Physical examination maneuver

Physical Exam

Cranial Nerve VII

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How to Perform

Observe the face at rest and during movement for asymmetry. Ask the patient to raise the eyebrows, close the eyes tightly and keep them closed against gentle resistance, and smile. Note any asymmetry and whether the forehead is involved or spared.

How to Interpret

Showing 2 of 6 findings

Facial Weakness

Forehead spared, with weakness limited to the lower face
Rule in
HelpfulDerived CI
Rule out
Very helpfulDerived CI
Evidence:Moderate

Stroke

Crossed motor paresis (ipsilateral cranial-nerve weakness with contralateral limb weakness) in a patient with confirmed acute ischemic stroke
Rule in
Very helpfulDerived CI
Rule out
Not helpfulDerived CI
Evidence:Moderate

Related Bedside Tests

Eye InspectionMembers
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Eye Inspection
Rule in:VHHyperthyroidism, VHStroke, HSerious Eye Disease +18 more
Rule out:HConjunctivitis, SHHypovolemia, MHAnemia +18 more
Pupillary Light ReactionMembers
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Pupillary Light Reaction
Rule in:VHSerious Eye Disease, HPoor Neurologic Outcome, HStructural Brain Lesion +11 more
Rule out:SHPoor Neurologic Outcome, SHSerious Eye Disease, SHStructural Brain Lesion +11 more
Alternate Cover TestMembers
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Alternate Cover Test
aka Cross-cover test, Test of skew
Rule in:VHSkew Deviation, VHVestibular Dysfunction, HStroke +1 more
Rule out:VHStroke, VHVestibular Dysfunction, HSkew Deviation +1 more
Cranial Nerve VMembers
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Cranial Nerve V
Rule in:VHStroke, ICOrbital Fracture, IEMidfacial Fracture +2 more
Rule out:NHOrbital Fracture, NHStroke, IEMidfacial Fracture +2 more
Extraocular MovementsMembers
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Extraocular Movements
Rule in:VHStroke, SHHyperthyroidism, SHMyasthenia Gravis +9 more
Rule out:HMyasthenia Gravis, SHHyperthyroidism, NHOrbital Fracture +9 more
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Gait Assessment
Rule in:VHStroke, HFalls, HVascular Parkinsonism +24 more
Rule out:SHDementia, SHVascular Parkinsonism, MHFalls +24 more

Related Systems / Regions

Head, Eyes, Ears, Nose, ThroatNeurological

Related Diagnoses

Facial WeaknessPeripheral Facial Nerve PalsyStroke

Related Chief Complaints

Altered TasteDroolingDrooping of One Side of the FaceEar PainFacial DroopFacial NumbnessFacial WeaknessInability to Close One EyeLoss of TasteWatery Eye

References

  • Francis IC, Loughhead JA. Bell's phenomenon. A study of 508 patients. Aust J Ophthalmol. 1984;12(1):15-21. doi:10.1111/j.1442-9071.1984.tb01119.x. PMID: 6732654.
  • Tao WD, Liu M, Fisher M, et al. Posterior versus anterior circulation infarction: how different are the neurological deficits? Stroke. 2012;43(8):2060-2065. PMID: 22678088.
  • Navi BB, Kamel H, Shah MP, et al. Rate and predictors of serious neurologic causes of dizziness in the emergency department. Mayo Clin Proc. 2012;87(11):1080-1088. PMID: 23063099.
  • Ohira S, Yamaguchi Y, Yui R, Wada K. 'Precursory symptoms, awareness or progression of facial palsy' are more useful than 'forehead wrinkling ability' in differentiating central facial palsy examined in the emergency department. Acta Otolaryngol. 2024;144(3):263-267. doi:10.1080/00016489.2024.2341974. PMID: 38662879.
  • Guerrero-de Ferran C, Valdez-García JE, Rivera-Alvarado IJ, González-García ÁE, Bastán-Fabián D, Rangel-Trejo M. Ocular and palpebral manifestations of facial palsy: an epidemiologic descriptive study. Clin Ophthalmol. 2023;17:1007-1011. doi:10.2147/OPTH.S398190. PMID: 37035515. PMCID: PMC10076617 (open access).
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.