Physical Exam

Cranial Nerve VII

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Video coming September 2026

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

Stroke

Posterior Circulation 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:Limited

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 neurologic 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.
Wongwandee M, Hongdusit K. Analysis of Upper Facial Weakness in Central Facial Palsy Following Acute Ischemic Stroke. Neurol Int. 2025;17(1):12. doi:10.3390/neurolint17010012. PMID: 39852776. PMCID: PMC11767383 (open access).
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.