CEREBROSPINALECTOMY
ER: "Facial droop, twenty-nine, nothing else wrong with him." Me: "Has he been outside?" ER: "...it is August." Me: "Then that is a yes, and I want the tick question asked out loud." Late summer, a young adult, an isolated facial palsy, and a tick-endemic zip code. The season is part of the differential, which is why the calendar hangs where I can see it. Send this to whoever thinks the calendar is not part of the exam.
EXPLAINED (ACCURACY-CHECKED)
Lyme neuroborreliosis is a recognized cause of peripheral facial nerve palsy, particularly in endemic regions and with a marked seasonal (late spring through summer) distribution; bilateral facial palsy is a classic presentation.
PubMed: Lyme neuroborreliosis as a cause of facial nerve palsy with strong seasonal and geographic clustering - PMID 36856886, PMID 33977412. Card names no test, no treatment, and no advice; it asserts only that season and exposure belong in the history.
PERMANENT LINK
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