Bell Palsy, Trigeminal Neuralgia, Meningitis, Encephalitis, and West Nile Virus

These disorders separate first by anatomy and urgency. Bell palsy is an acute peripheral facial-nerve palsy. It weakens the upper and lower face on one side, so the patient may be unable to wrinkle the forehead, close the eyelid, smile symmetrically, or keep fluids in the mouth. Trigeminal neuralgia is a facial-pain syndrome: brief, severe, electric-shock-like attacks arise in one or more divisions of the trigeminal nerve and are commonly triggered by light touch or movement. Meningitis is inflammation of the meninges; encephalitis is inflammation of brain tissue that produces brain dysfunction. West Nile virus can cause meningitis, encephalitis, or an anterior-horn-cell syndrome with acute flaccid paralysis. The first nursing question is whether the presentation is focal and stable or suggests a time-critical central nervous system process. Isolated whole-side facial weakness may fit Bell palsy, but facial weakness with limb weakness, aphasia, visual loss, severe imbalance, or sudden severe headache requires immediate activation of the local stroke process. Shock-like facial pain without an abnormal neurologic examination may fit trigeminal neuralgia; for persistent numbness or another abnormal neurologic finding, promptly notify...