Neurology Question 46

A 53-year-old man is evaluated for persistent right-sided facial weakness. Three months ago, he first noticed “droopiness” of the right side of his lower face, difficulty closing the right eye and wrinkling the forehead, increased sensitivity to loud noises, and occasional slurred speech. Bell palsy was diagnosed, and he began a 10-day course of prednisone. He has noted only limited improvement, with continued facial drooping and mildly dysarthric speech; he now uses an eye patch over his right eye at night. The patient takes no medication.

On physical examination, vital signs are normal. Right-sided facial weakness involving the forehead, orbicularis oculi, and lower facial muscles is noted. Taste recognition is impaired on the anterior right side of the tongue. Facial sensation and the muscles of mastication are intact. The corneal reflex is present bilaterally, and the jaw reflex is normal. Hearing is intact bilaterally, as are extraocular reflexes, motor and sensory function, and deep tendon reflexes.

Which of the following is the most appropriate next step in management?

A  Acyclovir

B  Clinical observation

C  MRI of the brain

D  Physical therapy

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