Bell's Palsy in Pregnancy
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A 26 years old mother was doing well in her 3rd trimester. Pregnancy was going good. Her expected due date was at the end of July month. (prevalence rate is high during autumn season)1. One morning at 36th week of pregnancy while returning from routine morning walk, she felt pain below her right ear and headache. She concluded it as lack of sleep, so she slept back. When she got up, bels palsy was showing its peak on her face along with knuckle rigidity. There was generalized edema over face and no sensation at the right side of face. Immediately she approached to neurologist where immunoglobulin and methylprednisolone were advised for initial two days. Investigation such as CBC, LFT, RFT were advised and reports came with elevated levels of-alkaline phosphatase, total leukocyte count, erythrocyte sedimentation rate, differential leukocyte count Controversy was in prescribing higher doses of corticosteroids and antiviral due to adverse effect on baby. Team of gynecologists and neurophysicians concluded to take the baby out by L.S.C.S. Abnormal delivery may have exerted pressure over nerves. A healthy baby was delivered. Oedema over the face released to some extent as fluid pressure was relieved. One aspect to be monitored was suture site as corticosteroids may delay wound healing. On 10th post-operative day sutures were removed and wound healing was good, she discharged from hospital with follow up advice. After one month she was advised for physiotherapy. There was no improvement till 4th month. At mothers aspect in spite of family support and expert counselling she was feeling very low. She started avoiding going out, interacting with people, sometimes she feel lack of interest in baby care. 5th month she started improving, regaining lip moments, drooling of tears also improved. Muscle over fore head and blowing balloon, sealing of mouth were yet to improve. After one month pause to physiotherapy again session was started this time she experienced twitching of lips, pain while electric stimulation, over stimulation of sebaceous glands. In medication folic acid tablets were still continuing. As there was no improvement in next 2 months of therapy, so it was stopped. At 10th month of getting affected review had been taken from senior neuro physician who stated that 70 percent recovery has taken place. Complete recovery will not take place. After 2 years period of Bell's palsy, it can only be noticed while smiling, blowing balloon, and tightly sealing the mouth.
Bells Palsy, Herpes zoster, Cranial nerve.