Cranial Nerves Seven to Twelve Case 2

1. Question

A 57-year-old woman comes into the ED with right sided facial weakness. She woke up with it this morning and is otherwise feeling well. She is unable to close her right eye. There is no history of trauma.

Which nerve is affected?

Right lower (peripheral) facial nerve
Left lower (peripheral) facial nerve
Right upper (central) facial nerve
Left upper (central) facial nerve

2. Question

How do you differentiate between a central and peripheral lesion in this patient?

3. Question

Why is it important to differentiate between central and peripheral CN lesions?

4. Question

Which of the following is NOT a clinical finding of this nerve lesion and the relevant branches of the facial nerve?

Loss of taste to the anterior two-thirds of the tongue (chorda tympani)
Hyperacusis (nerve to stapaedius)
Dry eye (parasympathetic supply to lacrimal glands)
Patient may have vesicles in the ear canal if she has herpes zoster infection (Ramsay Hunt syndrome)
Hoarseness