Right-sided Facial Palsy Research Articles

A rare case of peripheral facial paralysis associated with meningococcal meningitis - case report

Introduction. Meningococcal meningitis is a severe form of bacterial meningitis caused by the bacterium Neisseria meningitidis (N. meningitidis). It is a medical emergency and requires prompt treatment to prevent severe complications or death. Peripheral facial paralysis is one of the rare complications that can occur in this condition. Aim. This paper aimed to draw attention to the possibility of an unexpected complication in a child with meningococcal meningitis, which requires prompt clinical and paraclinical management. Materials and methods. We present the case of a 2-year and 8-month-old female patient who, in the context of meningococcal meningitis, develops peripheral facial paralysis, a very rare complication, especially in the pediatric population. Results. The patient initially presented with clinical and paraclinical signs of a respiratory viral infection. However, in a febrile context, she has two generalized tonic-clonic paroxysmal episodes, characterized by gaze fixation, each lasting 2-3 minutes, followed by spontaneous recovery. Laboratory tests revealed neutrophilia, anemia, and elevated inflammatory markers, while the cranio-cerebral CT scan showed no structural changes. Blood cultures were also collected, and treatment was initiated with third-generation cephalosporin antibiotics, along with supportive and symptomatic therapy. The following day, the patient exhibited signs of right-sided peripheral facial paralysis, and intravenous corticosteroid therapy was added to the treatment. Approximately 24 hours after admission, the blood culture tested positive for gram-negative cocci, suggesting meningococcal meningitis. A cerebral MRI was performed, revealing changes indicative of acute meningoencephalitis. The clinical and paraclinical course was slowly favorable, with a slight persistence of facial asymmetry and intermittent ataxic syndrome. Conclusions. Meningococcal meningitis remains a relevant pathology in the pediatric population, able of causing severe complications that can result in long-term disability for the patient. Prompt treatment is crucial when this condition is suspected.

Navigating Diagnostic and Therapeutic Challenges in Suspected Neuromelioidosis: A Comprehensive Case-Report of a Post-natal Mother

Neuromelioidosis, a severe neurological form of melioidosis caused by Burkholderia pseudomallei, presents significant diagnostic and therapeutic challenges. This case report describes a 28-year-old post-natal woman with progressive right-sided weakness, facial palsy, and respiratory distress. MRI findings, including the tunnel sign, and cerebrospinal fluid (CSF) analysis were crucial for diagnosis. Despite initial broad-spectrum antibiotics, targeted treatment with meropenem, ceftazidime, and trimethoprim-sulfamethoxazole led to significant clinical improvement. This case highlights the importance of early recognition and appropriate management of neuromelioidosis to improve patient outcomes.

Biopsy of the facial nerve in slow-onset facial palsy

IntroductionPrimary squamous cell carcinoma of the parotid gland typically presents as a palpable, often painless mass. Peripheral facial palsy as the only sign of malignant neoplasia is rare. In these cases, the diagnosis is regularly confirmed by radiological imaging followed by surgical exploration and biopsy. However, if there is no detection of malignant lesions and no evidence of a tumor, the reluctance to take a biopsy of an unremarkable nerve can lead to misdiagnoses.Case reportA 40-year-old female patient without medical history presented to our clinic with a complete right-sided peripheral facial palsy that had slowly progressed for 2.5 years. All other otorhinolaryngological examination findings were within normal limits. Magnetic resonance imaging examination of the head and neck and 18-fluorodeoxyglucose positron emission tomography showed unremarkable results. We proceeded with surgical exploration, which revealed no evidence of a tumor and an externally completely unremarkable facial nerve. A biopsy from the main trunk area of the nerve revealed an infiltration by a squamous cell carcinoma. Total parotidectomy with resection and reconstruction of the facial nerve and neck dissection was performed. Considering the absence of a primary tumor and other tumor formations the diagnosis of a completely regressive primary squamous cell carcinoma of the parotid gland was confirmed.ConclusionIn conclusion, in the case of slow-onset peripheral facial palsy that persists without signs of recovery, a gadolinium-enhanced MRI should be performed. If imaging is unremarkable and there is no primary tumor detection along the course of the facial nerve, a surgical exploration with biopsy of the facial nerve is necessary.

