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Introduction

Bell's palsy is a weakness (or palsy) of muscles and loss of functions innervated (provide nerve input) by the Facial Nerve (Cranial nerve VII).  This weakness is likely the result of inflammatory swelling of the facial nerve. Patients with this condition generally present with acute facial paralysis.  Bell's palsy occurs in approximately 25 out of 100,000 people annually. The exact cause of Bell's palsy is not known, but in many cases a viral infection may be playing a role, including the herpes virus in particular.  Where Lyme disease is endemic, it needs to be considered and requires antibiotics if strongly suspected or confirmed.

Symptoms

One of the earliest signs of Bell's palsy is a sharp ache behind the ear on the affected side, often after a viral infection or towards the end of pregnancy or just after delivery. This is followed by weakness of mouth movement and eye closure resulting in a unilateral facial droop.  People also can experience change in subjective taste (loss of taste sensation on the anterior 2/3 of the tongue on that side), blurry vision (from cornea exposure and eye dryness from reduced tear production on that side due to lacrimal gland denervation), changes in hearing (hyperacusis where loud sounds are perceived as louder or painful from the ear on that side), and problems with slurring, drooling, and eating and sometimes tingling sensations on the affected half of the face. These symptoms may develop over the course of several hours or a day. The severity of the symptoms varies from person to person. Even mild cases of Bell's palsy may take many months to resolve. As a general rule, the more severe the facial weakness, the longer the recovery will be.

Diagnosis

There is no single test to diagnose Bell's palsy. Other conditions such as injury, stroke and tumor will need to be ruled out clinically and sometimes in atypical cases with an imaging study such as magnetic resonance imaging (MRI) or computerized tomography (CAT) scan.  Blood work to look for conditions such as Lyme's disease, B12 deficiency and inflammatory states that may result in weakness of the facial nerve may also be ordered.  Risk is increased in people with diabetes.

Treatment

People with idiopathic (no known cause) Bell's palsy are usually treated with a short course of steroids (such as prednisone) to decrease swelling of the nerve. An antiviral medication, such as acyclovir, may also be prescribed for possible viral etiologies.  Cornea protection is important if eye blinking and tear production are limited.  Prognosis is generally good with significant recovery seen in the first 3 months, but residual weakness still present at that point can improve slowly over a year or more. Physical therapy offers limited benefit in some cases and may be recommended. Infrequent late complications may include spontaneous abnormal muscle spasm or involuntary movements on the formerly paralyzed side or abnormal tearing from that eye. Botox may have a treatment role for some of those late complications.

Patient Testimonials









"Just wanted to thank you and your staff for creating such a safe environment at your K Street office. I was reassured to see everyone wearing their masks properly yesterday! When a patient's mask started to slip in the reception area, someone IMMEDIATELY came out to ask him to pull it up. It was so reassuring!”

“I am happy to let everyone know how great the Neurology Center/Chevy Chase is. My primary care doctor referred me there because of neuropathy symptoms. He advised that every doctor there is first class, and any will serve me well. I was assigned to Dr. Nabil Altememi, and how fortunate for me. He is brilliant, thorough, experienced, confident and a great communicator. After two appointments now, I am confident in my experience and my judgment. I commend the Neurology Center to you, and I specifically commend Dr. Altememi. Good luck.” –TM
 
“I like the fact that there is very little waiting to see the doctor. Dr. Stephanie Block takes time to hear questions and answer them. I don't feel rushed. And there's plenty of parking.” –NF
 
“Dr. Ezra Cohen takes the time to go through my health issue and concerns on my first visit. He is really great and I just recommended him to one of my friends who is looking for good neurologist. Other staff members are pleasant and the waiting time is reasonable. Overall experience was great.” –MMM
 
“The Neurology Center is awesome and particularly Dr. Eric Jeffries. He’d been tracking an issue with my health for a few years. He sent me to a surgeon this past fall because he didn’t like what he saw. I had surgery in December and the issue has been resolved. Not only is Dr. Jeffries top notch, but the staff is always friendly and helpful. I’d recommend them to anyone.” – LK
 
