Bilateral Facial Nerve Palsy: A Diagnostic Dilemma

Pothiawala, Sohil; Lateef, Fatimah

doi:10.1155/2012/458371

Cited by 39 publications

(45 citation statements)

References 13 publications

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“…Various causes of lagophthalmos have been described in the past with facial nerve palsy being the most common. Nocturnal lagophthalmos can be seen in transient facial nerve involvement but we could not find any evidence linking facial palsy to hypernatraemia 6 7. Besides this, neurological examinations were normal in both the infants.…”

Section: Discussioncontrasting

confidence: 57%

Nocturnal lagophthalmos: never seen before in hypernatraemic dehydration

2014

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We present two cases in which a 10-month-old male infant and another 15-month-old female child presented with symptoms of sleeping with their eyes wide open (lagophthalmos) with features of gastroenteritis (GE) and dehydration. The first child had been seen and discharged the previous day from the paediatric emergency department (ED) with a diagnosis of GE. He presented the following day with sleeping discomfort with his eyes wide open and ongoing symptoms of GE. The second child presented to the ED with features of GE. She was found to be sleeping in the ED with her eyes wide open. Investigations of both children revealed hypernatraemic dehydration. Correction of the electrolyte imbalance in both cases over a period of 48 h led to the resolution of symptoms.

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Section: Discussioncontrasting

confidence: 57%

Nocturnal lagophthalmos: never seen before in hypernatraemic dehydration

2014

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“…Unlike unilateral facial nerve palsy, which is usually idiopathic, bilateral facial nerve palsy often indicates a serious underlying medical condition, which can include Lyme disease, sarcoidosis, Guillain-Barré syndrome, diabetic (mellitus) neuropathy, and multiple idiopathic cranial neuropathies. 1 Here, we report the case of a patient with syphilis who presented with bilateral facial nerve palsy as his initial symptom.…”

Section: Discussionmentioning

confidence: 97%

Bilateral facial nerve palsy as the sole initial symptom of syphilis: a case report

Ting

Wang

Lee³

et al. 2015

CJEM

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Bilateral facial nerve palsy is an exceedingly rare condition and presents a diagnostic challenge. Bilateral facial nerve palsy may result from cranial trauma, congenital abnormalities, inflammation, infiltration, or infection, but is rarely associated with syphilis. Here, we report a case of syphilis in which bilateral facial nerve palsy was the only initial symptom.A 22-year-old man presented at our emergency department with isolated bilateral facial nerve palsy. Results for initial serum and cerebrospinal fluid examinations were normal, including the rapid plasma reagin titer. One week later, the patient developed rashes on the torso, palms, and soles. At this time, a high serum rapid plasma reagin titer was detected, and the Treponema pallidum particle agglutination test was positive. Once the tests were confirmed, the patient admitted to a history of unprotected sexual behavior. Penicillin G treatment was effective, and a 3-month followup examination demonstrated a complete recovery.We recommend that syphilis be considered when diagnosing sexually experienced young men presenting with bilateral facial nerve palsy, even in the absence of skin manifestations. Failure to recognize facial signs of syphilis could result in inappropriate management, affecting the patient's clinical outcome. RÉSUMÉLa paralysie bilatérale du nerf facial est un trouble extrêmement rare, qui pose des difficultés de diagnostic. La paralysie bilatérale du nerf facial peut résulter d'un traumatisme crânien, d'anomalies congénitales, d'une inflammation, d'une infiltration ou d'une infection, mais elle est rarement associée à la syphilis. Sera exposé ici un cas de syphilis dans lequel la paralysie bilatérale du nerf facial était le seul symptôme initial de la maladie.Un homme de 22 ans est venu consulter au service des urgences pour une paralysie bilatérale et isolée du nerf facial. Les analyses sérologiques et l'examen du liquide céphalorachidien se sont révélés normaux au départ, y compris le test rapide de la réagine plasmatique. Toutefois, une semaine plus tard, des éruptions cutanées sont apparues sur le tronc, la paume des mains et la plante des pieds. Un titre élevé de réagine plasmatique a alors été détecté au test sérologique rapide, et l'épreuve d'agglutination passive de Treponema pallidum s'est avérée positive. Une fois les résultats confirmés, le patient a admis avoir eu un comportement sexuel risqué dans le passé. Le traitement par la pénicilline G a agi efficacement, et l'examen de suivi au bout de 3 mois a permis d'établir l'obtention de la guérison complète.Les auteurs recommandent donc que soit envisagé le diagnostic de syphilis chez les jeunes hommes ayant une vie sexuelle active et présentant une paralysie bilatérale du nerf facial, même en l'absence de manifestations cutanées. Le fait de ne pas reconnaître les signes faciaux de la syphilis pourrait conduire à une prise en charge inadaptée, et se répercuter sur les résultats cliniques.

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“…A documented case report which may underscore this theory describes a woman who presented to the emergency department with an acute bilateral facial nerve palsy of unknown etiology [13]. Bilateral facial palsy is extremely rare with an incidence only 1 per 5 million patients.…”

Section: Discussionmentioning

confidence: 99%

The Development of Guillain-Barre Syndrome (Gbs) in Association with Confirmed Lyme Disease. A Potential Autoimmune Response in Gbs Secondary to Tick-Borne Diseases?

Awan¹

2015

Clin Microbiol

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Vector borne diseases have been associated with a number of autoimmune diseases. In this case we report a 73 year old woman initially diagnosed with lyme disease who subsequently developed guillain-barre syndrome (GBS). Her relevant clinical presentation included protean symptoms of numbness and progressive weakness in her legs for three weeks prior to consultation by the neurology service. A lyme ELISA and confirmatory Western Blot testing were unequivocally positive. A clinical diagnosis of CNS lyme disease was made. Additional clinical evaluation included: electrophysiological testing, which demonstrated significant polyneuropathy consistent with demyelinating pathology. A lumbar puncture with cerebral spinal fluid analysis revealed a non-reactive VDRL, negative lyme DNA PCR, positive lyme IgG antibody and an elevated protein-elevated albumin with normal white count. Upon further clinical deliberation this constellation of signs and symptoms was determined to be more consistent with a diagnosis of GBS rather than CNS lyme disease. Initiation of medical therapy included IVIG (intravenous immunoglobulin) and parenteral ceftriaxone. This case may report an additional vector of disease in patients presenting with clinical signs and symptoms of GBS.

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Bilateral Facial Nerve Palsy: A Diagnostic Dilemma

Cited by 39 publications

References 13 publications

Nocturnal lagophthalmos: never seen before in hypernatraemic dehydration

Nocturnal lagophthalmos: never seen before in hypernatraemic dehydration

Bilateral facial nerve palsy as the sole initial symptom of syphilis: a case report

The Development of Guillain-Barre Syndrome (Gbs) in Association with Confirmed Lyme Disease. A Potential Autoimmune Response in Gbs Secondary to Tick-Borne Diseases?

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