Case Study: 34 yom Facial Paralysis

10:10 in the AM. You respond to a 34 year-old-male c/o possible CVA. Upon arrival you find him seated in his apartment living room surrounded by two friends. He is alert and appears anxious. He tells you he was perfectly fine when he went to bed last night at around 11 PM. This is his appearance when asked to look at you and smile:


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He complains of no other symptoms and his vital signs are within normal limits. No other abnormalities are detected on your physical exam and he has no past medical history. Your Cincinnati Stroke Screen is negative, except for the right-sided facial paralysis. Remember for the Cincinnati Screen having any 1 of the 3 positive is a 72% chance of ischemic stroke.

Is this a stroke? View the Conclusion.



  • Brandon O says:

    More consistent with Bell’s palsy (or nerve palsy secondary to whatever… maybe something fun like Lyme). Paresis localized to the face is a little unusual for stroke, he’s pretty young, and most of all, stroke usually leaves the forehead muscles preserved, since they’ve got a nice dual innervation from both sides of the brain. Hemiparesis of the forehead like this is very suggestive of Bell’s.

  • Shane says:

    Prob bell’s palsy. Ask him to lift his eye brows.

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