Case 1 of 2NeurologicLocalized weakness (e.g., Bell palsy)
A 32-year-old male presents to your clinic with a 20-hour history of one-sided facial weakness. He has trouble closing his right eye. He denies any pain but is very distressed about the symptoms, which appear to be getting worse. On examination, vital signs are normal. There is right-sided facial drooping involving the forehead, consistent with a lower motor neuron pattern.
Question 1 of 5
This presentation is consistent with Bell palsy. What pharmacological management options should you offer this patient?
Select 2. (0 / 2 selected)
100%
AHigh-dose intravenous methylprednisolone 500 to 1000 mg daily for 3 days
BValacyclovir 1000 mg PO TID for 7 days; consider adding if paralysis is severe or complete, especially if a viral etiology such as herpes zoster (Ramsay Hunt syndrome) is suspected
CEmpiric antibiotics (for example, amoxicillin)
DBotulinum toxin injection acutely
EPrednisone 60 mg PO once daily for 5 days, then taper over the next 5 days; start within 72 hours of symptom onset for best outcome
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