Lower Motor Neuron Facial Nerve Research Articles

Uncommon Bilateral Idiopathic Facial Nerve Palsy (Bell's Palsy) in an Infant: An Atypical Age and Clinical Challenges Explored: A Case Report.

Our case study explores Bell's palsy, a rare lower motor neuron facial nerve paralysis, particularly rare in newborns. While often idiopathic, it can stem from congenital or developmental factors. Unilateral facial paralysis is more prevalent, with Bell's palsy accounting for more than 50%, while bilateral facial paralysis is exceptionally rare. We present a distinctive case of idiopathic Bell palsy in a 3.5-month-old infant, initially affecting the right side and spontaneously resolved within 30 days, followed by involvement on the left side a month later. Despite comprehensive evaluations and treatment, persistent facial weakness was observed on the left side. The patient initially responded well but faced ongoing challenges during the second attack. Our findings underscore the need for further research to improve the understanding and management of these cases.

Facial nerve palsy following bee sting: a case report

One of the most common insect poisoning is bee sting. It can produce local symptoms such as pain, redness, and fever following a local pain. Rarely, anaphylaxis, myocardial infarction, organ failure, epilepsy and other neurological diseases have been reported. Lower motor neuron facial nerve palsy is one of the common diseases of the Otorhinolaryngology clinic. Although it is usually idiopathic, trauma and tumors are the two most common causes. Usually, it is diagnosed clinically and the grade of palsy is based on House Brackmann Classification. We present a case of left Bell’s palsy due to bee sting. A 21-year-old male patient was referred to our clinic for persistent incomplete eye closure for two weeks duration. Upon further history, he complained that prior to the left sided facial weakness he was stung by a bee the night before on his left toe and developed the facial weakness when he woke up in the morning. He did not get immediate treatment. Clinically he had Grade III left lower motor neuron facial nerve palsy. Other ear, nose and throat examinations were unremarkable. He was treated with oral steroid and eye care. One week upon follow up, his facial weakness was completely resolved.

Tuberculosis manifesting as bilateral acute parotid swelling with unilateral lower motor neuron facial palsy: an unusual presentation

A 41-year-old female presented to the otorhinolaryngology department with a history of painful swelling over the bilateral parotid region, low-grade fever for the past one month and progressively worsening left-side facial weakness for the last 15 days. She had received multiple courses of antibiotics elsewhere, which did not result in any improvement except pain. She had no past history of any comorbidities or any previous history of tuberculosis. Examination revealed that she had a non-tender, circumscribed, solitary, 3×3 cm size, firm swelling over the bilateral parotid region. Clinical signs of grade V facial nerve palsy (House and Brackmann classification) were noted. There was a severe grade left lower motor neuron facial nerve palsy (left side) seen. There was no cervical lymphadenopathy. The rest of the head and neck examination was unremarkable. Fine needle aspiration cytology (FNAC) from the most prominent part of the swelling was suggestive of granulomatous inflammation. The patient was initially treated with intravenous antibiotics, supportive care and started on antitubercular drugs (once the diagnosis was established) under the National Tuberculosis Eradication Program (NTEP) to which she responded well and after three months of therapy, her swelling and facial weakness improved significantly. In addition to reporting a completely rare kind of presentation, this paper reviews relevant literature and stresses the need for a high degree of suspicion for tuberculous parotitis in a patient with bilateral parotid swelling. The use of fine needle aspiration is important so that this curable condition can be diagnosed early and medically treated. In this way, surgical intervention can be avoided and further complications can be prevented.

