[Peripheral facial paralysis as the first symptom of unknown metastatic primary tumor]

The spread of metastases to the brain and the leptomeninges is usually a terminal event in patients with known malignancies. We report on two patients, in whom the diagnosis of a diffusely metastasizing carcinoma was considerably delayed by the initial symptom of a peripheral facial nerve paralysis. The clinical, neuroradiologic and cerebrospinal fluid findings are discussed. A malignant neoplasm with diffuse or focal metastasis to the leptomeninges is a rare cause of peripheral facial paralysis of unclear genesis. The necessity of a lumbar puncture plus magnetic resonance imaging of the brain to enable an early diagnosis is emphasized.