Motor Neuron Facial Palsy Research Articles

AYURVEDIC MANAGEMENT OF BELL’S PALSY: A CASE STUDY

Introduction: Vatavyadhi is considered one of Mahagada. Ardita vata is one among the vatavyadhi, which may be correlated to Bell’s palsy due to the resemblance of signs and symptoms like deviation of angle of the mouth, decreased function of the affected muscle, numbness or pain in the affected side of the face. Bell’s palsy is the most common unilateral lower motor neuron facial palsy that usually develops spontaneously. Bell’s palsy is around 23 per 100,000 people per year, and it affects men and women equally, with a peak incidence between the age group 10-40 years. Ardita can be successfully managed with Ayurvedic treatment, viz. Nasya karma, Murdhni taila, Karnapurana, Snehana Svedana. Materials and method: A 49-year-old male patient complained of deviation of the angle of the mouth towards the left side and was unable to close the right eye for four days was reported to Panchakarma OPD of Alva’s Ayurveda Medical College and hospital, Moodbidri. Snehana, Svedana, Nasya karma and Murdhni taila were selected, along with internal medications and Kinesio taping. The duration and outcome of the treatments were recorded. Result: The patient recovered markedly with the treatment. Conclusion: Ardita can be managed successfully with various Panchakarma measures, internal medications, and the taping technique.

A Study on Otorhinolaryngologist Perspective of Etiology and Outcomes in Lower Motor Neuron Facial Palsy: A Single Centre Experience Over a Year.

To analyse the aetiology and outcomes of all patients attending otorhinolaryngology department for Lower Motor Neuron type facial palsy over one year. STUDY DESIGN-Retrospective study. SETTING-SRM medical college hospital and research institute, Chennai from Jan 2021 to December 2021. SUBJECTS-23 patients with LMN facial palsy in the ENT department were analysed. METHOD-Details about the onset of facial palsy, history of trauma, surgeries were collected. Facial palsy grading according to House Brackmann was done. Relevant investigations, neurological assessments, appropriate treatment, facial physiotherapy, eye protection and relevant surgical management were carried out.Outcomes were assessed by HB grading. Among 23 patients, mean age of presentation of LMN palsy is 40.39 ± 15.0years. According to House Brackmann staging 21.73% had grade 5 facial palsy, 43.47% had grade 4,30.43% of patients had grade 3 and 4.34% had grade 2 facial palsy. 9 patients (39.13%) had facial palsy due to idiopathic cause, 6 (26.08%) had facial palsy due to otologic cause, 3(13.04%) due to Ramsay hunt syndrome and post traumatic in 8.69% of patients. Parotitis in 4.3% of patients and iatrogenic in 8.69% of patients. 18(78.26%) patients were treated medically alone and 5 (21.73%) patients required surgery.Mean duration of recovery is 28.52 ± 12.6days. In follow up, 21.73% of patient had grade 2 facial palsy and 76 .26% of patients had recovered completely. Facial palsy in our study had very good recovery due to early diagnosis and early start of appropriate treatment.

A unilateral FLAIR-hyperintense lesions in anti-MOG-associated encephalitis with seizures (FLAMES) case from a developing country: A case report

The new clinical and radiological entity of the myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is known as the FLAMES syndrome. It will add to the literature and enhance the understanding of this disease. Our case presented a 25-year-old male patient with no known comorbid presented with a generalized sudden headache of moderate intensity for 10 days who came to our hospital. A right-sided upper motor neuron facial palsy was found on the examination. The diagnosis was further confirmed utilizing the MRI scan and the presence of MOG-IgG antibodies. The patient was started on intravenous methylprednisolone which lead to improvement of his symptoms. In the follow-up contrast-enhancing MRI of the brain, the findings suggested near resolution as compared to the initial MRI. The FLAMES have been categorized as a subtype of the MOGAD. It is commonly found in males as compared to females and the mean age in which it commonly affects is 29 years with the common age group of 11-46 years. The clinical symptoms and physical signs along with the findings of unilateral cortical FLAMES on MRI suggest the distinctive findings of the FLAMES syndrome. Patients commonly present with symptoms like fever, headache, and cortical symptoms like aphasia. There is a dire need of improving the understanding of this clinic-radiographic syndrome which makes it critically important to ensure the timely diagnosis and prompt consideration of the required medications.