Frequency and Clinical Outcomes of Facial Nerve Palsy at District Level Teaching Hospital, Pakistan

Background: Facial nerve palsy, characterized by the dysfunction of the seventh cranial nerve, is a common neurological disorder that significantly impacts patients' quality of life. It manifests as unilateral facial weakness or paralysis, with Bell's palsy being the most prevalent cause. This condition requires thorough clinical evaluation and appropriate management to ensure optimal recovery outcomes. Objective: The objective of this study was to determine the frequency and clinical outcomes of facial nerve palsy in patients presenting to a district-level teaching hospital in Lakki Marwat, Pakistan. Methods: A cross-sectional study was conducted from May 2023 to October 2023 at the Physiotherapy Department of District Headquarter Hospital, Lakki Marwat. Patients with a confirmed diagnosis of facial nerve palsy by a neurophysician were included, while those with congenital facial nerve palsy or upper motor neuron lesions were excluded. Ethical approval was obtained, and written informed consent was collected from all participants. Clinical assessments were performed using the House-Brackmann scale to evaluate the severity of facial nerve dysfunction. Data were collected through a semi-structured questionnaire and analyzed using SPSS version 25. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to present the data. Results: Out of 102 patients, 59 (57.9%) were male, and 43 (42.1%) were female, with a mean age of 38.2 ± 10.36 years. The majority of patients (41.1%) were in the 31-40 years age group. Right-side facial palsy was more prevalent, affecting 64 (62.7%) patients. The House-Brackmann grading revealed that 49 (48.2%) patients were in Grade IV, 24 (23.5%) in Grade V, 15 (14.7%) in Grade III, 8 (7.8%) in Grade VI, and 6 (5.8%) in Grade II. Bell’s palsy was the most common cause, accounting for 52 (51%) cases, followed by external trauma in 22 (21.6%) patients, infections in 18 (17.6%) patients, and tumors in 10 (9.8%) patients. Treatment outcomes showed complete recovery in 65 (63.7%) patients, incomplete recovery in 28 (27.5%), and no recovery in 9 (8.8%). Conclusion: Facial nerve palsy was more common in male patients, with the right side of the face being predominantly affected. Bell’s palsy was identified as the leading cause. The study highlights the importance of early diagnosis and intervention, particularly physiotherapy, in managing facial nerve palsy. Further research is recommended to explore long-term outcomes and optimize treatment strategies.

Case of lightning strike in a cow

The article presents a case of two cows struck by lightning, one of which survived. The cows sought shelter under an old, withered willow. Clinical examination involving inspection and palpation revealed neurological signs: right-sided facial nerve palsy characterized by flabby ear droop, ptosis of the upper eyelid and forehead, drooling, palsy of the right orbicular nerve of the eye and ophthalmological signs, such as conjunctival redness, lacrimation, local corneal opacity of the right eye and optic nerve palsy (the pupil did not react to light). The cow also exhibited notable aggression, restlessness and hypersensitivity to touch. The patient was administered NSAID meloxicam twice with a 24-hour interval between doses and a preparation containing butaphosphan and cyanocobalamin. After several days, the signs disappeared, except for a slight right ear droop, which persisted for a long time. The article also discusses the risk of such cases occurring in temperate climate areas. Lightning strikes pose a threat, killing many people and animals worldwide every year.

