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Difficulty: MediumPhysical Examination Findings

Match the following distinct neurological physical examination findings with the corresponding clinical condition or anatomic lesion.

  • Complete unilateral weakness of the facial muscles, including the inability to raise the eyebrow or close the eye tightlyPeripheral facial nerve (CN VII) lesion
  • Unilateral drooping of the upper eyelid, a constricted pupil, and absence of sweating on the same side of the faceDisruption of the cervical sympathetic pathway
  • Unilateral weakness of the lower facial muscles with preserved ability to raise the eyebrow and wrinkle the foreheadUpper motor neuron (central) facial lesion
  • An eye deviated downward and outward, accompanied by profound ptosis and a dilated, unresponsive pupilCompressive lesion of the oculomotor nerve (CN III)

Answer

Complete unilateral facial weakness matches peripheral CN VII lesion; ptosis, miosis, and anhidrosis match sympathetic pathway disruption; lower facial weakness with forehead sparing matches upper motor neuron facial lesion; and a down-and-out eye with a dilated pupil matches a compressive CN III lesion.
The correct pairings rely on precise neuroanatomic localization. The upper face receives bilateral cortical innervation, so a central lesion spares the forehead, while a peripheral lesion affects the whole half of the face. Horner syndrome results from sympathetic disruption, causing miosis and partial ptosis, whereas a compressive CN III lesion disrupts both somatic and superficial parasympathetic fibers, leading to a blown pupil and profound ptosis.

Step-by-Step Solution

1
Analyze each neurological physical finding to determine the specific affected muscles, pupils, or autonomic signs.
The findings correspond to a complete facial palsy, Horner syndrome, a central facial palsy, and a complete oculomotor nerve palsy.
Identifying the specific pattern of deficits is the foundation for localizing neurological lesions.
2
Recall the neuroanatomical pathways responsible for these clinical presentations.
Understanding the difference between bilateral versus unilateral cortical innervation explains the facial palsies, while sympathetic versus parasympathetic pathways explain the pupillary findings.
Precise anatomic localization allows the matching of physical signs to their underlying structural lesions.
3
Match the constellation of signs with the specific nerve or pathway lesion.
The correct anatomic lesions are paired with their classic physical examination presentations.
This confirms the diagnosis based strictly on the physical examination.

Key Concept

Neurological Physical Examination Findings
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Topics

Physical Examination Findings

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