Lateral Medullary Syndrome Presenting as Babinski–Nageotte Syndrome with Ipsilateral Upper Motor Neuron Facial Palsy

Babinski–Nageotte syndrome is one of the variants of lateral medullary syndrome (LMS) with contralateral hemiparesis along with classical LMS findings. The simultaneous occurrence of ipsilateral central facial nerve palsy and contralateral hemiparesis is an extremely rare occurrence in LMS. We report the case of a 46-year-old male who presented with complaints of acute onset of vertigo, right-sided (ipsilateral) Horner syndrome, facial sensory loss, upper motor neuron facial nerve palsy, ataxia, and left hemiparesis (contralateral). Magnetic resonance imaging brain suggested acute infarct of the right dorsal medulla and medial aspect of the right cerebellar tonsil with attenuation of the distal segment of the right vertebral artery and right posterior inferior cerebellar artery.

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.

662 Bilateral Vocal Cord Paralysis and Cranial Polyneuropathy: A Rare Presentation of Ramsay Hunt Syndrome

Abstract Case Presentation A 61-year-old gentleman with chronic lymphocytic leukaemia presented with right sided disseminated vesicles, otalgia, hearing loss, facial weakness, dysphagia, hoarseness, breathlessness, and stridor. In the preceding 48 hours he had two A&E presentations with only right otalgia, facial weakness, throat tightness and mild breathlessness. Cranial nerve (CN) examination demonstrated right cheek numbness and absent jaw jerk reflex (CNV), right grade 6 lower motor neuron facial palsy (CNVII), impaired hearing (CNVIII), dysphonia, dysphagia, and asymmetric palate elevation (CNIX and X). Fibreoptic nasendoscopy (FNE) demonstrated bilateral vocal cord palsy. He was diagnosed with Ramsay Hunt syndrome (RHS) and disseminated herpes zoster (HZ) requiring intubation and ventilation, intravenous steroids, aciclovir, antibiotics and a prolonged intensive care admission. He was discharged after three months. Eight months later, he has a long-term tracheostomy, gastrostomy, and live-in carer. Discussion This is the only case found in the literature of RHS and associated bilateral vocal cord palsy with cranial polyneuropathy requiring a long-term tracheostomy. It highlights the significant morbidity attached with RHS complications, particularly in a patient with underlying malignancy. Awareness of these rare and potentially life-threatening complications should be raised to avoid investigation and treatment delay. HZ should be considered in patients with CNVII palsy and otalgia, with or without vesicles. Clinicians should perform full CN examination including FNE to assess for cranial polyneuropathy. RHS can present without vesicles, making it indistinguishable from Bell's Palsy. Therefore, we should consider treating Bell's Palsy with aciclovir. Furthermore, multidisciplinary management of disseminated HZ is essential.

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.

168 Asymptomatic dengue illness complicated by Guillain Barre syndrome

Arboviral infection Dengue can cause a spectrum of disease varying from asymptomatic illness to dengue fever to the severe dengue hemorrhagic fever. Neurological complications are rarely reported in the lit- erature (0.5–6%), mostly from dengue-endemic areas in tropics and subtropical regions. We report a case of a 59-year-old man who returned from a recent work-related travel from India. Three weeks following a mild viral prodrome, he developed bilateral lower motor neuron facial palsy with absent deep tendon reflexes. CSF showed albuminocytologic dissociation and electrophysiological studies showed demyeli- nating neuropathy. Routine GBS screen for common etiological viruses was negative and subsequently additional testing based on recent travel was performed which showed positive Dengue IgM and RNA in serum. The patient was treated with plasma exchange for 5 days and his facial weakness improved to a great extent.This case demonstrates the importance of considering arboviral infections such as Dengue in patients with GBS particularly in people living in or travelling from endemic areas. Additionally, like many other viral illnesses, there may not be clear clinical evidence of Dengue fever and the prodrome may go unnoticed and undiagnosed, hence a high index of suspicion is required.s_hasan_s@yahoo.com