Prevalence of facial nerve palsy in the neuro-medicine private clinic

Background. Due to dysfunction of the facial nerve (CN VII), Bell’s palsy occurs which is a facial paralysis of unknown cause, but viral infection is suspected. The study aims to determine the prevalence of facial nerve palsy in a private clinic in Basrah. Methods. The study was conducted at a private clinic and involved sixty-five patients with facial nerve palsy. It was a cross-sectional study in which any patient who attended the clinic and exhibited signs and symptoms of lower motor neuron facial nerve palsy underwent an examination to confirm the diagnosis and, if confirmed, were included in the study. While patients with other neurological disorders were excluded. Data collection started between October 1, 2022, and April 30, 2023. A total of 65 patients from the private clinic—males and females—aged from 4 to 70 years old were confirmed as having lower motor neuron facial nerve palsy. Results. This study at a private clinic found that Bell’s palsy was the most common facial paralysis, affecting more males than females and most of the patients in the age range of 18-39 years, also affecting mostly the left side, with onset more frequent during hot and cool weather conditions. Diabetes was significantly related to the onset of Bell’s palsy and weather temperature at the time of the clinic visit. Conclusion. Bell’s palsy has a peak age prevalence in the second and third decades of life, and temperature variations have no effect on the occurrence of Bell’s Palsy. Further studies are needed for an accurate estimation of the number of cases, to assess the severity, impact, and efficacy of Bell’s palsy management.

Incomplete Kawasaki Disease with Peripheral Facial Nerve Palsy and Lung Nodules: A Case Report and Literature Review

The diagnosis of Kawasaki disease (KD) is challenging and often delayed mainly in case of young infants and in presence of an incomplete disease and atypical features. Facial nerve palsy is one of the rare neurologic symptoms of KD, associated with a higher incidence of coronary arteries lesions and may be an indicator of a more severe disease. Here, we describe a case of lower motor neuron facial nerve palsy complicating KD and perform an extensive literature review to better characterize clinical features and treatment of patients with KD-associated facial nerve palsy. The patient was diagnosed at the sixth day of disease and presented extensive coronary artery lesions. A prompt treatment with intravenous immunoglobulins, aspirin and steroids obtained a good clinical and laboratory response, with resolution of facial nerve palsy and improvement of coronary lesions. The incidence of facial nerve palsy is 0.9-1.3%; it is often unilateral, transient, more frequent on the left and seemingly associated with coronary impairment. Our literature review showed coronary artery involvement in the majority of reported cases (27/35, 77%) of KD with facial nerve palsy. Unexplained facial nerve palsy in young children with a prolonged febrile illness should prompt consideration of echocardiography to exclude KD and start the appropriate treatment.

Eight-and-a-half syndrome as the first presentation of multiple sclerosis in an Asian male: a case report

BackgroundMultiple sclerosis is a diffuse chronic demyelinating disease of the central nervous system. It is relatively uncommon in the Asian population and even more so in males. Despite the usual involvement of the brainstem, eight-and-a-half syndrome remains a rare first presentation in multiple sclerosis. Only a few cases have been reported previously, but none involving the Asian population. Eight-and-a-half syndrome, a neuro-ophthalmological condition, is characterized by one-and-a-half syndrome with ipsilateral lower facial nerve palsy, which localizes lesions to the pontine tegmentum. This case report demonstrates the first case of eight-and-a-half syndrome as the first presentation of multiple sclerosis in an Asian male.Case presentationA healthy 23-year-old Asian man presented with sudden onset of diplopia followed by left-sided facial asymmetry for 3 days. Assessment of extraocular movement revealed left conjugate horizontal gaze palsy. On right gaze, there was limited left eye adduction and horizontal nystagmus of the right eye. These findings were consistent with a left-sided one-and-a-half syndrome. Prism cover test revealed left esotropia of 30 prism diopters. Cranial nerve examination showed left lower motor neuron facial nerve palsy, while other neurological examination was normal. Magnetic resonance imaging brain showed multifocal T2 fluid attenuated inversion recovery hyperintense lesions, involving bilateral periventricular, juxtacortical, and infratentorial regions. A focal gadolinium contrast-enhanced lesion with open ring sign on T1 sequence was seen at the left frontal juxtacortical region. Multiple sclerosis was diagnosed on the basis of the clinical and radiological evidence, which fulfilled the 2017 McDonald criteria. Positive oligoclonal bands in cerebrospinal fluid analysis further confirmed our diagnosis. He had a complete resolution of symptoms 1 month after a course of pulsed corticosteroid therapy, and was subsequently placed on maintenance therapy with interferon beta-1a.ConclusionThis case illustrates eight-and-a-half syndrome as the first presentation of a diffuse central nervous system pathology. A wide range of differential diagnoses needs to be considered in such a presentation as based on the patient’s demographics and risk factors.

