Yeah too often to get that done so I was phone on I I was on the phone I was was just on like refusing this morning to communicate with you too looking for a smear area for the right to left atrium tube it's made the pain itself a little bit either because any of you may need to be diagnosed he does have an obgyn for 2 previous years and he's under cardiologist because he has a very he's quite bloody naturally and he keeps having these episodes where he goes really bruddy don't know why mhmm but I don't know real like pattern good it's just he's had these like background headaches for about a week so all quite normal they're adult ache about 5 out of 10 but it's been managing with paracetamol and then this morning he's had this headache and then he's had that's headache associated with the facial droop as well yeah but it's no kind of worse than usual and not like a sudden sudden panic or anything it's just kind of a sort of general background headache yeah and it gets worse no no no no no no no no no no it's a pen for it yeah I'm not sure I'm gonna off my foot I'm so hard what what's going on with this I'm gonna be fine other than the fact can you rest back down the line there because I'm gonna go out okay I'm back hang in the back yeah same missus demba yes hi I'm ross I'm 1 of the medical instruments nice to meet you how are you not too bad what's been happening then I just I don't know that right it's a rather strange thing you're right about and you've had a headache for a while understand yeah fine tell me about that like a migraine mhmm it wasn't the right thing what makes you say migraine do you have migraines before well it's like a migraine mhmm but I don't resist it for less week or 2 mhmm a week or 2 of migraine yeah it keeps coming and going but it's always on its right side mhmm mhmm that's it that's it fine alright and any weakness in any part of your body my right your mouth in in what ways my eye can't shut my eye properly right you can't shut which eye this 1 the right eye yeah yeah fine fair enough and have you been feeling well lately have you had any coughs coughs or colds or anything like that no no I have any ear symptoms cough yeah I had ear symptoms you had ear symptoms a little tone in my ear when was that like 4 weeks ago but I had it for like 9 weeks and what kind of stuff is coming out brown fluid brown fluid from your ear yeah very serious ear infection yeah could easily be sometimes you can get this weird effect on the nerves in the face which we call bell's palsy when you have an ear infection recently it can affect the nerves people always tell me that they can't close their eyes on that side it causes a slight facial droop so I think that's probably what's going on but obviously you've come here rushed to consider a stroke so it's worth considering it do you mind if I examine you quickly I'd to come round and come in the back now that's alright that's a rough cut as well there alright yeah so okay it's a privilege to be down when it's in 10 minutes yes like to you to increase your eyes for me on both sides nice and tight that's great lovely can you blink your eyes for me that's great what month february and how old are you don't know so I have to trust you that's the best that's fine thank you can I just ask you to follow my finger with your eyes that's great that's fine next I'll just test the fields of your vision I'll cover your eye up alright can you see my hand here yeah and keep looking at my face can you see my finger here and here yeah that's great and keep looking at my face can you see it just in the corner of your vision here yeah and here yeah lovely stop sides for me here yeah here yeah and here yeah lovely everyone normal then so then you've got do you have this slight droop on the right hand side of your face can you lift your eyebrows up at all fine so a little bit weak on that side as well yeah fine can you scrunch your eyes up really tight that's fine don't let me open that's great puff out your cheeks give me a big smile again can I see your tongue can you say ah ah lovely that's thank you your left arm can I ask you to just lift it up for me and just hold it up I'll just count to 10 1 2 3 4 5 6 7 8 9 10 that's lovely and then I'll ask you to do the same with your right hand you might need a bit of help thank you I you won't bryce 1234678910 that's great thank you very much can I ask you to do the same with your legs lift 1 of them up for me don't mind which 1 2 3 4 5 that's great you can rest that down and show me the other 1 1 2 3 4 5 that's lovely touching your nose and then touching my finger I don't mind with which hand that's great yeah and the other lovely can I see a bit more with your right hand is that alright and your nose again and to my finger big nose it's a bit difficult isn't it think it's not helping I think you're making it harder it's a great job job and again she's much better with the legs was your day at work because you're down to it actually we're on the back of our head I don't she's very strong in my legs as I usually do I'm fine good balance that's great thank you that's great and can you feel me touching you here and here do you feel the same on both sides yes how about here on your ankles