Bell’s palsy

Caught recently in a NYT Magazine story on medical diagnosis (a regular series in the magazine) in which one of the potential diagnoses was Bell’s palsy (the patient turned out to be suffering from Lyme disease). Ah, I have personal history with Bell’s (as it’s sometimes referred to, in truncated form).

On the condition, from Wikipedia:

Bell’s palsy is a form of facial paralysis resulting from a dysfunction of the cranial nerve VII (the facial nerve) causing an inability to control facial muscles on the affected side. Often the eye in the affected side cannot be closed. The eye must be protected from drying up, or the cornea may be permanently damaged resulting in impaired vision. In some cases denture wearers experience some discomfort. The common presentation of this condition is a rapid onset of partial or complete paralysis that often occurs overnight.

A photo of Bell’s palsy on the right (with drooping on the left side of the photo, which is of course reversed):

First event: Jacques. From my man Jacques’s brief medical history:

early 1992, Bell’s palsy on the left appears suddenly (and, atypically, never passes away); resultant inability to close left eye, ultimately threatening the cornea in this eye and eventually requiring surgery

It took a little while to be sure of the diagnosis, since Jacques had so many neurological conditions going on at the same time.

Afterwards, I irrigated his eye several times a day with liquid tears, but it was not enough. So eventually a surgeon inserted a small weight in his left eyelid — a very cool bit of minor surgery, at which I assisted — and the threat of blindness was averted.

Second event: me. Some years later, after Jacques had died and I was alone, I woke up one morning drooling some. I paid little attention to that — hey, people sometimes drool a bit in sleep — until I went to the bathroom and saw myself in the mirror: face drooping on the left. I looked like a classic right-side stroke patient (with symptoms on the left side of the body).

But no panic. I knew enough about both stroke and Bell’s palsy to realize that this was just Bell’s — annoying, but not serious. Two considerations: first, the symptoms were facial, with no involvement of other parts of the left side of my body (in particular, no left-arm or left-leg weakness; except for the facial droop, the left side of my body worked just fine); and second, there was no cognitive impairment, as I checked by, among other things, talking to myself for a little while, to reassure myself that I had no aphasic symptoms (and, of course, I was thinking clearly enough to reason through a quick diagnosis).

So I didn’t call 911, but merely waited until my doctor’s office opened and I could ask for an immediate appointment, explaining that I had just experienced the sudden onset of Bell’s palsy but wanted to check things out with my doctor. Got an appointment right away, my doctor appreciated my reasoning, he checked for other left-side symptoms and for cognitive impairment, and sent me on my way with sympathetic and soothing words.

Alas, I had a crucial departmental faculty meeting that day, concerning the progress of our graduate students, so I couldn’t just hole up at home. I assured my colleagues that, despite appearances, I was just fine. By the end of the day, I’d gotten notes from a number of colleagues who’d had Bell’s; I was impressed by how common Bell’s seemed to be, and variously soothed and alarmed by the stories: sometimes it passed away in a few days, sometimes it persisted for many months.

(It turns out that there’s a Ranker posting on “31 Celebrities Who Have Had Bell’s Palsy”: George Clooney, Pierce Brosnan, Sylvester Stallone, Katie Holmes, Roseanne Barr, and more.)

My own Bell’s passed away in a couple of days.

Differential diagnosis requires distinguishing Bell’s palsy from not only stroke but also herpes zoster (viral) infection and, yes, Lyme disease. The ultimate causes of Bell’s seem to be poorly understood. Treatment with corticosteroids, especially prednisone, can speed recovery, but my doctor and I decided together not to go this route, because I had a history of very bad reactions to prednisone.

One Response to “Bell’s palsy”

  1. Jack Hoeksema Says:

    Bell’s is a bit scary. It comes totally unexpected and there is nothing the doctor can do about it. I had it in 1995 or so, and it lasted several weeks. I had to tape one eye shut at night to prevent it from drying out. I also had the experience that all of a sudden everybody seemed to know somebody who’d had it.

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