Isolated Lower Motor Neuron Facial Nerve Palsy as a Presenting Sign in COVID-19 Associated Orbital Mucormycosis Patients: A Retrospective Observational Study

Purpose: The main purpose of this study is to emphasize that isolated facial nerve involvement can be the first presenting symptom in patients suspected of COVID-associated Mucormycosis (CAM). Methods: This study is a retrospective observational study conducted at a tertiary care referral center which included patients with a history of CAM, who presented with isolated facial nerve palsy as initial presentation between March 2021 to March 2022 along with their follow-up. All the patients were managed with combined modality treatment with antifungal therapy and debridement of the necrotic tissue and fungal debris. Results: There were 184 eyes of 148 patients diagnosed with CAM. All patients developed rhino-orbital mucormycosis (ROM) following the COVID-19 infection and the duration between diagnosis of COVID-19 and ROM was 36±23 days. 42(28%) patients presented with isolated Facial Nerve Palsy (FNP) as the initial presentation. The mean age was 48.5 years (range 38 to 67years) with a male predominance of 29 (69%). All were unilateral cases and were of Lower motor neuron type presentation. All the patients (100%) were treated with systemic Liposomal amphotericin-B and sinus debridement. At a mean follow-up of 13.1 months, 19 (45%) of the patients had improvement in Facial Nerve function and 23 (55%) had static functioning. None of them had worsened. With medical intervention and tarsorrhaphy, the corneal condition was improved in all patients. Conclusion: Isolated FNP is an unusual but important sign in the presentation of mucormycosis which can be misdiagnosed with a cerebrovascular accident leading to delay in the management. This is a large case series with isolated FNP in CAM cases. A high index of suspicion for mucormycosis in diabetic patients presenting with isolated facial palsy can save the life and salvage the eye.

A rare diagnosis of nine syndrome: Clinical, imaging findings, and literature review

In this article, we reported a rare case of nine syndrome, which is characterized by clinical signs of the one-and-a-half syndrome, ipsilateral facial palsy, contralateral hemiparesis, hemihypesthesia, or ataxia. A 44-year-old male presented with sudden onset of double vision for 3 days. Examination revealed left horizontal gaze palsy, internuclear ophthalmoplegia, left lower motor neuron facial nerve palsy with right hemiplegia, and hemihypesthesia. Magnetic resonance imaging brain showed evidence of acute infarction at the left paramedian pons. Magnetic resonance angiography revealed a beaded small-caliber basilar artery suggestive of intracranial vasculopathy in the posterior circulation. The patient has been treated with an antiplatelet and lipid-lowering agent. His right hemiparesis has improved, but the ocular motility and left facial paresis persisted. The literature reviews of 14 cases of nine syndrome were discussed, and the biography background, clinical pictures, etiology, neuroimaging, treatment, and recovery status were described.

SARS-CoV-19-associated Rhino-orbital and cerebral mucormycosis: clinical and radiological presentations.

We describe presenting clinical and imaging manifestations of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)-associated Rhino-oculo-cerebral mucormycosis (ROCM) in a hospital setting during the second wave of SARS-CoV-2 pandemic in India. Data on the presenting manifestations were collected from 1 March to 31 May 2021. Associations between clinical and imaging findings were explored, specifically: (1) the presence or absence of orbital pain and infiltration of a superior orbital fissure on imaging; (2) the presence of unilateral facial nerve palsy and pterygopalatine fossa infiltration and geniculate ganglion signal on contrast magnetic resonance imaging, and (3) vision loss and optic nerve findings on imaging. Orbital pain was reported by 6/36 subjects. A fixed, frozen eye with proptosis and congestion was documented in 26 (72%), complete vision loss in 23 (64%), and a unilateral lower motor neuron facial nerve palsy in 18 (50%). No association was found between the presence of orbital pain and superior orbital fissure infiltration on imaging. The ipsilateral geniculate ganglion was found to enhance more profoundly in 7/11 subjects with facial palsy and available magnetic resonance (MR) imaging, and the ipsilateral pterygopalatine fossa was found infiltrated in 14. Among 23 subjects with complete loss of vision, 9 (39%) demonstrated long-segment bright signal in the posterior optic nerve on diffusion MR images. We conclude that orbital pain might be absent in SARS-CoV-2-associated ROCM. Facial nerve palsy is more common than previously appreciated and ischemic lesions of the posterior portion of the optic nerve underlie complete vision loss.

