Facial weakness

FIGURE 4.2 Seventy-three-year-old female with sudden right hemiparesis, left facial weakness, dysarthria, nausea, and downheat nystagmus. Posterior circulation angioplasty demonstrated occlusion of the proximal hasilar artery (arrows— a and b). Note the retrograde opacification of the superior cerebellar arteries through postero-inferior cerebellar to superior cerebellar arteries collaterals (b). 

A stroke results in numbness or weakness down one side facial weakness problems with balance/coordination, dysphagia, dysphasia and dysarthria and loss of consciousness (in severe stroke). 

Ataxic hemiparesis constitutes about 10% of cases. It is the combination of corticospinal and ipsilateral cerebellar-like dysfunction affecting the arm and/or leg. It includes a syndrome in which there is little more than dysarthria and one clumsy hand. The lesion is usually in the pons, internal capsule or cerebral peduncle. Dysarthria, with or without upper motor neuron facial weakness, may also be a lacunar syndrome with similar lesion localization as ataxic hemiparesis, but there are other localizing possibilities as well. 

Fig. 10.7. Use of T2-weighted and diffusion-weighted (DWI) MRI. (a) A patient without vascular risk factors presented with a history of transient left arm and facial weakness 10 days earlier. The T2-weighted image (left) is normal but DWI (right) shows an acute right parietal infarction (arrow), (b) A patient presented with a history of transient right arm and facial weakness and sensory loss nine days before presentation. The T2-weighted image (left) is normal but the DWI (right) shows an acute left thalamic infarction (arrow).

Adverse events in patients who receive botulinum toxin injections for hemifecial spasm are virtually identical to those that occur in treatment of BEB. However, diplopia and lower facial weakness are more common in patients with hemifacial spasm. 

The stroke physician will also monitor the patient s breathing pattern for signs of airway obstruction or impaired ventilatory drive, air escaping from the side of the facial paresis, unequal palpebral fissure (as occurs with ptosis on the side of a Homer s), or impaired lid closure on the side of facial weakness. 

Ear Hemotympanum Vesicles Basilar skull fracture Facial weakness due to zoster-associated Vllth nerve palsy... 

Ptosis and facial weakness cases with rapid onset... 

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