Bell Palsy, Trigeminal Neuralgia, Meningitis, Encephalitis, and West Nile Virus

These conditions divide into two very different bedside problems. Bell palsy and trigeminal neuralgia are usually focal cranial-nerve syndromes. Meningitis and encephalitis can deteriorate quickly because inflammation involves the meninges or brain itself. West Nile virus may begin as a febrile illness but becomes an emergency when it causes meningitis, encephalitis, or acute flaccid paralysis. The first question is therefore not “Which diagnosis is on the list?” It is “Is this a localized cranial-nerve problem, or is the patient developing a systemic or central neurological emergency?” A patient with sudden facial weakness needs a stroke screen before being reassured that it is Bell palsy. A patient with fever, headache, neck stiffness, or altered mental status needs urgent infection assessment. A patient with new confusion or seizures needs an encephalitis pathway even when neck stiffness is absent. In Canada, an RPN acts within provincial scope, employer policy, and the available medical directives, but time-sensitive assessment, isolation, escalation, and prescribed treatment should not wait for a routine review.