To assess facial droop in a suspected stroke, which command best assesses facial symmetry?

• A. Pucker lips and whistle for me
• B. Wrinkle your forehead for me
• C. Follow my finger with your eyes
• D. Please smile for me while looking upward at the lights

Answer: (D)

Assessing facial weakness from stroke relies on how the facial muscles respond to a voluntary smile. The forehead muscles receive bilateral input, so asking someone to wrinkle their forehead can look normal even with a facial palsy. A smile, however, engages the lower-face muscles that are more clearly affected by a unilateral stroke. If one side is weak, the mouth corners and cheek on that side don’t rise evenly, producing noticeable asymmetry. Having the patient smile while looking upward at lights helps standardize the effort and makes any asymmetry easy to observe. Other commands test areas less sensitive to unilateral weakness or focus on eye movements, which don’t directly reveal facial droop.