Re: serious question

Robert CLS, MT(ASCP) wrote:
David Rind wrote:

paul_r wrote:

I went to the doctor and it turned out to be bell palsy...they put me
on valtrex and some steroid...so i should be fine

Good to know. Ramsay Hunt (the suggested diagnosis that caused some
debate here) is a form of Bell's Palsy caused by varicella-zoster virus.
It typically hurts more than other forms of Bell's Palsy which is what
caused me to suspect the diagnosis. With Ramsay Hunt, there should be
vesicles visible in the ear canal, so if they did not see these it was
likely more run-of-the-mill Bell's Palsy rather than Ramsay Hunt.

--
David Rind
drind@xxxxxxxxxxxxxxxxxxxxx


I was thinking Bell's Palsy also but didn't think it was because of the
pain he mentioned.
So much for my expertise in neurology although it isn't a lab
involvment situation.

There are definitely reports of Bell's Palsy presenting with pain -- the involved nerve does provide some sensory innervation in and around the ear so it makes sense that there could be pain with inflammation of the nerve.

That said, I always wonder how anyone can be sure that it is not due to varicella-zoster virus (Ramsay-Hunt) since presumably some cases would not have vesicles. Maybe there are serologic studies that have confirmed cases of painful Bell's Palsy without a change in antibodies to VZV....

In the end, nearly all such patients with Bell's Palsy end up getting treated with an antiviral agent that has activitiy against VZV (even though there are conflicting data on benefits), so it probably doesn't really matter whether the etiologic diagnosis is made or not.

--
David Rind
drind@xxxxxxxxxxxxxxxxxxxxx
.

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