18th July 2023

A 54-year-old woman presents to A&E with a 6-month history of progressive worsening of left-sided facial weakness and sensitivity to sound in the left ear

A 54-year-old woman presents to A&E with a 6-month history of progressive worsening of left-sided facial weakness and sensitivity to sound in the left ear. She has a past medical history of COPD and typically suffers with one lower respiratory tract infection in the wintertime, which requires antibiotics. Despite this, she has never been hospitalised because of her COPD. She has a 35-pack-year cigarette smoking history. She informs you that she has never had any ‘funny turns’, loss of colour vision or any abnormal motor or sensory symptoms prior to developing left-sided facial weakness.

On examination, she has weakness of her left orbicularis oculi and frontalis muscles. When she is asked to smile, the left-hand side of her mouth does not move. Sensation in the face remains normal. Upper limb, lower limb and cerebellar neurological examination are all normal.

Which of the following diagnoses would best explain her symptoms?

Select the SINGLE most appropriate option from the list below. Select ONE option only.