Solve the Medical Riddle: One Side of Her Face Suddenly Drooped and She Couldn’t Smile or Close Her Eye, First Week

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

We’ll start this week by letting you know what the patient told her PCP and how the doctor proceeded with the examination. Next week, the PCP and a neurologist will continue to look for clues to the medical riddle. The third week, we’ll let you know what some people have suggested as possible diagnoses. The fourth week, the doctor will reveal the actual diagnosis. Then we’ll move on to a new riddle for the following month!


The Patient Reports Her Symptoms


Marjorie, age 58, asked for an emergency appointment with her doctor when the left side of her face suddenly started drooping and she couldn’t smile or close her left eye.


As always in ThirdAge Medical Riddles, the doctor uses the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

This week, we’ll learn what Marjorie told her PCP:

“Thank you for agreeing to see me right away! If you had been too busy, I was going to go to urgent care or the emergency room. I’m so scared! When I woke up this morning, I felt perfectly fine. Then while I was having my coffee and checking my email before getting ready to go to work, the left side of my face started to feel weird. About an hour later, after I took my shower, I looked in the bathroom mirror. I tried to smile, but my face was lopsided and I couldn’t totally close my left eye. Yikes! I yelled to my husband that maybe I was having a stroke and he came running. He was freaked out by what he saw. As you know I’m a fourth grade teacher. Currently, I’m teaching summer school. I called the school and said they had to get a sub for me. Then I called you right away. After I got the appointment, my husband insisted on driving me here. He called his office and said he’d be late. He’s out in the waiting room now. Maybe you should ask him to come in and help me make sense of what you tell me. I am so rattled that I’m afraid I won’t process everything you say!”

The doctor did call Marjorie’s husband into the examining room so he could help her with asking questions. He had his tablet with him and he took notes, which was very good idea. Marjorie visibly relaxed when she realized her husband would have a record of what went on during the visit.