feel the same yes and on your face is there any sensory changes feels the same on both sides that's good I need to ask you to just have a look at these for me can you tell me what some of those objects are bike bucket ride truffle oaks fantastic can you read some of these words for me no chit chop 50 50 do you think your speech is a bit slurred or not really yeah little bit a little bit it's tiny bit isn't it yeah fine next I'll just ask you to tell me which of my hand is moving down mhmm down down down that's great that's the end of my assessment which is fine I think this is a bell's palsy of the side of the face I think we usually get some blood tests from people to make sure there's nothing else causing it I think that'd a reasonable thing to do we can start you on some steroids to make sure there's nothing else causing it in your head does that sound alright yeah have you fallen and hit your head lately no not in any bites or anything like that not in any hit your head good that's fine sometimes it can be from trauma to the nerve in the face alright very good I'll go and we'll get some blood tests in a and e make sure that everything's okay I'll check my boss to make sure they're happy with it as well and then we'll try and get you out of here we usually give people a course of steroids which is a medicine to dampen down the inflammation which affects the nerve in those people right okay yeah alright alright guys have you seen did you notice that it involves the forehead have you guys seen it just yeah for their yeah show us again with you come and see you can we come around and see you what do you think come on walkie dance don't don't don't it's cruel he's cruel it's interesting to see for these guys who see it on the variety of strokes the people who are worried about strokes so show us your lime flowers again nice and fine so you see how the right eyebrow doesn't really move nearly as much as the left see the crinkles on the left and there's no crinkles on the right that's because the nerve that supplies the forehead comes from both sides of the brain so if have a forehead sparing lesion it'll be from 1 side of the brain so the forehead will move normally because it gets supplied from both cerebral hemispheres so you have a stroke on 1 cerebral hemisphere the other 1 will take over and you'll still be able to raise your eyebrows in this case can't lift your eyebrow up which means that the lesion the problem is in the nerve that supplies that part of the eyebrow the facial nerve this is a facial nerve palsy which does cause it right yeah which can happen as you say after a recent fungal infection I'll go and chat to my boss make sure they're happy as I say and then get you in and get some blood tests from you so you probably need scan then because obviously you're pretty confident on what it is perfect my boss may feel differently I doubt it I I think more frequently and so it's just steroids then you usually give a course of steroids yeah so a week's of high dose steroids as for other things in background that can inflame the facial nerve we did say we didn't we were not really like yeah without limb weakness I think 1 should always should be thinking is this is what you're doing we did have that this talk in about blood clots but we weren't confident enough yeah yeah you know that's my job isn't it to to see lots of people with this cool glad to see you thank you yeah that's fine awesome we'll come back and get some blood tests and get everything sorted alright lovely it was nice to meet you next time thank you thank you so much boss it's pleasure good can you do second I'm wrong wrong wrong I'm I suspect she's got a rash it's like a snake it's okay I'm not sure yeah if we can get cream for it parasternal short no this is subcostal subcostal yeah she won't really do any para therapeutic surgery there's a discontinuity I think she's blown up think down in in in her in which is a horrible thing so this is lv and then there's discontinuity here then into the artery or into the artery I think it's contained in the I think this is an either abscess or a contained rupture of her yeah of her interior of her would say in the taboo yeah that's a good step definitely have the order I can see there's the mitral valve yeah I believe it's probably more thickened than you that is the flow doesn't seem to be as static or anything like that and then I think you no no I'm just gonna have to look at the ekg so it's sort of very depressed I see no I now I appreciate the anatomy alright there's the rv there's the lv and then this fluid filled with continuity as you say I think yeah and it's got blood flow in it so it's got so it's got yeah it's it is connected by the ventral side yeah there's is this 20 I don't know I don't think that's the oh no because that's the ivc ivc coming in and that's to the right atrium and then I thought you'd they'd tell you because I told you about it I said oh got this in the world I said oh no we would never do anything without this in the world wow it's it's a great deal it's it's a a it's is a prisoner yeah in the show as well and has had a sore ear and had ear exudate coming out last month and now presents for the right sided face 3 is it right ear