STUDY - Technical - New Dacian's Medicine
Masklike
facies (facial bradykinesia) (Classical / Allopathic Medicine)
A total loss of
facial expression, masklike facies results from bradykinesia,
usually due to extrapyramidal damage. Even the rate of eye
blinking is reduced to 1 to 4 blinks/minute, producing a
characteristic “reptilian” stare. Although a neurologic
disorder is the most common cause, masklike facies can also
result from certain systemic diseases and the effects of drugs
and toxins. The sign typically develops insidiously, at first
mistaken by the observer for depression or apathy.
HISTORY:
Ask the patient and his family or friends when they first noticed the masklike facial expression.
Ask the patient if he's experiencing facial pain. If so, ask him to describe it.
Ask the patient if he's experiencing limb weakness, paresthesia, or vision disturbances.
Review the patient's medical history, noting especially neurological disorders and viral infections.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Ask about changes in dosage or schedule. Also, ask the patient about alcohol intake.
Ask the patient and his family or friends when they first noticed the masklike facial expression.
Ask the patient if he's experiencing facial pain. If so, ask him to describe it.
Ask the patient if he's experiencing limb weakness, paresthesia, or vision disturbances.
Review the patient's medical history, noting especially neurological disorders and viral infections.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Ask about changes in dosage or schedule. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Determine the degree of facial muscle weakness by asking the patient to smile and to wrinkle his forehead. Typically, the patient's responses are slowed.
Inspect the patient's face, and note edema, rash, or facial weakness.
Perform a neurological assessment.
Test motor reflexes, noting weakness.
Determine the degree of facial muscle weakness by asking the patient to smile and to wrinkle his forehead. Typically, the patient's responses are slowed.
Inspect the patient's face, and note edema, rash, or facial weakness.
Perform a neurological assessment.
Test motor reflexes, noting weakness.
SPECIAL
CONSIDERATIONS:
If the patient's facial weakness results from Guillain-Barré syndrome or myasthenia gravis, be prepared to initiate emergency respiratory support.
If the patient's facial weakness results from Guillain-Barré syndrome or myasthenia gravis, be prepared to initiate emergency respiratory support.
PEDIATRIC
POINTERS:
Masklike facies occurs in the juvenile form of Parkinson's disease.
Masklike facies occurs in the juvenile form of Parkinson's disease.
PATIENT
COUNSELING:
If the patient's masklike facies results from Parkinson's disease, explain to his family that the sign may hide facial clues to depression - a common occurrence with Parkinson's disease.
If the patient's masklike facies results from Parkinson's disease, explain to his family that the sign may hide facial clues to depression - a common occurrence with Parkinson's disease.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.