Is that a facial nerve palsy or are you just sad to see me?

It's always satisfying when your memory kicks in when it's needed. Fortunately, this happened yesterday when I saw an elderly gentleman for the first time, carefully escorted into the consulting room by his wife.
While husband and wife agreed Mr A wasn't quite himself, more specific details were difficult to elicit. Eventually I gleaned that Mr A had prostate cancer with bony metastases, was considered stable by his specialist, but had been 'sleepy' for a few days. No vomiting, no headache. Strikingly, neither husband or wife mentioned the bleeding obvious, Mr A's facial assymetry.
My questions on this point revealed that Mr A didnt know what on earth I was talking about but that Mrs A had also noticed her husband's mouth had taken on a certain diagonal quality.
This is where the memory banks came in, for the immediate question was whether he had an upper or lower motor neurone lesion. Sure, it's medicine 101, but to be honest it had been a while since an instant verdict was needed on this one.
Fortunately, the bilateral upper motor neurone innervation of the upper face was still somewhere in my brain's deeper recesses, and the presence of a left sided pronator drift confirmed the probability of an intracerebral lesion, although on this one my memory perplexed me by suggesting prostate metastases rarely went to brain.
Interestingly but sadly, a head CT revealed multiple metastases, perhaps prostate but most likely melanoma. Unbenown to our practice, Mr A had had a melanoma removed decades before.
If you'd like a brush up on upper versus lower motor neurone lesions, go to
http://clinicalcases.blogspot.com/2004/09/stroke-or-bells-palsy-facial-droop.html