Question

A 33-year-old woman comes to your office and reports that she is "having a stroke." She has no medical history and no significant risk factors for cerebrovascular disease, but today she has sudden onset of inability to tightly close her eyelid and to frown or smile on the right side of her face. Her physical examination is otherwise unremarkable. The nurse practitioner recognizes that this likely represents paralysis of cranial nerve (CN):

a) IV.
b) V.
c) VI.
d) VII.

Answer 1

The woman's symptoms are consistent with paralysis of cranial nerve VII (facial nerve), which is responsible for controlling facial muscles, unlike cranial nerves IV, V, or VI which control eye movement, facial sensation and mastication, and lateral eye movement.

Step-by-step explanation:

The 33-year-old woman's symptoms of inability to closely close her eyelid and to frown or smile on the right side of her face likely suggest paralysis of the c) cranial nerve VII, also known as the facial nerve. The facial nerve controls the muscles of facial expression, and its dysfunction can lead to an asymmetric facial appearance with one side not moving normally. These symptoms are not characteristic of the functions controlled by cranial nerves IV, V, or VI, which involve eye movement, facial sensation and mastication, and lateral eye movement, respectively. Since the woman does not have significant risk factors for cerebrovascular disease and her physical examination is unremarkable in other aspects, a diagnosis of Bell's palsy, which is a type of facial nerve paralysis, could be considered, rather than a stroke.