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What is the likely diagnosis?

A 13 year old boy presents with facial weakness. On examination he has paralysis of his facial muscles on the left hand side, including the left side of his forehead. He has a mild ptosis of his left eye. 
1. Todd's paresis.

2. Bell's palsy.

3. Ischaemic stroke.

4. Intracerebral haemorrhage.

5. Space-occupying lesion.

This question is part of Neurology Quiz
Asked by Drbishop, Last updated: Jul 11, 2020

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3 Answers

tsolakianthoula

Tsolakianthoula

Answered Apr 22, 2020

I agree, the clue was kind of misleading. Bell's palsy might be the clue.

 

John Adney

John Adney

Answered May 01, 2017

Patients with bell's palsy typically have difficulty closing their eyes and do not present with ptosis. Patients with lesion affecting the sympathetic innervation of the superior tarsal muscle, or the oculomotor nerve which supplies the levator palpebrae superioris may present with ptosis.
 

John Smith

John Smith

Answered Dec 05, 2016

Bell s palsy

When assessing facial weakness, it is important to establish if there is sparing of the muscles of the forehead. Control of the forehead muscles has bilateral upper motor neurone input, so an upper motor neurone lesion (unless it was bilateral) would spare, or partially spare, the forehead muscles as there is input from the contralateral side. A lower motor neurone lesion would not spare the forehead. Bells palsy is a unilateral lower motor neurone facial weakness.
 

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