A 78-year old patient presents to the ED and reports a change to his face that he worries is a
stroke. During the he is found to have significant changes to the muscles of his face. The patient
was unable to wrinkle the forehead on the right half of his face, close his eye tightly, or retract
his mouth to smile. During ocular testing it was noted that his right eye was unable to move
laterally (to the right) but could move medial without difficulty. When returning to neutral
(forward gaze) the right eye moved slowly and showed a slight esotropia. Using the presentation
above draw the location of the single smallest lesion that could account for al of the above
symptoms. Remember to label the sides of your drawing (right/ left) and include labeling of all
necessary structures and the level of the brainstem or spinal cord (rostral pons, caudal medulla,
C5 spinal cord, etc.). 10pts If this same patient did not have difficulty wrinkling the forehead or
with eye movements (ie. Only presents with lower facial paralysis) would your answer change?
Why? (no drawing necessary for this question) 5pts.
A 78-year old patient presents to the ED and reports a change to his .pdf
1. A 78-year old patient presents to the ED and reports a change to his face that he worries is a
stroke. During the he is found to have significant changes to the muscles of his face. The patient
was unable to wrinkle the forehead on the right half of his face, close his eye tightly, or retract
his mouth to smile. During ocular testing it was noted that his right eye was unable to move
laterally (to the right) but could move medial without difficulty. When returning to neutral
(forward gaze) the right eye moved slowly and showed a slight esotropia. Using the presentation
above draw the location of the single smallest lesion that could account for al of the above
symptoms. Remember to label the sides of your drawing (right/ left) and include labeling of all
necessary structures and the level of the brainstem or spinal cord (rostral pons, caudal medulla,
C5 spinal cord, etc.). 10pts If this same patient did not have difficulty wrinkling the forehead or
with eye movements (ie. Only presents with lower facial paralysis) would your answer change?
Why? (no drawing necessary for this question) 5pts