A RARE CASE OF CONCOMITANT ABDUCENS AND CONTRALATERAL LOWER MOTOR NEURON FACIAL NERVE PALSIES FOLLOWING BLUNT HEAD TRAUMA ASSOCIATED WITH TEMPORAL BONE FRACTURE

This case report describes a case of concomitant abducens and contralateral lower motor neuron facial nerve palsies following blunt head trauma associated with left temporal bone fracture. A 11year old boy was brought to the emergency department with alleged history of fall from swing set. Detailed ocular examination and assessment of function of all the twelve cranial nerves of the patient revealed left oculomotor nerve paresis, left abducens nerve palsy and right sided lower motor neuron (LMN) facial nerve palsy. The patient was run through various neuroimaging investigations which showed longitudinal fracture of the left temporal bone. The patient was treated aggressively with systemic and oral steroids. On discharge, the left oculomotor nerve paresis had healed completely with no improvement in the other two affected cranial nerves. During one month follow up, the abducens and facial nerve palsies still persisted.

A CASE OF FOVILLE SYNDROME

60 year old diabetic and hypertensive female presented to casualty with right hemiplegia and hemianesthesia with lower motor neuron type of facial nerve palsy and loss of pain, temperature on left side of the face. She had difculty adduction and abduction on left eye with horizontal nystagmus in the contralateral eye when abducted while vertical movements were preserved. MRI brain was done which showed acute focal non hemorrhagic infarct in the left hemi pons along with partial basilar artery thrombosis. Hence a diagnosis of foville syndrome with inter nuclear opthalmoplegia was made. Classically foville syndrome is characterised by ipsilateral sixth nerve palsy, lower motor neuron facial nerve palsy, fth sensory nuclear palsy along with contralateral hemiparesis and hemisensory loss. The patient was started on single antiplatelet along with high intensity statin. On follow up after 3 months patients power improved.

Post-Varicella Neurological Complications: A Preliminary Observation from a Tertiary Care Centre of Eastern India.

Objectives:The objective of this study is to analyse detailed clinical presentations, imaging findings, and outcome in a series of 17 cases (n = 17) with neurological complications following acute varicella infection.Methods:It is an observational study on the patients who presented to the neurology outpatient department of our institute with neurological abnormalities following acute varicella infection within the last 3 months.Results:Neuroimaging, either computed tomography or magnetic resonance imaging, cerebrospinal fluid analysis, electroencephalography and nerve conduction studies were performed in all the patients along with other specialized investigations as per clinical context. The age of presentation varied from childhood to middle age (median age was 23 years) and range of clinical spectrum was also wide. Peripheral nervous system involvement was more common in the form of Guillain–Barré syndrome (29.4%) and isolated lower motor neuron facial nerve palsy (23.5%) compared to central nervous system (CNS) involvement. CNS involvement was documented in the form of ataxia (11.76%), myelopathy (17.6%), stroke (5.88%) and encephalitis (5.88%).Conclusion:Chickenpox is a common viral disease and most patients recover without any complication. Although rare, neurological complications following acute varicella infection may have myriad presentations ranging from lower motor neuron facial palsy to life-threatening encephalitis. Compared to other studies, varicella encephalitis and ataxia were not so common in our study group. Response to therapy was uniformly good except in the patients presenting with ataxia. Response was particularly good to central and peripheral demyelinating disorders.

