Thursday 2nd May 1991   Morning surgery 10:40

“This gentleman seems to have had a stroke, Dr Dennis.”
“I don’t think so, young man.” Valerie Vaughan ushered Vernon into Dad’s consulting room. “Hmm . . . is this another medical student?” she said looking at Dilys who was sitting next to me.
“Yes, this is Dilys. She’s in the fifth year with Dylan.” My Dad smiled at Mrs Vaughan.
Dylan opened his notebook: “Vernon Vaughan is a 78 year old . . .”
“Excuse me!” Mrs Vaughan interrupted. “It’s always a good idea to start by allowing the patient to speak for himself. In fact, I would regard that as my number one learning point for today and I am sure Dr Dennis would agree.” Mrs Vaughan continued without giving my Dad a chance to respond. “Vernon, can you explain how your symptoms started? I think you developed some discomfort in your right ear?”
“Yes, that was on Monday. It was just behind my ear.”
“Then, last night, you noticed weakness of the right side of your face. Your mouth started to sag and you were dribbling. Cleaning your teeth was difficult.”
“Yes, that’s right.” We could see that Vernon’s face was lopsided when he spoke
“This morning, breakfast did not taste quite right?”
“It didn’t have much taste at all, Valerie.”
Mrs Vaughan looked at us. I could sense this was another important learning point.
“Vernon, have you noticed any weakness of either arm or leg?”
“No, they seem fine.”
“Are you sure, Vernon?”
“Yes, Valerie.” Vernon winced.
“Are you in pain, Vernon?”
“No, it’s your voice, Valerie. It’s really grating today; more than normal.”
Mrs Vaughan shook her head dismissively. “It would be very unusual, Dylan,” Mrs Vaughan continued, “for a stroke to cause weakness of the facial muscles but not affect the arm or leg. Normally, if the right side of the face was affected, we would expect paralysis of the right arm and leg.”
Dylan nodded sheepishly.
“You will notice that Vernon cannot raise his right eyebrow.” Vernon tried. He managed to lift his left eyebrow but there was no movement of the right side.
“Close your eyes, Vernon.”
Vernon could not close his right eye properly.
“Can you see the way Vernon’s right eye rolls upwards when he tries to shut it?”
We all nodded.
“That’s called Bell’s Phenomenon,” Mrs Vaughan said. “They used to say that it confirmed the diagnosis but, more recently, it has been discredited, I think.” Mrs Vaughan looked at my Dad for confirmation. “We need to look at the whole picture; don’t we Desmond?”
My Dad nodded.
“So, it looks like the diagnosis is Bell’s palsy.” Mrs Vaughan continued. “The symptoms are due to swelling and inflammation of the facial nerve and not a stroke.” She turned to my Dad. “I don’t know if you still recommend steroids, Dr Dennis.”
“I will need to have a look at him first, Mrs Vaughan.”

My Dad confirmed the diagnosis, wrote out a prescription and arranged to see Vernon again in two weeks.
Mrs Vaughan took the prescription and turned towards Dylan. “I can’t see this young man getting through finals, Dr Dennis. It is such a waste of tax payers’ money.”
My Dad chuckled. “I am sure he’ll be fine, Valerie. He is brighter than he seems.”

Bell’s Palsy.
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