Facial Weakness

indicates a CONTRALATERAL

SUPRANUCLEAR

lesion

indicates an IPSILATERAL NUCLEAR OR INFRANUCLEAR lesion

(Spontaneous emotional expression affected).

CAUSES

- vascular

- tumour

- demyelination

- infection

(see opposite)

(Spontaneous emotional expression may be unaffected with subcortical lesions)

(Spontaneous emotional expression affected).

CAUSES

- vascular

- tumour

- demyelination

- infection

Unilateral involvement of the upper and lower face with defective eye closure indicates an IPSILATERAL NUCLEAR OR INFRANUCLEAR lesion

(see opposite)

LESION, LOCALISATION AND CAUSE

Note the distribution:

Unilateral involvement of the lower face, with near normal eye closure indicates a CONTRALATERAL

SUPRANUCLEAR

lesion

Bilateral involvement of the upper and lower face

Eyes move outwards and upwards on attempted closure -Bell's phenomenon

BILATERAL -

INFRANUCLEAR lesions

BILATERAL -

NUCLEAR lesions

(associated with other features of pseudobulbar palsy: (see page 534)

BILATERAL -

INFRANUCLEAR lesions

MUSCLE DISEASE

Pontine lesions

- infarction

- haemorrhage

- demyelination

- tumour

- infection

- syringobulbia

- motor neuron disease

- Moebius' syndrome *

- Guillain Barré syndrome

- Lyme disease

- Infectious mononucleosis

- Sarcoidosis

- myasthenia gravis

- muscular dystrophy

Bilateral involvement of the upper and lower face

Eyes move outwards and upwards on attempted closure -Bell's phenomenon

* Moebius' syndrome: a congenital failure of the development of the facial and abducens nuclei (bilateral).

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