If you have a patient with isolated CN VII palsy (Bell's Palsy), and straightforward symptoms with no red flags (such as concern for carcinomatous meningitis), do you routinely get an MRI brain or do you just make a clinical diagnosis?

Topics: Neurology • Neuro-infectious disease

Answer from: at Academic Institution

In my practice, I do not order a brain MRI if there are no red flags. I treat with a course of steroids; 60 mg of prednisone for four days, 40 mg for four days, 20 mg for four days and then stop. I see the patient back in six weeks. If they have not made a complete recovery, I perform MRI imaging wi...

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at Beaumont Health
If patient already have a negative CT brain then I...

Answer from: at Community Practice

I give a week’s worth of prednisone with no taper and schedule an MRI with contrast and attention to brainstorm in four 4 weeks. I tell them to cancel the MRI if their symptoms start improving before the 4 weeks are up and come to the ER if new symptoms develop.

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