PMC3618043_01
a On the command 'show your teeth', left facial paresis is seen. b Smiling without asymmetry after a joke.
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F1
On examination, all voluntary movements on the left side of her face were paretic (such as lifting eyebrows, closing the eyes or showing the teeth) on command or imitation (fig. 1a), but automatic movements, like smiling or coughing, where very symmetric and totally preserved (fig. 1b).
Axial (a) and coronal (b) diffusion tensor imaging (DTI) color maps showing diffuse color intensity decrease in the pyramidal tract, with marked decrease in the left precentral gyrus, premotor region and corona radiata. DTI fiber tractography (c) with ROI placed in the pons showing asymmetry of fiber integrity in the left corona radiata/centrum semiovale.
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F2
Moreover, significant reduction of FA was observed in the transition between the precentral gyrus and premotor region bilaterally - with left-side predominance (fig. 2a-c).
a On the command 'show your teeth', bilateral facial paresis is seen. b Smiling after a joke.
crn-0005-0047-g03.jpg
PMC3618043_01_crn-0005-0047-g03.jpg
F3
Her face become very paretic, without voluntary movements (fig. 3a); however, normal involuntary movements remained intact (smiling, yawning or sneezing) (fig. 3b).