a lady with bell's palsy

Had been frequenting the wards a lot recently.

Today, I was asked by a senior to have a 'peek' at a patient's face. It is perhaps not a good time to talk to her, since she had just been broken a bad news yesterday, he said. I noticed that she is jaundiced, and has R sided facial weakness. Flipping through her chart - patient was presented 3 months earlier with Bell's palsy, which has not resolved over months.

A familiar scene flashed through my mind. I met a patient with Bell's palsy earlier, with the same first name as her. And she has the same side of facial weakness. I even wrote a case report on her. I dont know if she was the same lady I met.

This time, she came back to the hospital with weight loss and pruritus. Her U&E and LFTs are deranged. And she reported having an insect bite 5 months ago (?Lyme). Scans showed that she had extensive mets to the brain, bone and liver. Primary lesion unknown, there are still ongoing investigations. It seems that Bell's palsy is her first symptom of the still unknown culprit, which is now may no longer be termed Bell's.

Poor lady. :(