Otosclerosis: Etiology and Prognostic Factors

Otosclerosis is a temporal bone osseous dyscrasia that causes auditory impairment over time. Aberrant growth of a new bone in the middle ear eventually immobilizes and stops the stapes from oscillating in reaction to sound vibrations, resulting in gradual and persistent hearing impairment. Both ears are generally affected by the disease. Otosclerosis is a rapid occurrence of unexplained facial nerve palsy. With just an estimated prevalence of 15-30 per 100,000, it would be the most prevalent reason for lower motor neuron facial nerve paralysis. There are broadly two types of Otosclerosis, namely histological and clinical Otosclerosis. A minor incidence of Bell's palsy usually goes away in about a fortnight. It takes to recover from a more severe instance of complete paralysis varies. Among the potential complications are. Multiple sclerosis, Miller-Fisher syndrome, Guillain–Barré syndrome, and autoimmune encephalitis are autoimmune diseases. In patients with otitis media, malignant otitis externa damage to your facial nerve is irreversible.
 Nerve fiber regrowth is abnormal. When you try to move others, specific muscles may contract involuntarily (synkinesis) – for example, when you grin, the eye on the afflicted side may shut.
 Due to prolonged dryness and scratching of the transparent protective coating of the eye (cornea), the eye becomes wholly or partially blind.
 Patients report fast and increasing symptoms over a day to a week, with a 72-hour maximum severity. One-half of the face will be weak, resulting in eyebrows, forehead, and mouth angle instability. The incapacity to shut the afflicted eyelid or lip on the affected side is a common symptom. A partial or total weakening of the forehead is the most apparent physical exam finding. If the integrity of the forehead is preserved, a significant reason should be looked into. Most of the cases of Otosclerosis have idiopathic or unknown causative agents. In some patients with Otosclerosis, a sponge-like bone grows abnormally in the middle ear chamber. Because of this expansion, the ear bones cannot vibrate in response to acoustic pressure.

Bell’s Palsy: An Overview

Bell’s Palsy is a unilateral lower motor neuron facial nerve paralysis of unknown cause. It is the most common cause of acute unilateral facial paralysis and a condition many medical practitioners will encounter throughout their working career (1). With respect to Ophthalmology, paralysis of the orbicularis oculi exposes the eye to significant pathology which will usually require Ophthalmic input to manage and reduce the risk of adverse long-term sequelae.

Bell's palsy

Bell's palsy is the term given to an idiopathic lower motor neurone facial nerve paresis or paralysis. It is of rapid onset, almost always unilateral, and may be associated with facial or retro-auricular pain or otalgia. It is the most common diagnosis associated with facial nerve palsy; a GP will see a case approximately every 2 years in practice in the United Kingdom. Early diagnosis and steroid treatment increase the likelihood of full recovery, whereas ocular complications can be prevented by lubricants and lid taping. Over 70% of patients recover within a year. Options to improve facial appearance and function, in those who do not experience a complete recovery, include surgery.

A Good Outcome Following Delayed Debridement of Lumbar Paraspinal Abscess after Postoperative Epidural Catheterization: Case Report

Paraspinal abscess or clinically significant soft tissue infection following epidural analgesia is a rare but serious complication if left untreated. We report a 54-year-old gentleman with underlying chronic diabetes mellitus who had a motor vehicle accident and had undergone several surgeries. A course of steroid was provided for delayed left lower motor neuron facial nerve palsy (House-Brackmann stage 4). The epidural catheter was inserted with a single attempt at the L3/L4 level. One month later, he complained of crippling lower back pain and growing swelling with a punctum. MRI showed a paraspinal abscess with bilateral involvement of the spinae erector. This report is intended to highlight the excellent outcome of surgical treatment for paraspinal abscess despite the late presentation. A high level of suspicion should be taken into account when the patient is immunocompromised, particularly with steroid use and chronic diabetes mellitus. Early detection via MRI, high suspicion index and immediate surgery have extraordinary benefits in managing paraspinal abscesses.

