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Lack of facial expression Assessment Questionnaire

Questions Your Doctor May Ask - and Why!

During a consultation, your doctor will use various techniques to assess the symptom: Lack of facial expression. These will include a physical examination and possibly diagnostic tests. (Note: A physical exam is always done, diagnostic tests may or may not be performed depending on the suspected condition) Your doctor will ask several questions when assessing your condition. It is important to openly share any pertinent information to help your doctor make an accurate diagnosis.

It is also very important to bring an up-to-date list of all of your all medical conditions, medications including dosages, and names of numbers of any specialist you see.

Create your printable checklist by answering questions that your doctor may ask below:

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  1. How long have you had a lack of facial expression?

    Why: to determine if acute or chronic.

  2. Was it a sudden or gradual onset?

    Why: e.g. if sudden onset must consider facial paralysis (due to Bell's palsy, diabetic neuropathy and stroke). If gradual onset must consider facial paralysis (due to acoustic neuroma, advancing petrositis, brain tumor or brain abscess).

  3. Does the lack of facial expression spare the forehead muscles?

    Why: e.g. if still able to furrow the brow and wrinkle the forehead, the cause of the lack of facial expression is most likely due to facial paralysis from a brain stroke or brain tumor.

  4. Is it unilateral or bilateral?

    Why: e.g. if both sides of the face are affected, this may suggest facial paralysis ( due to Guillain-Barre syndrome, bilateral parotid disease, primary muscle disease such as Dystrophia myotonica, motor neurone disease and myasthenia gravis).

  5. How would you explain your mood lately?

    Why: may provide information concerning the possibility of depression as a cause of flat affect.

  6. What are your stressors at the moment?

    Why: e.g. questions specifically about relationship, family, children, social support, occupation, general physical health and financial stresses - may provide information concerning the risk of depression.

  7. Have you had a facial injection of botox toxin?

    Why: this toxin is designed to smooth out minor facial wrinkles and thus can give an apparent lack of facial expression.

  8. History of head trauma?

    Why: may suggest fracture of petrous temporal bone causing a facial nerve palsy.

  9. Has there been a recent tick bite?

    Why: may suggest Lyme disease.

  10. Risk factors for stroke?

    Why: e.g. high blood pressure, high cholesterol, diabetes, smoking, atrial fibrillation, family history of early stroke.

  11. Past medical history?

    Why: e.g. Diabetes, strokes, multiple sclerosis, sarcoidosis, middle ear infection, Parkinson's disease, scleroderma, Wilson's disease.

  12. Past psychiatric history?

    Why: some psychiatric and psychological disorders feature an absence of expression on the face called a "flat affect" e.g. depression. Other less common psychological disorders with a flat affect include Autistic disorder and Asperger's syndrome. Blunting of affect is a disorder that may be seen in schizophrenia. The usual modulation of mood is lost, and the person lacks warmth, but does not convey the lowering of affect seen in severely depressed people.

  13. Medications?

    Why: e.g. oral contraceptive pill may increase the risk of stroke; some medications may increase the risk of depression e.g. beta-blockers, anti-Parkinson drugs, corticosteroids, anti-cancer drugs, non-steroidal anti-inflammatory medications, combined oral contraceptive pill, progesterone-only contraceptives.

  14. Family history?

    Why: depression, diabetes, stroke, multiple sclerosis.

  15. Paralysis or weakness of one side of the body?

    Why: If paralysis or weakness was of sudden onset consider stroke, extradural or subdural hematoma (blood clot). If weakness of body is on the opposite side to the facial paralysis consider brain stem thrombosis (clot) or hemorrhage (bleed). If the weakness of one side of the body is gradual in onset consider a brain tumor, brain abscess or brain degenerative disease.

  16. Ear ache or hearing loss?

    Why: should consider acoustic neuroma, petrositis, mastoiditis, herpes zoster and cholesteatoma.

  17. Symptoms of Bell's palsy?

    Why: e.g. marked weakness on one side of the face, mouth sags, drooling from the affected side of mouth, loss of taste on front of tongue, eye may water, pain behind the ear.

  18. Symptoms of depression?

    Why: e.g. depressed mood, crying spells, flat affect ( absence of expression on the face), anhedonia (loss of interest or pleasure), increase or decrease in appetite (usually decreased), weight loss or gain, insomnia or increased sleeping (usually early morning waking), fatigue, loss of energy, feelings of worthlessness, feelings of excessive guilt, poor concentration, difficulty making decisions, low libido, thoughts of death or suicide attempt.

  19. Psychotic symptoms?

    Why: e.g. hallucinations, delusions, disordered thought - may suggest schizophrenia but people with severe psychotic depression may also experience these symptoms, especially delusions. Blunting of affect is a disorder that may be seen in schizophrenia. The usual modulation of mood is lost, and the person lacks warmth, but does not convey the lowering of affect seen in severely depressed people.

  20. Symptoms of Parkinson's disease?

    Why: e.g. tremor of the fingers and thumbs, slowness of movement, stiff aching limbs, difficulty with fine movements, writing becomes small, fixed facial expression.

  21. Symptoms of Myasthenia gravis?

    Why: e.g. easy muscle fatigability especially eyelids, neck, shoulders, lower legs and trunk, droopy eyelids, double vision, weak voice, flat facial expression, facial expression difficulty.

Conditions listing medical symptoms: Lack of facial expression:

The following list of conditions have 'Lack of facial expression' or similar listed as a symptom in our database. This computer-generated list may be inaccurate or incomplete. Always seek prompt professional medical advice about the cause of any symptom.

Select from the following alphabetical view of conditions which include a symptom of Lack of facial expression or choose View All.

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