Study of aetiology and associated topodiagnostic and electrodiagnostic tests among subjects with lower motor neuron facial palsy

Background : Lower motor neuron (LMN) facial palsy is a very common clinical occurrence with an estimated incidence of 20 to 30 per 100,000 population. LMN facial palsy is commonly encountered by Otorhinolaryngologists, internal medicine practitioners and Neurologists alike. Being a mixed nerve, it’s paralysis can lead to mechanical impairment and emotional, social implications. Objective: To study the topodiagnostic and electrodiagnostic tests associated with Lower Motor Neuron Facial palsy among the study subjects. Methodology : The present cross sectional study conducted by the Department of otorhinolaryngology, neurology, neurosurgery , Pediatric and General Medicine Departments at JSS Medical College and Hospital Mysore from October 2015 to September 2017. A total of 155 study subjects were enrolled for the purpose of the study during the study period who met the inclusion criteria were enrolled for the purpose of the study . Results : Bell’s palsy was the most common etiology identified with 101 cases, 65.2%% of the individuals, followed by Ramsay Hunt syndrome with 12 cases, 7.7%, followed by traumatic and delayed facial palsy. Iatrogenic and delayed facial palsy was seen in 5 individuals, 3.2%.Pregnant and post partum patients were 3, 1.9%.

Complete and incomplete lower motor neuron facial palsy in post-COVID-19 mucormycosis

Purpose:To study facial nerve palsy (FNP) in post-COVID-19-mucormycosis patients and its ocular complications, report different presentations of FNP in such patients, and propose its etiopathogenesis based on presentation and clinico-radiologic localization.Methods:A prospective cohort study was carried out in patients of post-COVID-19-mucormycosis who presented at our tertiary center, over a period of 3 months. Motor and sensory examination of the facial nerve was done to diagnose FNP and localize the lesion clinically. Slit-lamp examination was done for grading corneal involvement. MRI brain, orbit, and paranasal sinuses (PNS) with contrast were studied to find involvement along the facial nerve. It was assessed whether this site of lesion corresponded with clinical localization. Data were analyzed using the percentage of total cases and Fisher’s test.Results:A total of 300 patients with post-COVID-19 mucormycosis were examined, of which 30 (10%) patients were found to have FNP. All were lower motor neuron (LMN) type and were associated with corneal complications. The most common site clinically was distal to the chorda tympani (66.66%) and radiologically was infratemporal (IT) fossa (63.4%). The clinical localization significantly correlated with the radiological findings (P = 0.012). Twenty percent of patients showed incomplete involvement of facial musclesConclusion:FNP was found to be of LMN type. The most common site of insult was IT fossa. There was a good clinico-radiological correspondence of lesions. Isolated lesions were also found along the peripheral nerve course, presenting as incomplete facial palsy. Recognition of FNP in post-COVID-19 mucormycosis, in all its variable forms, is important to manage corneal complications.

ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM) AS A COMPLICATION OF CHADOX1 NCOV-19 RECOMBINANT (COVISHIELD) VACCINATION

Acute disseminated encephalomyelitis (ADEM) is a demyelinating disorder presenting with myriad of neurological manifestations. We describe a case of a 22-year-old male presenting with bilateral lower motor neuron (LMN) facial nerve palsy with quadriparesis in a case of post Covisheild vaccination. T2-weighted Magnetic resonance imaging of brain revealed non-enhancing multifocal altered hyperintensity lesions, suggestive of ADEM. He was treated with methyl prednisolone and intravenous immunoglobulin, following which patient's clinical symptoms resolved. To conclude with, ADEM should be included in the differential in a patient presenting with bilateral LMN facial nerve palsy and upper motor neuron quadriparesis following COVID 19 vaccination.

