A 42-year-old man attends the emergency department complaining of weakness down one side of his face. Over the past 2 days, he has noticed an altered taste sensation and pain in and around the ear on the same side. There is no history of trauma. He has not noticed any discharge from the ear and there is no limb weakness. He is a known asthmatic and he suffers with depression. He is currently using salbutamol and becotide inhalers and takes paroxetine 20 mg od. He has no known allergies.
Examination Cardiovascular, respiratory and abdominal examinations are normal. His gait and balance are normal. Neurology of the upper and lower limbs is unremarkable. Some asymmetry in face is visible. On showing his teeth, the right side of his face droops. On raising his eyebrows, there is a loss of the forehead facial wrinkles on the right and he has difficulty in closing his right eye. The rest of…
