Upper and (old) Lower Facial (VII) Nerve Palsies On Opposite Sides

摘要

An 86 year-old woman suffered a left internal capsule strokeone month before these photos. She had right facial weaknessalong with mild right arm and leg weakness as residua. Six yearsearlier she had had a left sided Bell’s palsy with an excellentrecovery. Photo A shows a mildly increased right palpebral fissureand mildly reduced right naso-labial fold. These findingsindicate mild facial weakness on the right. In photo B, whensmiling, one can see an increase in the naso-labial fold asymmetry,and contraction of the left orbicularis muscles. In photoC her left peri-orbital muscles contract as she puckers her lips,indicating synkinesis, a very common phenomenon in peoplewho recover from a Bell’s palsy.