14. facial paralysis

A 59-year-old woman complained of paralysis of the right side of her lip, over the previous two days, following the appearance of oral ulceration, and pain in her tongue and palate, and associated difficulty in closing her eye on the same side. She had not experienced any head injury or any chemical exposure, had normal blood pressure and was not on any medications.

Examination showed right-sided complete facial palsy but no skin lesions (Figure 1). The patient could not grin to show her teeth nor close her eyes. There were no other neurological signs.

Oral examination revealed right maxillary ulcerations. Her paralysis showed significant improvement over the next two weeks.

(a) Stroke is characterized by loss of brain activities (temporary or not), usually due to ischaemia or haemorrhage, causing an inability to move limbs, speak and/or understand and see. The main risk factors are older age, high blood pressure, tobacco smoking and heavy alcohol drinking. Stroke is not the cause for the facial paralysis in this patient as her paralysis duration was short but without numbness or weakness in her arms or legs, or difficulty in speaking, yet the oral ulcerations were unilateral. Additionally, the younger age of our patient, her abstention from alcohol or tobacco and normal blood pressure eliminate the risk for stroke.