Sequential contralateral facial nerve palsies following COVID-19 vaccination first and second doses

Abstract

A 61-year-old man presented to the ENT emergency clinic with a history of unilateral facial nerve palsy occurring shortly after each dose of the Pfizer-BioNTech COVID-19 vaccine. The first episode developed 5 hours after administration of the first dose and the second 2 days after administration of the second dose. Investigations at initial presentation to the emergency department were unremarkable, and the patient was diagnosed with Bell’s palsy on both occasions. We describe the first case of Bell’s palsy occurring after each dose of any UK-approved COVID-19 vaccine. Single episodes of unilateral facial nerve palsies have been reported in clinical trials and in subsequent case reports. There has been no evidence, however, of an episode after each dose. We also describe the earliest onset of symptoms from timing of administration of the vaccine, further suggesting the Bell’s palsy was associated with the vaccine.

Left Bell's palsy following the first dose of mRNA-1273 SARS-CoV-2 vaccine: A case report

“…We can assume that the timing of Bell's palsy onset after mRNA vaccine administration varies, with early manifestation occurring as early as 5 h after vaccination, as reported in a male patient who received BNT162b2 and developed recurrent Bell's palsy after the second dose of vaccine. 8 In this case, the first episode occurred 5 h after the first dose was administered, and the second occurred 2 days later.…”

“…, 7. , 8. ; a recent study analyzed the reported frequency of neuralgic amyotrophy, Bell's palsy, and Guillain-Barrè syndrome in VigiBase, the World Health Organization's (WHO) global database of suspected adverse drug reactions, in patients who received COVID-vaccine.…”

“…The most accredited hypotheses are the reactivation of latent Herpes Simplex Virus type 1 in the geniculate ganglia of the facial nerves, an autoimmune mechanism through the mimicry of host molecules by the antigens of the vaccines, or an immune-mediated demyelination analogous to Guillain-Barrè syndrome. 5 Until recently, the data available in the literature about the development of Bell's palsy after administration of post-mRNA vaccines in the general population were limited, consisting mainly of case reports [5][6][7][8] ; a recent study analyzed the reported frequency of neuralgic amyotrophy, Bell's palsy, and Guillain-Barrè syndrome in VigiBase, the World Health Organization's (WHO) global database of suspected adverse drug reactions, in patients who received COVID-vaccine. 9 Regarding Bell'palsy, the authors stated that this disorder was disproportionately more frequently reported with COVID-19 vaccines than with other viral vaccines over the full database, with a higher frequency in males and in the age subgroup 65-74 years and ≥75 years.…”

Multiple cranial nerve palsies following COVID‐19 vaccination—Case report

“…Several cases are reported of peripheral facial palsy after immunization with PBV: a patient with two episodes of contralateral Bell's palsies arising shortly after inoculation with the first and second dose of the PBV 5 and other cases of unilateral facial palsy occurring 36 h after the second dose. 6 Another published case involved abducens nerve palsy 2 day after PBV.…”

Disproportionality analysis of adverse neurological and psychiatric reactions with the ChAdOx1 (Oxford-AstraZeneca) and BNT162b2 (Pfizer-BioNTech) COVID-19 vaccines in the United Kingdom

“…Some cases of Bell’s palsy have been reported after receipt of either the BNT162b2 or mRNA-1273 vaccine. [22,28,29] Furthermore, the estimated rate ratio of Bell’s palsy among participants of BNT162b2 and mRNA-1273 clinical trials assigned to the vaccine group versus those receiving placebo was 7.0 (p=0.07), suggesting a strong association. [17] Similarly, we observed an increased frequency of Bell’s palsy and some of its symptoms, such as facial paralysis and dysgeusia,[30] after BNT162b2 vaccination.…”