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Published on: March 1, 2015
Bilateral Peripheral Facial Nerve Palsy: A Rare Clinical Picture.
Tim Geisselmaier1, Almir Husic1, David Dashti2
1Department of Internal Medicine, University Center of Internal Medicine, Cantonal Hospital Baselland, Liestal, Switzerland.
Summary
Bilateral peripheral facial palsy (BPFP) is rare. This case highlights a patient with BPFP, hoarseness, and a history of thrombotic thrombocytopenic purpura and Crohn's disease, responding to steroid treatment.
Area of Science:
- Neurology
- Immunology
Background:
- Bilateral peripheral facial palsy (BPFP) is an uncommon condition often linked to systemic diseases.
- A comprehensive diagnostic approach is crucial for identifying the underlying cause of BPFP.
Purpose of the Study:
- To report a rare case of sequential bilateral peripheral facial palsy (BPFP) in a patient with a complex medical history.
- To discuss the diagnostic challenges and potential pathophysiological links in BPFP.
Main Methods:
- A case report of a 65-year-old male presenting with sequential BPFP and hoarseness.
- Diagnostic work-up included MRI, extensive laboratory testing (infectious, autoimmune, malignancy), and cerebrospinal fluid analysis.
- Treatment involved prednisolone (1 mg/kg body weight).
Main Results:
- The patient presented with severe BPFP (House-Brackmann Scale VI) and hoarseness.
- MRI revealed bilateral facial nerve enhancement (neuritis facialis) without stroke or demyelination.
- Extensive testing ruled out common infectious, autoimmune, and malignant causes.
- Treatment with prednisolone resulted in significant clinical improvement (House-Brackmann Scale II) and resolution of hoarseness.
Conclusions:
- This case underscores the importance of a broad differential diagnosis for BPFP.
- While type 2 diabetes was a risk factor, the association with prior thrombotic thrombocytopenic purpura and Crohn's disease is exceptional, suggesting potential shared mechanisms.
- Steroid therapy proved effective in this patient.
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