Unilateral Facial Weakness

Abstract

A 69-year old woman who was on treatment for pulmonary tuberculosis presented with sudden onset of right-sided facial weakness of 12 hours duration. This was associated with a three-week history of throbbing right ear pain. There was no hearing loss, tinnitus, vertigo, or headache. She was diagnosed with pulmonary tuberculosis 50 days ago, for which she was prescribed a daily regime of ethambutol, isoniazid, rifampicin, and pyrazinamide. She had hypertension but no ischemic heart disease or diabetes. Her vitals showed a blood pressure of 116/60 mmHg and a pulse rate of 90 beats per minute. Her neurological examination revealed a loss of right-sided forehead creases, inability to close her right eye, right facial muscle weakness, leftward deviation of the angle of the mouth on smiling, and loss of the right nasolabial fold. Corneal reflexes showed slow eyelid closure on the right side. There was no slurring of speech or weakness of the muscles of the upper or lower limbs. There were no rashes, vesicles, or erythema noted on otoscopic examination.

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