60 year-old man presented to the ED complaining of
right-sided headaches for one year. Recently, his
girlfriend began noticing occasional episodes of confusion.
He finally agreed to present for evaluation when the
headache became severe the day before. His
neurological exam was completely normal except for that
depicted on the following video.
This proved to be an interesting case as the findings
on CT scan were a bit surprising in light of the paucity of
findings on exam. As is evident on the video, the
patient exhibits a central facial nerve palsy. As
differentiated from a peripheral palsy, intact forehead
movement indicates an upper motor neuron lesion. The
only finding on this patient's exam was weakness of the
lower facial musculature when he attempted to smile.
The CT scan, as shown below, revealed a large
(5 x 4 cm) right frontal parenchymal hemorrhage. A
small amount of surrounding edema is noted. The
appearance and history was suspicious for hemorrhage into
an underlying lesion, likely a meningioma.
Meningiomas are commonly found in the frontal lobes and
tend to occur between ages 40 and 60 yr.
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