Thrombotic thrombocytopenic purpura presenting as stroke mimics with normal diffusion-weighted MRI

BackgroundThrombotic thrombocytopenic purpura (TTP) is a rare and fatal thrombotic microangiopathy-based hematologic disease. Stroke has been reported as atypical neurological manifestations of TTP in some cases.Case presentationA 65-year-old male presented with typical acute ischemic stroke symptoms including sudden-onset dysarthria, right-sided facial paralysis and hemiplegia. However, his CT and MRI scans were negative without showing any new ischemic lesions. He was diagnosed with TTP with severe thrombocytopenia, mild anemia, increased LDH, and low ADAMTS-13 activity. The symptoms and positive signs were rapidly resolved after administrating the plasma exchange therapy.ConclusionClinicians should consider the possibility of TTP when a patient presents with acute stroke-like symptoms and thrombocytopenia, especially in an emergency room, either with or without new stroke lesions on the brain CT and MRI.

Successful recanalization of an acute occlusion of the left internal carotid artery and the left cerebral middle artery via the transbrachial approach: A case report

Introduction: This case study presents an elderly patient with an acute ischemic stroke due to occlusion of the left internal carotid artery (ICA) and the left cerebral middle artery (MCA). The study aimed to evaluate the feasibility and effectiveness of a transbrachial approach for mechanical thrombectomy (MT) in patients with tandem occlusions. Patient concerns: The patient presented with stroke symptoms, including severe aphasia, right-sided facial palsy, left gaze deviation and right-sided weakness. The patient had a history of uncontrolled hypertension. Diagnosis: Diagnostic tests, including computed tomography and angiography, confirmed the presence of occlusions in both the left ICA and the left MCA. Interventions: The patient received MT bridging intravenous thrombolysis. When bilateral iliac arteries were found to be occluded, a puncture via the transbrachial approach was attempted. Angiography suggested an acute occlusion of both the left ICA and the left MCA. The C1 segment was inflated with a pre-dilated balloon and the thrombus in the M1 segment was removed successfully. Outcomes: Successful reperfusion was achieved, and the patient had a good outcome at discharge. No access-site complications were encountered. Conclusion: Transbrachial approach for MT, especially in those with tandem occlusions, is feasible and could provide an alternative to the transfemoral approach. This approach may be beneficial for patients with occlusions in multiple sites or with iliac artery occlusions. Further research is needed to evaluate the long-term effectiveness of this approach.

A Case Study of <i>Suttigai</i> (Thermal Cauterization) in the Management of <i>Mugavatham</i> (Bell’s Palsy)

Bell’s palsy (Mugavatham) is a unilateral lower motor neuron facial paralysis of acute onset. Suttigai (Thermal cauterization) provides prompt relief. This study aims to establish the efficacy of Suttigai therapy in the management of Mugavatham. A 35-year-old male patient diagnosed with right-sided facial paralysis was treated with Suttigai therapy. The “House and Breckmann” assessment scale was used to evaluate the case. After the Suttigai therapy, the scale rating improved from grade IV to grade I. The asymmetry of the face and the motor functions significantly improved as a result. The efficacy of Suttigai treatment for the management of Mugavatham is successful with immediate relief. Hence more and more efforts are needed to optimize the treatment and utilization of Suttigai therapy in the management of Mugavatham.

Ovarian non-Hodgkin lymphoma with central nervous system involvement: A case report

Background: Ovarian lymphoma is rare. Extranodal non-Hodgkin lymphoma (NHL) represents 0.5% of malignant genital diseases. Due to its rarity, there are no accepted treatment protocols. Diffuse large B cell lymphoma (DLBCL) has a central nervous system (CNS) involvement rate of 3-5%.
 Case presentation: A 38-year-old presented to the gynecological oncology clinic with abdominal pain and distension. Her tumor marker CA-125 levels were elevated. She developed right-sided facial nerve palsy and blindness. A diagnosis of aggressive NHL with a differential of DLBCL was made by histopathological and immunohistochemical examination of the excised ovarian tissue. A head computed tomography scan revealed subtle enhancing opacity suspicious of lymphomatous deposits. She was lost to follow-up after ten months of chemotherapy and cranial radiotherapy.
 Conclusion: Primary lymphoma of the ovary is rare, and the prognosis is often poorer when compounded with CNS involvement. Because of poor prognosis in the presence of CNS involvement, this case highlights the need for timely diagnosis and management.