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.

Recurrent Bilateral Lower Motor Neuron Type of Facial Palsy with Hearing Impairment: Hyperphosphatemic Familial Tumoral Calcinosis.

Hyperphosphatemic familial tumoral calcinosis (HFTC) presents with varied neurological manifestations that have been reported in the literature like facial palsy, vision and hearing impairment, stroke, and headache. In this article, we reported a 12-year-old girl child patient with recurrent facial weakness with bilateral hearing impairment and multiple ulcerative lesions on lower limbs and elbows. On examination, she had lower motor neuron (LMN) facial palsy with conductive hearing loss. The investigations showed hyperphosphatemia (9.3 mg/dL) with normal serum calcium (10.4 mg/dL), alkaline phosphatase (147.9 U/L), parathyroid hormone (23.12 pg/mL), and renal function tests. Elevated serum calcium and phosphorus product (96.72 mg 2 /mL 2 ) and elevated renal tubular reabsorption of phosphate (TMPxGFR) value (9.16) were noted. Skeletal survey showed hyperostosis in the long bone diaphysis, vertebrae, ribs, pelvic bone, skull, and facial bones with narrowing of cranial ostium, characteristically without any peri-articular soft tissue calcifications. An angiogram showed multiple intravascular calcifications. She was managed with a low-phosphate diet, sevelamer, niacinamide, acetazolamide, sucroferric oxyhydroxide to lower serum phosphate level, and topical sodium thiosulfate ectopic cutaneous calcification. Exome sequencing showed novel homozygous inframe deletion of ACG in FGF23 gene exon 3 at c.374_376 delins position (p. Asp125del) in the proband and a mutation in the heterozygous state in the mother and elder sibling, thus confirming a molecular diagnosis of HFTC. Our case had a unique neurological presentation of recurrent bilateral lower motor nerve facial palsy, hearing loss, multiple ectopic cutaneous calcifications without peri-articular deposits, multiple intravascular, intracranial, and vertebral endplate calcification, which has not been reported earlier. The proband showed a novel pathogenic variant suggesting an expanding phenotype of HFTC.

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.

Wallenberg syndrome with ipsilateral upper motor neuron facial palsy: A rare manifestation

Lateral medullary syndrome presents with features of ipsilateral Horner syndrome, ipsilateral ataxia, and contralateral hyperalgesia. Patients can have ipsilateral lower motor neuron-type of facial palsy if there is rostral extension of the infarct as it involves the facial nucleus. Presence of ipsilateral upper motor neuron facial palsy is rare, which is due to the involvement of the corticofacial fibers which ascend in the dorsal medulla to reach the facial nerve nucleus. Our case supports the presence of this hypothetical neuroanatomical loop of supranuclear corticofacial fibers.

Cerebral venous sinus thrombosis with lower motor neuron facial palsy

Cerebral venous sinus thrombosis with lower motor neuron facial palsy

Ayurvedic Management of Facial Paralysis -A Single Case Study

Bell's palsy or acute idiopathic lower motor neuron facial palsy are similar to Ardita vatapresenting with palsy on one side of the face. Sudden paralysis or weakness of the muscles on one side of the face controlled by the facial nerve characteristics this condition. Bell's palsy is an idiopathic, immune-mediated condition that is thought to be triggered by an infection. In today's science, steroid medication is the preferred treatment for full facial palsy. A 66-year-old person was diagnosed with Ardita vataas a result of a nor bearing pain in left ear and was treated with Mahamasha taila Nasyaand oral Ayurvedic medicines, as well as two Panchakarmasessions. The treatment lasted four months in total, but significant benefits were shown after just one month, indicating practically complete recovery without the use of any additional drugs.The patient had the identical ailment in the right side of hisface 5 years ago, and he received complete relief after 2 years of allopathic treatment. This instance serves as proof of the efficacy of Ayurvedictreatment in the treatment of Ardita vata(Bell's palsy) and as a proposal for more research on a larger number of patients.

