Evaluation of prognostic factors in patients with Bell's palsy.

BACKGROUND: Bell's palsy is a common neurological problem that leads to peripheral palsy of the facial nerve. Most patients have a favorable response with or without treatment while some are left with significant facial deformity. Identification of factors which influence the outcome in patients with Bell's palsy may help clinicians counsel better. METHODS: A prospective cross-sectional study was carried out in the Department of Neurology Nobel Medical College, Biratnagar, between February 2020 and February 2021 after obtaining ethical clearance from the institutional review committee. Patients were assessed at the time of presentation to hospital and followed up at 1 week, 1 month, and 3 months after the onset of illness to evaluate for recovery. RESULTS: Sixty-two (61.4%) of 101 patients had a favorable outcome at the follow up on the third month, achieving H-B grade 2 or lower, while 33 (32.7%) had moderate dysfunction and 6 (5.9%) had severe dysfunction. The following factors were associated with favorable outcome: younger age of onset (p < .001), lower initial H-B grade of III or IV (p = .001), lesser degree of amplitude reduction on affected side as compared to unaffected side (p = .001) and absence of hypertension and diabetes. The following factors did not influence outcome at three months: duration of Bell's palsy (p = 0.142), side of face affected, and gender (p = .09). CONCLUSIONS: Most of the patients with Bell's palsy have favorable outcomes. Age, hypertension, initial H-B grade, and extent of facial nerve degeneration as recorded by nerve conduction studies are important predictors of outcome.

Ischemic jejunal stricture in patients with extrahepatic portal vein obstruction.

Ischemic jejunal stricture due to mesenteric vein thrombosis (MVT) rarely occurs in patients with extrahepatic portal vein obstruction (EHPVO). This is because the thrombus often occludes only a short segment of superior mesenteric vein adjacent to splenoportal confluence, facilitating development of collateral veins that protect bowel from ischemia. However, ischemic strictures can develop when the thrombus involves jejunal veins, venous arcades or vasa recta. We report three patients with EHPVO, who developed jejunal strictures due to MVT. They presented with symptoms of proximal bowel obstruction. Two of these patients had evidence of recurrent deep vein thrombosis (DVT), suggesting possibility of an underlying prothrombotic state. One of them had completely occluded bilateral iliac veins and inferior vena cava following DVT, 10 years ago. At the same time, he was identified as having a portal cavernoma. Contrast-enhanced computed tomography showed portal cavernoma together with MVT in all the patients. The thrombus was identified in the jejunal veins in two patients and in the entire superior mesenteric vein up to splenic vein in one patient. All three patients were found to have a tight concentric stricture involving a long length of proximal jejunum. Two patients required urgent surgical intervention and one died.

Idiopathic cystic artery aneurysm complicated with hemobilia.

Aneurysm of the cystic artery is not common, and it is a rare cause of hemobilia. Most of reported cases are pseudoaneurysms resulting from either an inflammatory process in the abdomen or abdominal trauma. We report a healthy individual who developed hemobilia associated with cystic artery aneurysm. The patient was managed with cholecystectomy and concomitant aneurysm repair. Visceral artery aneurysms are rare and can rupture with potentially grave outcome due to excessive bleeding. Angiographic embolization is a common method of treatment for visceral artery aneurysms. Open cholecystectomy and aneurysm repair was performed in our patient due to radiological evidence of associated cholecystitis.

Balloon retrograde transvenous occlusion of fundic varix.

A middle-aged woman presented with massive upper gastrointestinal bleed. The source of bleeding was a large fundic varix; a large splenorenal shunt was also present. The fundic varix was treated safely and effectively with balloon retrograde transvenous occlusion.