Dr.

Ricardo Andres Aldana

MIOLOGÍA DE LA CARA Olarte
Esp Msc
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A 44-year-old, right-handed woman presents to an outpatient clinic 1 month after
being diagnosed with influenza, for which she received treatment with oseltamivir.
She reports that 2 weeks after her illness, she began experiencing an insidious
headache along her left occipital region. She also describes left ear hyperacusis,
difficulty furrowing her left eyebrow and closing her left eye, left-sided tongue
numbness, and left facial asymmetry. At that time, she presented to her primary care
physician, who indicated that it was probably due to the effects of her viral illness.
She prescribed the patient prednisone and valganciclovir for 1 week, with no
improvement in her symptoms. She was also given an eye patch and eye drops, as
well as a prescription for physical therapy.
Upon physical examination, the patient is noted to be of average build, with normal
body mass index. Her head is normocephalic and atraumatic. She is oriented to
person, place, and time. Her speech is fluent and clear, and she is able to follow
complex commands. Her pupils are equal, round, and reactive to light.
The fundi are normal, and spontaneous venous pulsations are present. Extraocular
movements are intact, and visual fields are full to visual confrontation. A decreased
palpebral fissure is noted in her left eye, along with weakness in left eye closure and
an inability to furrow her left eyebrow. Her muscles of mastication are normal. She
has prominent left facial asymmetry, with flattening of the nasolabial fold. Her
hearing is grossly symmetrical, with subjective hypersensitivity to sound in her left
ear. Her palate elevates in the midline, and the tongue has normal motion without
fasciculations. Weber and Rinne test results are unremarkable. Finger-to-nose, heel-
to-shin, and tandem gait are normal.
She has normal muscle bulk and tone; strength and sensation are normal in her upper
and lower extremities. Her deep tendon reflexes are normal throughout, except 3+ in
her bilateral patellar tendons. Her toes are downgoing bilaterally, with no clonus.