Overview
The First Minute with a Sudden Facial Droop
A patient who suddenly cannot lift one eyebrow, close one eye, or smile symmetrically has a localization problem before a medication problem.
A patient who suddenly cannot lift one eyebrow, close one eye, or smile symmetrically has a localization problem before a medication problem. If weakness includes the forehead and lower face and the rest of the neurologic examination is normal, an acute peripheral CN VII palsy is the working pattern. Forehead sparing, additional neurologic deficits, bilateral or progressive weakness, severe ear pain, and ear vesicles move the patient out of the typical Bell palsy pathway. Protect an exposed cornea immediately, then use the symptom-onset clock to determine whether corticosteroid treatment can be started within 72 hours.