Abstract
Brainstem infarction typically presents with vague symptoms, including headache, nausea, vomiting, and vertigo. Rarely do patients present with complete unilateral facial paralysis, mimicking Bell’s palsy. Here we report the case of a 40-year-old woman who presented to the emergency department with intractable nausea, vomiting, and vertigo upon waking along with left-sided upper and lower extremity numbness and right-sided facial paralysis. Her atypical presentation of unilateral facial nerve paralysis in the context of nausea, vomiting, and vertigo prompted neurological studies, which were significant for a small punctate infarct in the pons involving the right facial colliculus. History, physical examination, and clinical suspicion are important to prevent anchoring bias. Physicians rely on history and physical examination to help distinguish true Bell’s palsy from other causes of facial nerve paralysis. Stroke and other clinically emergent etiologies should be considered high on the differential diagnosis when patients have neurological signs and symptoms in addition to facial nerve palsy.
Highlights
Brainstem strokes account for 10% of ischemic strokes, and are most commonly found in the pons
The patient was alert and oriented, afebrile, with a heart rate of 81 beats per minute, and a blood pressure of 141/71 mmHg. It was immediately noted on physical exam that the patient had complete right-sided facial paralysis, instinctively raising suspicion for Bell’s palsy
The 40-year old patient had none of these risk factors known upon her initial presentation to the emergency department
Summary
Kelsey Burson 1 , Joshua Mastenbrook 1 , Kyle Van Dommelen 1 , Mauli Shah 1 , Laura D. 1. Department of Emergency Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, USA 2.
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