R. NICKBRYANMDS. JAMESZINREICHMD
A 50-YEAR-OLD man was normal until the age of 19 years, when he noticed that the left side of his face and body was becoming weak and was shrinking. These changes had ceased to progress when he was 27 years old. A general physical examination revealed atrophy of the left side of his face, neck, and extremities. There was complete ptosis on the left and total inability to move the left eye, but the pupils were reactive. The left masseter and temporalis muscles were severely atrophic, and there was a reduction in sensation to pain and temperature over the left cheek and mandible. There was also complete right peripheral facial paralysis, and the tongue deviated to the left. The magnetic resonance imaging scan of the skull showed marked atrophy of the soft tissue, muscles, and parotid gland on the left side of the face (Figure 1). The opposite side of the face showed compensatory hypertrophy of the salivary glands (Figure 2). On proton-density and T2-weighted magentic resonance images, the brain showed increased signals in the white matter adjacent to the lateral right ventricle and in the right frontal lobe (Figure 3 and Figure 4).
Torres-Larrosa T, Campos ME, Betancor L, Lopèz-Aguado D. Quiz Case 2. Arch Otolaryngol Head Neck Surg. 1999;125(9):1037-1039. doi: