26F with LMN facial palsy

Hello all this is G Jagadeesh,a eight semester student.This E Log depicts the patient centered approach to learning 

This is an an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.

This E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.

 A 26 year old postpartum female came to the general medicine OPD with chief complaints of

1) Unable to close the lid of right eye six hours prior to the C. Section.

2) deviation of angle of mouth to the left side six hours prior to the C-section

3) Pain over the right half of the Face six hours prior to the C-section

History of presenting illness:

She has under test in section on 6 October 2023

She was apparently a symptomatic six hours prior to the surgery and then she developed the deviation of mouth to opposite side and unable to close her right eye suddenly and then diagnosed to have a lower motor neuron type of Facial nerve paly. she has come to the OP on 17 October 2023.

Obstetrics history:

She is a female of G2, P2, L2

The first pregnancy was uneventful and delivered by Caesar in section and not associated with raising BP during pregnancy

The first baby was healthy born, 2.8 kgs and breastfeed within one hour after the delivery.

Second pregnancy was also uneventful and there is no history of pregnancy induced Hypertension  during all three trimester of pregnancy

But just six hours prior to C-section, she had developed a high blood pressure of 160/90 mm of hg 

Past history:

N/K/C/O DM,HTN,asthma,TB,epilepsy,CAD,CVD

Family history:

Not significant 

Personal history:

She consumes a mixed type of diet and her appetite was normal

Sleep is adequate 

Bowel and bladder movements are regular

No known addictions

General examination:

She is conscious coherent and cooperative

Well built and nourished

Pallor present

No signs of 

Cyanosis

Icterus

Clubbing

Lymphadenopathy 

Pedal oedema

On examination:

Loss of Nasolabial folds

Unable to close right eye lids

Unable to blow the mouth

Deviation of angle of mouth to opposite side 

Systemic examination

CVS:S1and S2heard no murmurs

Respiratory system:

NVBS heard 

Bilateral air entry present

Trachea is central

Bilateral equal chest expansion

CNS:

Normal

No focal neurological deficits

Provisional diagnosis

BELL’s palsy(LMN facial nerve palsy)

Treatment

Prednisolone 30mg for three days

Polybione forte once weekly IM