A 17-year-old girl presents to an urgent care clinic after waking up in the morning with a left-sided facial droop and an inability to fully close her left eye. Of note, she is currently on oral contraceptives and escitalopram and smokes half a pack of cigarettes per day. Her temperature is 98.2°F (36.8°C), blood pressure is 110/68 mmHg, pulse is 82/min, and respirations are 12/min. On exam, she has generalized, unilateral left-sided drooping of her upper and lower face, and an inability to move the left side of her mouth or close her left eye. Her extraocular movements and swallow are intact. She has no other neurologic deficits. Which of the following interventions would most likely address the most likely cause of this patient's symptoms?
AHead CT without contrast
BImplantation of gold weight for eyelid
CPrednisone alone
DValacyclovir alone
EIntravenous immunoglobulin
A 63-year-old man is brought to the emergency department by his wife because she is concerned he is having another stroke. The patient says he woke up with right-sided facial weakness and drooping. Past medical history is significant for a recent case of shingles treated with acyclovir, and a stroke, diagnosed 10 years ago, from which he recovered with no residual functional deficits. On physical examination, there is weakness and drooping of the entire right side of the face. Sensation is intact. The remainder of the physical examination is unremarkable. Which of the following additional findings would also most likely be seen in this patient?
ADecreased salivation
BWrinkled forehead
CExpressive aphasia
DComplete loss of taste to the tongue
EPartial hearing loss
A 31-year-old man comes to the emergency department because of drooping of the left side of his face since awakening that morning. He had difficulty chewing his food at breakfast. He was treated the previous day at the hospital after sustaining a head injury from falling off a ladder while working on his roof. A plain CT of the brain at that visit showed no abnormalities. He is in no apparent distress. His vital signs are within normal limits. The pupils are equal and reactive to light. There is drooping of the left corner of the mouth. The left nasolabial fold is flattened. When asked to close both eyes, the left eye remains partially open. There are no wrinkles on the left side of the forehead when the eyebrows are raised. Which of the following is the most appropriate next step in management?
ASteroid therapy
BAcyclovir therapy
CReassurance
DSurgical decompression
ESurgical repair
+ 7 more in the PDF
Browse all chapters