Code Status case · Beginner · Premium
Facial droop in a 44-year-old man
“My face isn't working right. Is this a stroke?”
“Left-sided facial droop, noticed this morning. Last known well at bedtime, about ten hours ago. He's worried it's a stroke. Want me to call a stroke alert?”
Your challenge
Samuel woke up with the left side of his face drooping, and the first thing the nurse asks you is whether to call a stroke alert. A stroke, a nerve problem, an infection carried by ticks, shingles near the ear or a growth in the salivary gland can all change how a face moves. The answer is in a careful look at his whole face and the rest of his body. Calling it a stroke too fast, or missing one, both carry a cost.
After the case, Attending’s Notes explains the decisions that mattered, backed by 10 sources.
Ready to make the call?
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Spoiler: the diagnosis and what this case teaches
Diagnosis
Bell's Palsy
Lesson 1
The Whole Face, and Only the Face
The forehead is a clue, not a verdict. Examine everything else.
- A weak forehead points toward the facial nerve
- Examine eye movements, hearing, limbs, and gait
- Bell's palsy usually peaks within three days
- Look harder for mimics in older or diabetic patients
Lesson 2
A Typical Bell's Needs No Tests
Test only when a finding would change your plan.
- Ear or mouth blisters suggest Ramsay Hunt
- Consider Lyme testing when exposure is plausible
- A slowly worsening palsy or a lump needs imaging
- Check glucose, then skip routine labs and scans
Lesson 3
Steroids Within 72 Hours
Steroids work best early, so start them today.
- Prednisone 60 mg daily for 5 days, then taper
- Start today, the sooner the better
- An antiviral is optional, never alone
- Most recover fully, and steroids help 1 in 10 more
Lesson 4
The Eye That Cannot Close
The droop gets the attention. The eye needs the protection.
- Lubricating drops through the day
- Ointment and gentle eyelid taping at night
- Eye pain, redness, or blurred vision is urgent
- Recheck within a week, sooner if the eye hurts
In the app, every line above opens into the detail behind it: doses, pitfalls and the evidence, with 10 sources linked to the originals.
Samuel is a fictional patient. Code Status is for training only and is not intended for real-world patient care, diagnosis, treatment, or clinical decision-making.