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.

Facial Nerve Palsy After Ear Infection: A Case Report

<strong>Introduction:</strong> The incidence of acute mastoiditis, a common complication of otitis media, has significantly decreased with the emergence of antibiotic therapy [1]. Classical symptoms of acute mastoiditis include fever, irritability, otalgia, swelling of the mastoid area, and retroauricular erythema [2]. Delay in appropriate antibiotic treatment of mastoiditis may lead to intracranial and extracranial complications. Facial nerve paralysis is a rare complication of otomastoiditis with different pathophysiologic mechanisms postulated [3]. Extensive literature search showed cases of lower motor neuron involvement of the facial nerve in affected patients. We report an unusual case of mastoiditis without fever complicated by epidural abscess and upper motor neuron facial nerve palsy in a previously healthy adolescent. <strong>Case Presentation:</strong> A 13-year-old male presented with painful progressive swelling behind his left ear of 5 days duration. Symptoms had started 2 weeks prior with complaints of left ear pain, and he was diagnosed with impacted cerumen and prescribed topical hydrogen peroxide. There was no history of fever, ear discharge, hearing loss or change in neurologic status. On admission, physical examination showed 4x4 cm tender swelling over the left mastoid region with forward displacement of the pinna and cerumen impaction. Neurological assessment was normal. Laboratory investigations showed peripheral leukocytosis (12,200 cells/uL) with neutrophilia (74%), and elevated c-reactive protein (87 mg/L). Head CT scan showed acute coalescent left mastoiditis with small left epidural abscess formation, displacing the left sigmoid sinus medially, and a developing left mastoid subperiosteal abscess (see <em><strong>Figure 1</strong></em>). A diagnosis of acute mastoiditis was made, and he was commenced on intravenous ceftriaxone and vancomycin with resultant decrease in size of the swelling and normalization of inflammatory markers. On the third day of admission, the patient developed mild right-sided facial asymmetry with sparing of the upper part of the face. Ceftriaxone was changed to piperacillin-tazobactam for broader-spectrum anerobic and gram-negative coverage. Otolaryngology evaluation revealed Bezold’s abscess requiring mastoidectomy. The father initially declined, given improvement in the patient’s symptoms, but consented to wide myringotomy and placement of a short-term myringotomy tube for further drainage and middle ear irrigation. Samples of pus collected were sent for aerobic, anaerobic, mycobacterial, and fungal cultures which all came back negative except for scant growth of Staphylococcus epidermidis. MRI done on the second post-operative day showed severe coalescent left otomastoiditis, mild meningeal enhancement compatible with meningitis along the left lateral temporal lobe, and a small sliver of epidural abscess along the left infratemporal fossa (see <em><strong>Figure 2</strong></em>). Antibiotic treatment was escalated from Piperacillin-tazobactam to meropenem to provide a broader gram-negative and anaerobic coverage. At this point, father consented, and patient underwent mastoidectomy with craniotomy and epidural abscess drainage. Patient received 14 days of parenteral antibiotics. He showed clinical and radiological improvement on repeat MRI, facial asymmetry resolved and patient was discharged home in stable condition to complete 1-month of oral antibiotics (levofloxacin + amoxicillin-clavulanate) with subsequent outpatient follow-up. <strong>Conclusion:</strong> Mastoiditis is a complication of otitis media that can lead to potentially life-threatening intracranial complications. Interestingly, the patient developed rightsided facial asymmetry sparing the upper part of the face suggesting a left upper motor neuron facial nerve palsy with involvement of the contralateral face. This finding is unique to our case, and to our knowledge has not been described in literature. A plausible anatomic explanation is the involvement of ipsilateral corticobulbar tract with subsequent interruption of the main input to the lower portion of contralateral facial nerve nucleus which controls the muscles of the lower face [4]. This results in sparing of the upper facial muscles characteristic of upper motor neuron lesion. Appropriate antibiotic treatment with surgical intervention led to complete resolution of symptoms.