From recurrent peripheral facial palsy to multiple sclerosis.

Area of Science:

• Neurology
• Neuroimmunology

Background:

• Multiple sclerosis (MS) is primarily a central nervous system inflammatory disease, but peripheral nervous system involvement can occur.
• Peripheral facial palsy, specifically isolated seventh nerve palsy, is a rare presenting symptom of MS, occurring in 1.6% of patients.

Observation:

• A 35-year-old woman presented with isolated seventh nerve palsy, initially misdiagnosed as Bell's palsy.
• The patient experienced recurrent peripheral facial palsy, with supportive cerebrospinal fluid and MRI findings.
• A definitive diagnosis of MS was delayed until other neurological symptoms emerged, fulfilling dissemination in space criteria.

Findings:

• The case illustrates that isolated cranial nerve palsies can be the sole initial neurological manifestation of MS.
• Recurrent peripheral facial palsy, coupled with specific diagnostic markers, should raise suspicion for underlying MS.
• Complete recovery from the initial seventh nerve palsy was observed in this patient.

Implications:

• Clinicians should consider multiple sclerosis in the differential diagnosis of isolated or recurrent peripheral facial palsy, especially when diagnostic criteria are met over time.
• Early recognition and diagnosis of MS, even with atypical presentations, are crucial for timely management and intervention.
• This case underscores the diagnostic challenges and the importance of longitudinal assessment in neuroinflammatory diseases.