A 60-year-old man is brought to the emergency department because of a 1-hour history of abnormal face shape. The patient has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. Vital signs are within normal limits. Physical examination shows facial asymmetry with drooping of the left corner of the mouth and loss of the left nasolabial fold. Which of the following additional examination findings on the affected side would be most suggestive of central nervous system involvement?

Question

A 60-year-old man is brought to the emergency department because of a 1-hour history of abnormal face shape. The patient has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus.  Vital signs are within normal limits.  Physical examination shows facial asymmetry with drooping of the left corner of the mouth and loss of the left nasolabial fold.  Which of the following additional examination findings on the affected side would be most suggestive of central nervous system involvement?

Quizplus · Accepted Answer

Eductional Objective: Because the upper face receives bilateral input from the motor cortices, central nervous system lesions typically cause unilateral lower facial weakness that spares the forehead.  In contrast, peripheral lesions (eg, Bell palsy) cause weakness of the entire side of the face.  Bell palsy may also result in decreased tear production, hyperacusis, and reduced taste sensation

A 60-Year-Old Man Is Brought to the Emergency Department Because