Facial Palsy, Hypoacusis and Vertigo as Inaugural Symptoms of Neuroborreliosis - Case Report

Jb Da Costa

doi:10.37871/jbres1235

Abstract

Introduction: Facial Palsy (FP) is the most common acute mononeuropathy and consists of a decrease in facial muscle strength due to facial nerve damage. Peripheral FP (PFP) can result from a wide variety of disorders and aetiologies, with Lyme Disease (LD) being considered one of the most common causes of FP. LD is an infectious disease that affects the central nervous system, causing Neuroborreliosis (NB) in 15% of cases. Cranial neuropathy is the most common form of presentation of NB, as uni or bilateral PFP. We describe a case of PFP with hypoacusis and vertigo as the inaugural presentation of neuroborreliosis. Case Report: We present a case report of a 75-year-old female patient, referred to ENT consultation due to a 3-day course of a grade 4 right PFP, moderate right sensorineural hearing loss and right vestibular hypofunction. The patient underwent cranioencephalic Computed Tomography (CT-CE) which excluded a central event and was treated with 2 cycles of oral corticosteroids, without any clinical improvement. A Magnetic Resonance Imaging (MRI) was performed, which showed an abnormal inflammatory uptake of the right facial nerve. An analytical positivity for Borrelia IgM was found and the diagnosis of polyneuropathic NB with involvement of the VII and VIII right cranial pairs was assumed. The patient completed 28 days of doxycycline, with FP and vertigo improvement and normalization of hearing acuity. Discussion/Conclusion: In the presented case, the absence of the classical migratory erythema or painful meningopolyneuritis didn’t exclude the diagnosis of NB. FP associated to signs of other cranial nerves involvement raised the hypothesis of a systemic polyneuropathic disease, which motivated the etiological investigation carried out.

Highlights

INTRODUCTIONHow to cite this article: da Costa JB, Barreto J, Neno M, Duarte D, Viana M
Facial Palsy (FP) is the most common acute mononeuropathy and consists of a decrease in facial muscle strength due to facial nerve damage
We describe a case of Peripheral FP (PFP) with hypoacusis and vertigo as the inaugural presentation of neuroborreliosis

Summary

INTRODUCTION

How to cite this article: da Costa JB, Barreto J, Neno M, Duarte D, Viana M. The ELISA test was repeated and showed positivity for Bb IgM and negativity for IgG and a new MRI was performed, exhibiting a decrease in contrast uptake in the right FN, with disappearance of contrast uptake in the nerve segment at the bottom of the IAC, in its labyrinthine segment and in the geniculate ganglion, persisting a linear contrast uptake in the tympanic and mastoid segments of the nerve (Figure 5). There was a clinical improvement of FP from grade 4 to grade 2-3, the hearing acuity normalized to pre-borreliosis levels (a bilateral and Figure 5 Coronal T1 + Gd; Minor enhancement along the right facial nerve, with disappearance of contrast uptake in the segment in the internal auditory canal, in the labyrinthine segment and in the geniculate ganglion, showing linear contrast uptake in the tympanic segment (red arrow) of the facial nerve. The patient remains without any clinical worsening of disease

Findings

DISCUSSION

CONCLUSION