Abstract

BackgroundBilateral facial nerve palsy is a relatively rare presentation and often points to a serious underlying medical condition. Several studies have reported presentation of bilateral facial nerve palsy in association with Lyme disease, Guillain-Barre syndrome, systemic lupus erythematosus, human immunodeficiency virus, sarcoidosis, diabetes and Hanson disease. While unilateral facial nerve palsy is sometimes associated with hemiplegia in sickle cell patients, no case of bilateral facial nerve palsy have been reported in the literature.Case presentationA 29-year-old black African woman who is a known homozygous haemoglobin S (HbSS) presented with bilateral facial nerve palsy. She had the said condition 2 months post delivery of her first child and reported for physiotherapy 3 months post incidence. The pre-treatment House Brackmann Facial Grading Scale (HBFGS) Scores were 3 for right side and 4 for left side. This patient was not on any medication for the facial palsy. After 4 sessions of combination therapy consisting of faradism, facial exercises and massage there was remarkable improvement in the neurological status of the facial muscles. The post treatment House Brackmann Facial Grading Scale score was 2 bilaterally.ConclusionBilateral facial nerve palsy may be an initial presentation of sickle cell anemia patients in the absence of other overt clinical presentations. Therefore sickle cell anemia should be considered among others, in the differential diagnosis of bilateral facial nerve palsy. Furthermore, this case report has highlighted the important role of physiotherapy in the management of bilateral facial nerve palsy.

Highlights

  • Bilateral facial nerve palsy is a relatively rare presentation and often points to a serious underlying medical condition

  • Bilateral facial nerve palsy may be an initial presentation of sickle cell anemia patients in the absence of other overt clinical presentations

  • Sickle cell anemia should be considered among others, in the differential diagnosis of bilateral facial nerve palsy

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Summary

Introduction

Bilateral facial nerve palsy is a relatively rare presentation and often points to a serious underlying medical condition. Case presentation: A 29-year-old black African woman who is a known homozygous haemoglobin S (HbSS) presented with bilateral facial nerve palsy She had the said condition 2 months post delivery of her first child and reported for physiotherapy 3 months post incidence. The pre-treatment House Brackmann Facial Grading Scale (HBFGS) Scores were 3 for right side and 4 for left side This patient was not on any medication for the facial palsy. While most unilateral facial palsy is idiopathic, with bilateral facial palsy an aetiological factor is often demonstrable [4] The majority of these cases are due to serious underlying medical conditions such as Lyme disease, Guillain-Barre syndrome, leukaemia, sarcoidosis, infectious mononucleosis and trauma and may need emergency medical treatment. 20% of these cases are due to idiopathic or Bell’s palsy where no evidence of systemic or local disease can be found [3]

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