Fred's Flaccid Face
Fred, a 77-year-old man, was well except for mild hypertension controlled by medication. On the day of admission, he became nauseated and vomited twice. He then noted right-sided numbness and drooping of the left side of his face.
Examination an hour later revealed a blood pressure of 200/100. He was alert with normal speech. His pupils were equal and reactive. He was unable to gaze to the left with either eye; and when he tried to look tot he right, his right eye abducted, but the left did not move. His left facial muscles were weak, including the corrugator. The remainder of his muscle strength was normal, and reflex changes were present. Pain, light touch, joint position, and vibratory sense were impaired on the right.
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