“The staff at each office over many years have been AWESOME!! My heart goes to Dr. Taryn Fortune. She is so thorough and has been diligent in helping me with my discomfort. I recommend that anyone who is wants a kind, caring, and thorough Neurologist Don't walk to Dr Fortune, Run!! She is the best!!!” – SM
 
“Thank you Dr. Stephanie Chen Block for your professional manner, your personal concern and your thorough description of my medical situation. Your advice and counsel were invaluable and I would highly recommend you to friends and family.” – DS
 
“Everyone at the Leisure World Office was very professional and courteous. We were taken on time.” – TJA
 
“The Providence staff and Dr. Moore were very pleasant. Dr. Moore was very detailed and he took his time explaining each step of the EMG so I was aware what to expect. The technician was pleasant and made me feel comfortable.” – CL
 
“Dr. Cohen was patient and thorough. I felt like he really cared. I would recommend this practice very highly.” – MB
 
“The White Oak staff is polite and made me feel welcome. My procedure was explained to lessen feelings of anxiety.” – MC

“I’ve been going here for years, and compare to the other doctor’s offices, this practice is great! Dr. Hari Hall is wonderful, very knowledgeable and cares about her patients. I highly recommend the practice!” -RJ

“The kindness and responsiveness of the staff are admired and appreciated!” -GG

“Dr. Rhanni Herzfeld is a hero. She was so great to me that my mom is actually going to move down from Michigan, partly to have access to such great resources like Neurology Center.” -ET

“Dr. Stephanie Block is a wonderful practitioner who listens carefully and always has good suggestions to offer. I would highly recommend her.” –RO

“Met with Dr. Neal Kurzrok for my diagnosis and Dr. Moore for my testing for peripheral neuropathy. I found Dr. Kurzrok to be a no nonsense but heavily qualified physician. He is straight to the point and I like that. I wanted to know just what my issues were and my options. Dr. David Moore knows how to do the professional testing phase and has an easy going bedside manner. He is qualified and very likeable. The Providence office space is very clean and the check in staff efficient.” –AG

“I truly loved the center. The staff was welcoming and attentive. I enjoyed visiting with Dr. Melissa Carswell who was very friendly, patient and professional. Thank you.” – MG

“Honestly, my experience with this practice has been nothing short of stellar. The doctors are thorough and caring. They listen and are eager to help. Dr. Taryn Fortune is amazing at what she does, and is generally a very cool person.”- DS

“The staff and doctors at the Neurology Center have been fantastic....very informative and supportive. I have full trust in their recommendations.” -BT

“The physicians and staff are great. Everything runs smoothly and stress free. Their objectives are scientific.” -JS

“I’ve never written a review before, but I feel compelled to after my excellent experience here. Dr. Philip Pulaski was fantastic - he explained everything very clearly and was very caring. Additionally, the staff are wonderful (Tammy in particular). They’ve gone above and beyond to ensure a very smooth client experience. All around this is a fantastic practice and I would recommend them to anyone in need of a neurologist.” -ST

“Good experience. Dr. David Taragin showed empathy and concern towards my husband who was not feeling well.” -CM

“Dr. Debbie Lin is amazing, very knowledgeable and caring, also very honest and direct. I first spoke with her PA, Ashley Holt today on a telemedicine appointment. She was also extremely helpful, knowledgeable and very clear. She was happy to answer any and all questions. This is a wonderful practice.” – HL

“I love everything about this practice. Easy location. Ample parking. Ease in making appointments. Immaculate office. Professional and kind administrative staff. The doctors and assistants I’ve seen have been top notch (and I come from a family of doctors!) I’ve raved about them to anyone who’ll listen- so glad I found this neurology group. I trust them implicitly.” – HG

“The Neurology Center is a highly professional and very caring practice. The doctors and staff are all friendly and helpful, and they opt for conservative rather than aggressive treatments while being fully pragmatic. Highly recommended.” - BB

