Special Operations Forces Medical Handbook

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Patient Education
Activity: Bedrest
Diet: As tolerated.
Prevention and Hygiene: Meningitis may be contagious and good personal hygiene is mandatory. Respira-
tory isolation for rst 24 hours of therapy (possible droplet spread of organism). Consider meningococcal
vaccine pre-deployment. Give intimate/household contacts of meningococcal meningitis patients prophylaxis
with ciprooxacin 500 mg x one dose in adults. Alternate regimens: ceftriaxone 250 mg IM, rifampin 600
mg q 12 hours x 4 doses or azithromycin 500mg one time.
No Improvement/Deterioration: Return to the medic for persistent fever or mental status changes.

Follow-up Actions
Return evaluation: Return to medic 3 to 5 days after discharge for reevaluation, including repeat neuro
exam.
Evacuation/Consultation Criteria: Evacuate immediately after starting antibiotics, if meningitis is suspected.
Refer to Infectious Disease or Internal Medicine for denitive treatment. Consult Neurology in difcult cases.
A lumbar puncture with evaluation of spinal uid is the denitive test to diagnose meningitis, which is not
available in a eld environment.
NOTE: Penicillin allergic patients may also have allergic reactions to ceftriaxone.

Neurologic: Bell’s Palsy (Idiopathic Facial Nerve Palsy)

CAPT Elwood Hopkins, MC, USN

Introduction: Bell’s palsy is a common peripheral mononeuropathy involving the seventh cranial nerve. It
usually follows a benign course, has no obvious underlying cause and is a condition from which nearly all
patients recover fully.

Subjective: Symptoms
Abrupt onset of ear pain followed by weakness in muscles of facial expression, slurred speech and drooling
when drinking; diminished or altered taste, increased sensitivity to sound on the involved side; evolves over 1-2
days; bilateral involvement and numbness are rare.

Objective: Signs
Using Basic Tools: Unilateral weakness (paresis) of the entire face, slurred speech and drooling

Assessment: Abrupt onset of unilateral facial muscle weakness in a young adult without other explanation
is likely to be Bell’s palsy.
Differential Diagnosis: Bilateral involvement can occur, but is rare and suggests more serious disease such
as sarcoidosis, Lyme disease or Guillain-Barre syndrome.
Idiopathic neuropathy
Herpes zoster - simultaneous characteristic vesicular eruptions in the ear canal or on the face.
Lyme disease - a history of tick bite and characteristic rash (erythema migrans).
Sarcoidosis - paralysis of additional parts of the nervous system.
Guillain-Barre - absence of reexes are typical of Guillain-Barre.
Myasthenia gravis - weakness of additional muscles (especially the eye muscles, causing double vision).
Peripheral Nerve System (PNS) Lesion - weakness of the forehead corrugator muscles and absence of involve-
ment in other parts of the nervous system suggest a more serious disorder such as a peripheral nerve problem
from a central lesion in the cerebrum or brainstem.

Plan:

Treatment:

1. Protect the eye from exposure keratitis (dryness, erythema, poor vision) and foreign bodies by wearing