Facial Drooping in Adolescent

peaches88 · Nov 21, 2016

Most likely cause would be Bell's Palsy... This patient would have likely set out in the waiting room of the ED after being triaged. If you had called an ambulance, they would have complained about the bill. Let me know if you find out what it was, I'm really curious now. I work ER and someone presenting with that one symptom, at that age, with no history, would have probably been treated for the Bell's palsy with no testing done, then sent home.

grammy1 · Nov 22, 2016

A few years ago we had a student with the same sx. Only the facial droop, nothing else. Went to ER and was determined to be Bell's Palsy. Was treated for that. After about 6 months the other symptoms began and it turned out to be a brain tumor, thankfully benign. A year after the fact, nurse from the high school told us that she is doing very well. There was never an ambulance called...

ohiobobcat · Nov 22, 2016

What would EMS have done? From what you have told us, the student was perfectly stable other than the facial droop. EMS can't do a CT scan, can't administer TPA. They would have done vital signs and MAYBE started a line. It would have been an expensive taxi ride to the hospital. Were you at all concerned that the student's condition would deteriorate en route to the hospital? I wouldn't have been based on what you told us.

My thought would have been Bell's Palsy as well, both as a school nurse and a former ER nurse.

Flare, ASN, BSN · Nov 22, 2016

I have a student going through that right now. His onset was about 1 week after having teeth extracted - but that was healing well - so who knows what exactly caused it. To complicate matters it's one of my non verbal autistic students, so he can't tell me if there is anything else bothering him along with the facial drooping and eyelid swelling. His parent has taken him back an forth to a neurologist for the bell's palsy and the symptoms have honestly been waxing and waning - though he got the most relief after the course of steroids he was on at one point. It's been about a month and while it's improved, he hasn't recovered yet.

As far as the initial - I call his dad and told him to pick him up right away to have him evaluated. At first i think he may have taken him to back the dentist since the first concern was for complications with the recent extraction - from there he went to his gp

GdBSN, RN · Nov 22, 2016

What would EMS have done? From what you have told us, the student was perfectly stable other than the facial droop. EMS can't do a CT scan, can't administer TPA. They would have done vital signs and MAYBE started a line. It would have been an expensive taxi ride to the hospital. Were you at all concerned that the student's condition would deteriorate en route to the hospital? I wouldn't have been based on what you told us.
My thought would have been Bell's Palsy as well, both as a school nurse and a former ER nurse.

I completely agree with this. 911 should only be called for life threatening situations.

BeckyESRN · Nov 22, 2016

In the absence of all other symptoms, my thought was Bell's Palsy. Although, since no one will fill you in, maybe they did get a terribly scary diagnosis-MS, brain tumor, ect- and now they are grieving. I hope all is well with your student and I do believe that I would ahve done the exact same in your situation.

Supernrse01, BSN · Nov 22, 2016

The parents were aware of what was going on and I'm assuming at least one of them was the one to pick the student up, after you called them. That means they were able to see the student with their own eyes and I'm assuming they took him/her straight to the ER. They could have requested an ambulance if they felt like that was needed. It doesn't sound like your assessment findings warranted a 911 call.

I'm interested to hear what the discharge diagnosis was.

NutmeggeRN, BSN · Nov 22, 2016

A few years ago we had a student with the same sx. Only the facial droop, nothing else. Went to ER and was determined to be Bell's Palsy. Was treated for that. After about 6 months the other symptoms began and it turned out to be a brain tumor, thankfully benign. A year after the fact, nurse from the high school told us that she is doing very well. There was never an ambulance called...

Ugh Brain tumor is my second guess after Bell palsey

NutmeggeRN, BSN · Nov 22, 2016

A facial droop, in the absence of any other symptoms, is NOT life threatening and thus I would not have called an ambulance. If there were any other signs of distress, sure 911, but parents were called and were able to take the child to the ER. and I would recommend ER over PCP as well, because most docs don't have an MRI or CT in their office and it can (and most likely would be done), emergently.

JenTheSchoolRN, BSN, RN · Nov 22, 2016

A facial droop, in the absence of any other symptoms, is NOT life threatening and thus I would not have called an ambulance. If there were any other signs of distress, sure 911, but parents were called and were able to take the child to the ER. and I would recommend ER over PCP as well, because most docs don't have an MRI or CT in their office and it can (and most likely would be done), emergently.

This. I had one kid present with a droop and immediately thought Bell's Palsy. Called parent, had kid picked up, and parent took them straight for eval at the ED. (Turned out not to be Bell's Palsy and symptoms resolved after 48 hours - they never found out the cause...)

ohiobobcat · Nov 22, 2016

Ugh Brain tumor is my second guess after Bell palsey

Me too, but still not worth an ambulance ride with the symptoms the student was presenting with.