“Highly recommend Dr. Hari-Hall. Have been a patient for a few years, and always receive excellent service. Toye and other technical staff are also always thorough and efficient.” -MM

“Great office atmosphere, the doctor was very informative and seemed genuinely concerned. The K Street office staff worked well together.” –AC

“The Leisure World office staff was helpful and friendly. The doctor we saw was caring and through.” –KBB

“The Providence staff was very professional and the doctor was on time and very thorough and listened to my concerns. I am glad The Neurology Center was recommended to me.” -GW

“Ashley Holt and Dr. Stephanie Block have helped me so much with my migraines. Ashley is a pro at giving Botox injections- always on time and efficient. This office has been a lifesaver for me!” – DB

“They are all very professional, courteous and handle appointments in a timely manner. I have never had to wait after my appointment time to be seen . Dr. Eric Jeffries is the best. He's honest and keeps it real with you. I recommend The Neurology Center in White Oak who is looking for neurological services.” – JC

“Everyone was extremely helpful and warm. Dr. Aman Savani was highly knowledgeable, gladly listened to me, answered my questions, welcomed my adult daughter who came with me and had support staff to provide the additional diagnosing necessities.” -CH

“Dr. Rhanni Herzfeld is everything you want a doctor to be: highly knowledgeable, attentive, inquisitive, sincere — and prompt! In short, she cares.” –CA

“Administrative Staff are competent and courteous and Clinical Staff are highly qualified and conduct themselves so that it is clear they have the patient’s best interests in mind.” – BS

“Physically, the Sleep Center resembles that which you would expect if staying at a very nice motel/hotel, a comfortable double bed, closet space, and a clean bathroom with towels, soap, and shampoo, plus TV. The staff were also very professional from the time of check-in, to showing you around your assigned room, and explaining the process for attaching the requisite electrodes on your body. If you awaken during the night in need of the bathroom, just say your assigned staff member’s name out loud and she will quickly appear to unhook your electrodes from the monitoring station. You are awoken early, around 5am, released from your electrodes and told you may now shower, get dressed, and go home. If, in my case, the testing resolves my sleep disorder, I will upgrade the facility’s rating to the highest level.” -PL

“A very professional yet friendly atmosphere that welcomes you at once, and a staff of very confident and competent caregivers. What more can I ask for? Dr. David Taragin is an extraordinary neurologist, and I know I am lucky to have him for my doctor.” -JK

“Very friendly and helpful staff. My doctor is very caring and has a lot of experience. I would recommend her to family and friends, as my daughter was very happy with the Neurology Center in Rockville.” – BG

“My daughter needed a sleep study to be done. I was contacted before hand, all questions were answered, staff could not have been more friendly, knowledgeable. They explained what was going on and when and what would happen. If I or someone in my family needs a study done, we will be coming here. First class all the way.” -ES

“The Neurology Center has a friendly front office staff always providing outstanding professional customer service with a smile. Dr. Philip Pulaski is the “BEST.” He is kind, compassionate, knowledgeable and really knows his stuff. He has always provided guidance and excellent medical advice throughout the years. Dr. Pulaski is my favorite “Doctor/Friend.” -Ms. M

“Great front desk presence (I don’t get to say that elsewhere). Professional and positive. That sets the tone for the appointment and the importance of this is frequently overlooked. Well done staff! Dr. Nadia Yusuf was warm and genuine and (most importantly) knowledgeable and communicative. Great visit. Keep up the great experience and work!” - MD

“Dr. Nabil Altememi listened to our concerns and took into a count all of my Mom’s issues before recommending the next step. He also let us choose how fast and how far to take the work up, because her issue did not require immediate neurological action. It was very reassuring.” -AB

“The K Street office staff was super kind and helpful, my neurologist was also incredibly kind and personable. One of the best private medical experiences I’ve ever had.” -AM

“Very clean and positive environment. Everyone was very professional. I was impressed with Dr. Nadia Yusuf.” - PL