Case study B A 62-year-old man came to the emergency room wi…
Case study B A 62-year-old man came to the emergency room with right facial weakness. He awoke in the morning with a “funny feeling” in his right eye and thought he might have conjunctivitis. He looked in the mirror and noticed his right face was drooping a little. He also thought his speech sounded slightly slurred, so he called his wife to confirm this. She told him to go to the emergency room and he complied. During examination he demonstrated intact corneal reflex (blink in response to touching the cornea) on both sides. His right eyebrow was slightly depressed, but his right lower face showed significant delay of movements with smile. Taste on both sides of the anterior tongue was intact in response to mustard or jam on a swab. Hearing was normal and he had a normal gag reflex with symmetrical palatal elevation. His speech sounded mildly slurred, but the patient reported that it sounded better than earlier in the day. Tongue protrusion deviated slightly to the right. Strength testing in the limbs revealed mild weakness in the right hand. All tendon reflexes (biceps, patellar, Achilles) were normal and there were no frontal release signs.