provement shown ( risk ratio 0.61 , 95 % confidence interval 0.39 to 0.97 , n = 1315 ) when the viral medication was combined with an oral steroid regimen compared to using steroids alone ( Baugh et al ., 2013 ; Gagyor et al ., 2015 ).
Differential Diagnoses
The signs and symptoms of someone with BP mimic many medical conditions causing neurological deficits ( Glober et al ., 2016 ). They include sepsis , otitis media , stroke , seizure , intracranial hemorrhage , transient ischemic activity , Lyme disease , central nervous system lesions , hypoglycemia , leprosy , shingles , neoplasms , and head trauma . With these in mind , it would be wise to heed the warning of Sir Terence Cawthorne ( 1965 , p . 494 ) who cautioned , “ All that palsies is not Bell ’ s .”
Treatment and Management Options
Acute onset of BP is scary and worrisome for patients . Efforts should be made to reduce anxiety and reassure the patient while explaining all aspects of their care . Initial treatment and management of BP centers around rapid diagnosis and considering more sinister life-threatening afflictions requiring timely action ( i . e ., stroke or blood glucose issues ; Glober et al ., 2016 ).
An acute diagnosis of BP by physicians or advanced-level providers is primarily based on the clinical physical examination , blood glucose level , and patient interview . According to Frock and McCaffrey ( 2005 , p . 60 ), BP is a
“ diagnosis of exclusion ” where about 90 % of cases can be diagnosed without expensive diagnostic tests .
Although guidelines are presented in this article , it is important to note that “ guidelines are not mandates and do not and should not purport to be a legal standard of care ” ( Baugh et al ., 2013 , p . 662 ). Clinicians should use their best judgment in treating patients with a combination of their formal training , institutional protocols , published guidelines , and evidence-based research .
Rule Out a Stroke
Hospital staff can assess the nervous system through a physical exam and the use of the NIHSS . With this , they can uncover deficits that indicate a stroke or known causes of facial paralysis . The NIHSS is the most common evidence-based hospital stroke scale in the United States ( Glober et al ., 2016 ). Care should be taken to ascertain whether there is an altered level of consciousness and whether motor deficits below neck level exist . If so , stroke or other conditions cannot be ruled out ; emergent stroke protocols may need to be implemented .
Check Blood Glucose
Hyperglycemia and hypoglycemia can impersonate both a stroke and BP ( Glober et al ., 2016 ). A diagnosis cannot be definitively made until the blood glucose is within normal limits .
Are CT Scans and Blood Work Necessary ?
Once a clinical diagnosis of BP is made at the bedside , many clinicians will opt for a head CT scan and routine blood work . However , clinical practice guidelines published by the American Academy of Otolaryngology- Head and Neck Surgery Foundation ( AAO-HNSF ) discourage routine imaging or blood work for patients with acute onset of BP ( Baugh et al ., 2013 ; Gilden , 2004 ). An exception to this is performing Lyme disease blood work in areas pervasive with that disease , such as Pennsylvania ( Baugh et al ., 2013 ). Other considerations include the benefit of the tests may not be cost-effective to the patient and hospital and the risk of over-radiating patients if not medically necessary ( Baugh et al ., 2013 ).
These tests may not assist in reinforcing the diagnosis of BP . Despite the AAO-HNSF guidelines , many clinicians still perform CT scans to look for skull fractures and deformities , brain tumors , aneurysms , bleeding , and infarction . This article does not imply that performing a CT scan is inappropriate . It is simply to inform readers of the recommendations given by the AAO-HNSF . Again , providers should use best clinical judgment along with institutional protocols to guide them .
Carotid Ultrasound Exam
If the clinician makes a clinical diagnosis of BP , a carotid ultrasound exam should be offered to the patient . The offer and acceptance / refusal of the exam should
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