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A man with drooping left side of his face.
Case 10(Get help)
A 26 year-old man comes to clinic after waking up yesterday with drooping of the left side of his face. He
had some mild aching behind the left ear when he awoke. While brushing his teeth shortly thereafter he
noticed his left face was drooping and that he had difficulty closing the left eye. He hoped it would go
away and is concerned he has had a stroke. He takes no medications and is in good health. On
examination, he cannot fully close the left eye and the left nasolabial fold is decreased.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor his condition and its treatment? What is the prognosis?
Case 10
A 26 year-old man comes to clinic after waking up yesterday with drooping of the left side of his face. He
had some mild aching behind the left ear when he awoke. While brushing his teeth shortly thereafter he
noticed his left face was drooping and that he had difficulty closing the left eye. He hoped it would go
away and is concerned he has had a stroke. He takes no medications and is in good health. On
examination, he cannot fully close the left eye and the left nasolabial fold is decreased.
1) Summarize the case briefly, including neuroanatomic localization and pathogenesis.
2) What is the most likely diagnosis? Name 1-2 alternative diagnoses, and discuss briefly why these
are less likely.
3) What additional information (history, exam, laboratory or other studies, consultations) would you
obtain? What laboratory findings would you expect if your most likely diagnosis is correct?
4) Assuming your most likely diagnosis is correct, how would you manage this patient? How would you
monitor his condition and its treatment? What is the prognosis?