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Neurological conditions presenting on the face

GPs' photographs of unusual cases appearing in their surgeries

This patient presented with tinnitus, dizziness and diminished hearing, writes Dr Koshy Johnson. He was seen in the ENT department for investigation. The diagnosis was right cerebello-pontine angle acoustic neuroma. He developed a lower motor neurone seventh nerve palsy (far left) and needed a right lateral tarsorrhaphy (centre). He is still applying lubricants topically.

He also had input from the plastic surgery department, a right-sided sub-periosteal facelift to try to help elevate the paralysed right side of his face.

He had a second craniotomy to remove a residual tumour. He developed a psuedo-meningocoele at the site of the craniotomy wound and a cysto-peritoneal shunt was inserted. Part of the shunt can be seen as a prominence just above and medial to the mid-clavicular line (left).

This 12-year-old presented with sudden onset of facial weakness, writes Dr Mike Wyndham. He was amazingly calm. I had never encountered the problem in someone of his age, which left me disconcerted. So without too much embarrassment during the consultation (one of the benefits of being more senior) I did a quick literature search on computer. It would seem the peak incidence for the condition is between 10 and 40 with equal sex distribution.

This was reassuring. The next question was whether to treat. I mentioned steroids to his mother who instantly responded 'no'. Indeed, looking at systematic reviews, it would seem she's right. There is really no evidence for their use.

I'm pleased to say he made a full recovery.

One of the beauties of general practice is that you never quite know what to expect. This was no exception. This eight-year-old had developed a little discomfort in his face, the day before his rash appeared. His mum thought it might be cold sores but the distribution was far too extensive.

A search through his notes revealed he had had chickenpox at the age of 10 months and so the diagnosis was herpes zoster.

There was a great deal of surprise when I explained this to his mother. She had associated the condition with older people, but I confirmed it was not uncommon in the first decade of life.

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