Table of Contents
Common Questions
Chat with CodyMD
Cody's Chat with Patient
Cody's AI Summary
Top 3 AI Diagnosis List
Review by Dr Albert DiPiero
Dr. DiPiero Video Guide to this Case Study
Resource Center
Testimonials
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Case Study
Meet your host
Albert DiPiero, MD MPH FACP
I am a co-founder and the Chief Medical Officer at CodyMD and your host for this edition of Cody Grand Rounds. I have been a practicing physician and faculty member at medical schools for over 26 years.
About The AI Doctor Case Study
CodyMD is a partnership between Human Doctors and AI Doctors. Cody is an AI Doctor who helps thousands of people every day. At each Cody Grand Rounds, I select a real case and review it with Cody, the AI Doctor.
Each case is based on a real patient but has been modified to maintain privacy and to emphasize certain teaching points.
Common Questions
What causes facial droop on one side?
Is eye closure difficulty serious?
Can stress cause facial droop?
Is it safe to ignore increased sensitivity to sounds on one side?
What is the role of prediabetes in facial droop?
How is Bell's palsy diagnosed?
What steps should be taken if facial droop symptoms appear?
Chat with CodyMD
Click the button below to initiate a conversation with CodyMD, your AI Doctor.
Cody's Chat with Patient
Below is a conversation transcript between the patient and our AI Doctor CodyMd.
Cody, the AI Doctor
Hi, I'm Cody, your AI doctor. I understand you're dealing with a left-sided facial droop. Can you tell me more about when you first noticed these changes?
Patient
Hi, Cody. Yes, it started about a day ago. I noticed it gradually, and it's been pretty consistent since then.
Cody, the AI Doctor
Thanks for sharing that. Have you experienced any difficulty closing your left eye or any changes in hearing like increased sensitivity to sounds on that side?
Patient
Yes, it's been a bit hard to close my left eye completely, and sounds are definitely harsher in my left ear.
Cody, the AI Doctor
Got it. And do you feel any tightness or any other unusual sensations on your left side? Any numbness or tingling?
Patient
It feels tight, but not numb or tingly. It's like the muscles aren't responding the way they should.
Cody, the AI Doctor
I see. Have you had any ear pain or discomfort that might be related to this?
Patient
No, my ear feels fine. I haven't noticed any pain at all.
Cody, the AI Doctor
Thanks for clarifying. Let's talk a bit about your medical history. I see you have prediabetes. Has it been managed or evaluated recently?
Patient
No, I haven't looked into it in about three years. I've just been swamped with work.
Cody, the AI Doctor
I understand work can be demanding. Are there any other neurological symptoms you’ve noticed, like weakness in your arms or legs, or changes in your balance?
Patient
Not really, no. It’s just been the face. Everything else feels normal.
Cody, the AI Doctor
Great to know. Could you tell me about any stress or lifestyle changes recently, especially given your work as a computer programmer?
Patient
Well, work's been hectic as usual, but nothing out of the ordinary. Just the usual stress, nothing new.
Cody's AI Summary
- You are a 34-year-old woman experiencing a gradual onset of left-sided facial droop for one day.
- You're having difficulty closing your left eye and have noticed increased auditory sensitivity without any numbness or pain.
- Your medical history includes prediabetes, which hasn't been evaluated in three years, and depression, though you’re not on any medication.
- You lead a busy lifestyle as a computer programmer but have no significant habits like smoking or drinking.
Top 3 AI Diagnosis List
Based on the information and conversations with Cody, we have prepared a top 3 AI Diagnosis List.
1. Bell's Palsy(45 % probability)
This is the most likely diagnosis due to the unilateral facial paralysis, difficulty closing the eye, increased sensitivity to sound, and absence of other neurological symptoms. Bell's Palsy is a peripheral nerve condition affecting the facial nerve.
2. Diabetic Neuropathy(35 % probability)
Though less likely given her age and the localized nature of the symptoms, prediabetes could present with nerve palsies.
3. Stroke(20 % probability)
Unlikely given the absence of other symptoms like limb weakness or speech difficulties, but facial droop can be a sign of a stroke, so thorough assessment is essential.
Review by Dr Albert DiPiero
Dr. Albert DiPiero
This case presents a classic picture of a peripheral nerve issue, primarily indicating Bell’s Palsy due to the isolated facial symptoms and sensitivity to sound without further neurological indicators. The AI's consideration of Diabetic Neuropathy, given the prediabetes, is warranted but less probable due to the patient's young age and symptom localization. Stroke must be considered in any facial droop scenario; however, given the isolated facial involvement, it falls lower on the differential list.
1. Bell's Palsy(80% probability)
The symptoms align well with Bell's Palsy, given its sudden and unilateral onset, and no other neurologic symptoms. Bell’s Palsy is an temporary weakness of one side of the face due to inflammation of the facial nerve. It is usually a temporary condition.
2. Diabetic Neuropathy(10% probability)
Quite unlikely owing to the patient's age and lack of diffuse symptoms typical of neuropathy.
3. Stroke(5% probability)
Low likelihood but merits exclusion due to potential severity.
4. Other Considerations:
Consider secondary causes of facial nerve injury such as Lyme disease, sarcoidosis, HIV and vasculitis.
Next Steps for Evaluation
Diagnostic Testing:
The first step is a detailed neurologic history and exam to confirm that the symptoms are consistent with an isolated deficit in the facial nerve on one side of the face.
If the above is not supported by a physical exam, then further neurological examination and imaging (such as CT or MRI) should be considered to rule out stroke.
Consider starting corticosteroids if Bell's Palsy is confirmed.
Potential Treatment Modalities
For Bell's Palsy, the focus would be on symptom management and improving nerve function.
Use corticosteroids to hasten recovery. Treatment with a 10-day course of oral prednisone, started within 72-hours of symptom onset is essential to speed full recovery.
Use of an eye patch and artificial tears to prevent corneal dryness is recommended.
Conclusion
The likely diagnosis of Bell’s Palsy should be pursued with symptomatic treatment as a priority. The importance of reassessing prediabetes management is also noted, to prevent potential complications. This approach aims for a rapid recovery while remaining vigilant for atypical presentations.
Dr. DiPiero Video Guide to this Case Study
Resource Center
Bell's Palsy and Facial Droop Resources
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