Bell’s palsy following post COVID-19 infection myocarditis in pregnancy: The first case report

Lower motor neurone facial nerve palsies are a rare complication of SARS-CoV-2 infection. Bell's palsy following COVID myocarditis has been reported previously but whether they are associated is not known. We report the first case of the above combination in pregnancy.

Facial nerve palsy secondary to parotitis

This 66-year-old woman, who was undergoing chemotherapy (weekly paclitaxel) for metastatic breast cancer, was admitted under the oncologists with dehydration secondary to vomiting and diarrhoea. While an inpatient, it was...

COVID-19 Associated Facial Palsy, A Clinical Dilemma.

Sir, Coronavirus-2019 (COVID-19) is found to present with a myriad of symptoms, ranging from a simple flu-like illness to complex neurological manifestations, and continues to baffle us with its presentations. We intend to highlight an important presentation of COVID-19 infection. A 43-year-old man presented with sudden onset right-sided facial weakness, following testing positive for SARS-CoV-2, where full diagnostic workup excluded other causes. This gentleman presented having woken up with sudden onset right-sided facial weakness. He tested positive for COVID-19 3 weeks prior and again on admission. Past medical history included insulin-dependent type 2 diabetes and hypertension, which were well controlled. Examination revealed Grade III right-sided lower motor neuron facial nerve palsy on the House–Brackmann grading system. There was no other neurological deficit. Ear, nose, and throat examination was normal. Admission blood tests revealed mildly elevated C-reactive protein (8 mg/dl) and a nonfasted plasma glucose of 7.9 mmol/L. Both computer tomography and magnetic resonance imaging of the head were normal. Lumbar puncture showed normal cell count and ruled out bacterial infection on culture and viral infection on polymerase chain reaction assay. Stapedial reflex showed an elevated threshold on the right side, while pure tone audiometry was within the normal range. Benefits of commencing steroids for facial palsy were considered, weighed against detrimental effects on blood sugars, and unproven benefit in COVID-19 infection. He was treated with 50 mg prednisolone daily with careful monitoring of blood glucose levels for 10 days, and eye lubricants. Upon follow-up, there was a great improvement in facial palsy to Grade II on the House–Brackman scale. COVID-19 continues to surprise and challenge with new presentations. One such symptom is possibly that of unilateral facial paralysis as shown by our case. Various central and peripheral nervous system manifestations of COVID-19 have been reported,[12] although not including facial palsy, and are sometimes the only presenting symptom. This is of immense value as we must have a high index of suspicion to manage the case appropriately and prevent further spread of infection. It remains unclear whether COVID-19 is neurotropic,[2] yet it has been linked to various nervous system manifestations. Aberrant immune response to COVID-19 may be responsible for polyneuritis cranialis[3] which could explain the involvement of cranial nerves in COVID-19 despite being not found in cerebrospinal fluid. A possible association between isolated cranial neuropathies and COVID-19 has been suggested in several case reports, which need further analysis to support causality.[4] Prakash and Raymond inferred that diabetes and hypertension do not influence the outcome of Bell's palsy.[5] Our case has considerable partial recovery and timely steroid intervention seems to have supported this. Although diabetes is associated with facial palsy, in these times, we have to approach any case with COVID-19 with an open mind to the neurological manifestations the virus can cause. We believe that facial palsy must be considered as one of the presentations of COVID-19 infection and keep your guard up with respect to the prevention of spread of the infection. Thanking you, Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Heerfordt’s syndrome: an uncommon manifestation of sarcoidosis

Heerfordt’s syndrome – the combination of facial palsy, parotid swelling, anterior uveitis and fever, is a rare manifestation of sarcoidosis. Here, we present case history of a patient with bilateral lower motor neuron facial nerve palsy, who was found to have bilateral parotid gland swelling and bilateral hilar lymphadenopathy. Computed tomography guided fine needle aspiration cytology from hilar lymph node findings were consistent with sarcoidosis. Subsequently, based on clinical features and cytological findings, the case was diagnosed as incomplete Heerfordt’s syndrome.
 Birdem Med J 2021; 11(1): 67-69