontal lines were slightly shallow, the right eye was not
completely closed. The right nasolabial groove became shallow, the
mouth corner was drooped to the left when showing teeth, the right
cheek cannot be bulged because of air leaking, and the tongue was
in the center when it was stuck out.
Then the neurologist doctor made a detailed examination
again and found that Mr. Bell had no special medical history.
After admission, he was treated with low-dose hormones,
vitamin B, Physiotherapy, and blood glucose control
Preliminary diagnose
Then
during
the
patient's
hospitalization
On 2nd
day of hospitalization:
1. MRI: no obvious abnormality was found on
the plain scan.
2. The electromyography: Damage to the right
facial nerve.
Blood test & Biochemistry
WBC: 6  109
/L
PLT: 213  109
/L
Na+
: 142 mmol/L
K+
: 3.6 mmol/L
Hb: 123 g/L
Cl-
: 110 mmol/L
Glu: 16 mmol/L
Physical Examination at neurology ward
The neurologist made a detailed
examination again; beside to that, the
results are shown at left.
Emerge. biochemistry examination
MRI
No obvious abnormality
was found on the plain
scan. (Normal facial n.)
Electromyography
The electromyography showed
damage to the right facial nerve.
New sign and symptoms
Light red rash on his right external auditory canal
with some blisters.
Could be VZV infection
Differential
Diagnose
Ramsy hunt
syndrome
In order to make final
diagnosis we should take
PCR test to confirm the
presence of viral infection.
Facial Electromyography
Viral infection
Affect facial n.
Acyclovir
IV drip
Acyclovir is in a class of antiviral medications.
Acyclovir
It is an antiviral medication. It is primarily
used for the treatment of herpes simplex
virus infections, chickenpox, and shingles.
Here in this patient the doctor used this drug
to treat shingles.
First-line therapy
After admission, he was treated with low-
dose hormones, vitamin B, Physiotherapy,
and blood glucose control.
PBL2-2
Flowchart
March, 2022
Teacher
Prof. Zhang Yan 张艳老师
Students
默汉 莎格
阿朵 艾里克
索菲雅 娜迪
哈沙 约书亚
李明
Saleh Shaghayegh
Safiyyah
Razy AliAkbar
Abubakar
Nadia
JJ
Harsha
瑞立
Raehilen
Medical history of patient gained by
doctor and Dr. ordered physical
examination, routine blood test,
biochemistry test and a Cranial CT.
After checking the results doctor
sent him to Neurology ward
Bell’s palsy
Is facial paralysis or weakness on
one side of the face and it results
from damage to the facial nerve
(the 7th cranial nerve).
On 3rd
day of hospitalization:
The doctor found that there was a light red rash
on his right external auditory canal with some
blisters. The patient felt a sound echo in his right
ear, and the foods were tasteless.
HIGH
NORM
Cranial CT scan
No abnormality on
the plain scan.
Na+
: 142 mmol/L
K+
: 3.6 mmol/L
Cl-
: 142 mmol/L
Glu: 3.6 mmol/L
HbA1c: 8%
N
HIGH
Facial EMG recordings can be
obtained by attaching small surface
electrodes on the skin over the site
of the muscles that play a role in the
facial expression of interest.
Anatomy of facial nerve
The patient felt a sound echo in his right ear.
The patient complains of tasteless foods!
Ramsay Hunt syndrome is
caused by at varicella-
zoster virus (VZV) VS with
Bell's palsy which is facial
paralysis without rash.
After one week of taking Acyclovir, Mr.
Bell got better and was discharged.
HbA1c with higher than 6.5%
has the risk for developing
type 2 diabetes. The Glu
level is also high which
confirm diabetes.
To remember the branches of the facial
nerve, you can use the following
mnemonic:
standing for:
1. Temporal
2. Zygomatic
3. Buccal
4. Marginal mandibular
5. Cervical branches.
Day
2
Day
1
Day 3