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AAEM case report #26: seventh cranial neuropathy

J M Gilchrist¹

¹Department of Clinical Neurosciences, Brown University School of Medicine, Rhode Island Hospital, Providence.

|May 1, 1993

Summary

Lyme disease can cause acute facial palsies. This case highlights differing nerve injury types (neurapraxic vs. axonopathic) in bilateral facial paralysis, impacting recovery outcomes.

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Area of Science:

Neurology
Infectious Diseases

Background:

Facial palsy can arise from various causes, including infections like Lyme disease.
Bilateral facial palsies are less common but present diagnostic challenges.

Observation:

A 25-year-old male presented with acute, bilateral facial palsies.
He had lymphocytic meningitis, a history of tick bites, and resided in a Lyme-endemic area.

Findings:

Serology confirmed Lyme disease.
Electrodiagnostic studies revealed a neurapraxic lesion on the right and an axonopathic lesion on the left.
Clinical course showed full recovery on the right and persistent plegia on the left.

Implications:

Lyme disease can cause distinct electrodiagnostic patterns in facial nerve lesions.
Differential nerve injury types explain varied recovery in bilateral facial palsies.
Electrodiagnostic evaluation is crucial for assessing facial palsy severity and prognosis in Lyme neuritis.

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