Headache with facial palsy

Chief Complaint A 30 y/o female complains of headache which was mild a week ago but gets severe a day back. She also complains of photophobia. No recent change in vision. History She is feeling feverish and has mild productive cough for 5 days. She is married and stays with her husband. Vitals BP: 139/85 mmhg, HR: 120 bpm, Resp rate: 30 breaths per minute, Temp: 101.2 degree F, SpO2: 95% on oxygen. Examinations Ophthalmic and neurological examination shows right facial palsy. Investigations HB: 14.9 g/dl WBC: 15.9*103/ul Platelets: 120*103/ul AST, ALT, Direct bilirubin level also significantly raised. Treatment What next should be done?

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Deranged LFTS Direct bilirubininia Thrombocytopenia and TLC shows leucocytosis H/o fever headache facial palsy with cough tachycardia needs xray chest first Facial palsy could be secondary to viral infections with hepatitis R/o hepatitis B with chest infection

Thanx dr Kute Ankush
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NICE ILLUSTRATION 30 YEARS OLD FEMALE WITH SEVERE HEADACHE AND PHOTOPHOBIA SHE HAS A KIND OF MIGRAINE ALSO HAS R FACIAL PALSY NEEDS COMPLETE OCCULAR WORK UP AS SHE HAS MILD PRODUCTIVE COUGH WITH MILD FEVER DO COVID 19 TEST

? MIGRAINE .. WITH.. PHOTOPHOBIA .. NEED'S.. NEUROLOGICAL..AND.. OPHTHALMIC..EVALUATION.. WITH EXPERTS OPINION..

Tnx Dr Ashok Leel sir
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Acute Alcoholic hepatitis with viral facial palsy Differential diagnosis Ischemic hepatitis Budd- cherry syndrome Acute cholangitis

Types of migraine include 1. Common 2. Classical 3. Cluster 4. Retinal 5. Ophthalmoplegic 6.Basilar This is most likely a case of ophthalmoplegic migraine .In this type neurologic symptoms precede the onset of headache ,the latter commonly occurs at the height of headache or just afterward.

Needs further investigation and evaluation to conclude particularly COVID 19 virus Infection must be ruled out and protocols must be followed. Stemetil MD+ PCM TDS Multivitamin and antioxidant orally. Tapering dose of steroid orally. Physiotherapy after conclusion. Symptomatic treatment

Thanks Dr Kute Ankush
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Look for Covid 19 Migraine with facial palsy Rull out GBS Septicemia Hepatic encephalopathy duo to chronic hepatitis

Viral hepetitis and viral Toxic Poly neuritis÷ GBS). Oral Corticosteroid.

Good history presentation Rule out covid 19 Rt pcr CBP,MP widal dengue serology Looking like viral fever with migraine With facial palsy Tab.acicylovir 800 mg daily 5 timesa day for 5 days Tab.Dolo 650 mg daily 3 times a day Tab.razo dsr daily one bbf Tab.wyslone 10 mg daily 2 timesa day for 1 week Tab .wyslone 5 mg 2 times a daily for next 5 days .tab.wyslone 5 mg daily one next 3 days Physiotherapy For 1 week electrocution physiotherapy Antitussive agent

SUGGESTIVE OF ..... OCULAR / VISUAL MIGRAINE..... WITH.. ........ POSSIBLY... .... DENGUE.. SECONDARY TO... SEPTICEMIA

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