Intraoperative electrical stimulation for persistent, post-traumatic facial paralysis.

Approximately 7-10% of temporal bone fractures result in facial nerve paralysis. Treatment is dependent upon the severity of the nerve trauma and can range from conservative medical management to surgical intervention. A study by Hato et al. detailed the relationship between surgical timing and recovery rate for patients with facial nerve palsy secondary to temporal bone trauma. The rates of complete recovery and good recovery decline that the longer surgical intervention is delayed. We present the case of a 14-year-old male with a temporal bone fracture and delayed onset right-sided facial paralysis. This patient was treated with a transmastoid middle cranial fossa (MCF) approach with intraoperative electrical stimulation of the perigeniculate portion of the facial nerve. Despite a 53-day delay between trauma and surgical intervention, the patient's facial function improved from House Brackmann (HB) grade VI to grade II within 6months. Intraoperative facial nerve stimulation, which we have previously used for unresolved Bell's palsy, may be useful for patients with post-traumatic, persistent facial paralysis.

Intracranial hemangioma‐associated cranial nerve VII palsy treated with propranolol in an infant with possible PHACE syndrome

A 2-week-old infant with a large vascular birthmark involving her right face presented with right-sided facial paralysis. MRI of the brain revealed multiple intracranial hemangiomas, and the hemangioma within the right temporal bone impinged on the facial nerve, which resulted in paralysis. Cranial nerve palsies are a rare neurological manifestation of PHACE syndrome. We report successful treatment of the facial nerve palsy with oral propranolol.

EFFECT OF ANU TAIL NASYA IN MANAGEMENT OF ARDIT WITH SPECIAL REFERENCE TO BELLS PALSY POST HERPES SIMPLEX VIRUS INFECTION: A CASE STUDY

In the modern era, when the whole world is developing and adapting to a new lifestyle, everyone has forgotten about personal health due to the contemporary lifestyle, Stress and increasing anxiety about work. Nowadays, we have seen an increased number of viral diseases which are very difficult to treat. These viral diseases act on the body due to reduced immunity of people, which is again due to day-to-day lifestyle. Bell’s Palsy is one of the viral diseases having symptoms like weakness of facial muscles causing deviation of the mouth, dropping of the eyelid which is caused by inflammation of facial nerve with mononuclear cells which is due to Infection or Immune cause. This present study was conducted on a patient to determine the effective management of Ardit/ Bell’s palsy, which has a less adverse effect at a low cost. The patient presented with Right-sided facial paralysis, Inability to close the right eye, and Slurred Speech; which was having a history of Herpes simplex had taken symptomatic treatment comprising of Antiviral and Steroids visited at OPD and diagnosed as Ardit, which was treated with Anu Tail Nasya for seven days and showed the significant result.

Incidence rate, risk factors, and management of Bell's palsy in the Qurayyat region of Saudi Arabia.

BackgroundBell’s palsy is an idiopathic facial nerve dysfunction causing temporary paralysis of muscles of facial expression. This study aimed to determine the incidence rate, common risk factors, and preferred treatment by the Saudi patients with Bell’s palsy.MethodThis cross-sectional study was carried out in the Qurayyat region of Saudi Arabia. The retrospective medical records were searched from 2015–2020 of patients diagnosed with Bell’s palsy at Qurayyat General Hospital and King Fahad hospital. A 28-item questionnaire was developed by a team of experts and pre-tested among patients with Bell’s palsy before being sent to the eligible participants. The data were analyzed using summary statistics, Chi-square test, Fisher exact test and Likelihood ratio test.ResultsWe identified 279 cases of Bell’s palsy from the medical records of the hospitals from the years 2015 to 2020, accounting for 46.5 cases per year and an incidence rate of 25.7 per 100,000 per year. Out of 279 patients with Bell’s palsy, only 171 returned the questionnaire accounting for a response rate of 61.2%. Out of 171 patients with Bell’s palsy, females (n = 147, 86.0%) accounted for the majority of cases. The most affected age group among participants with Bell’s palsy was 21–30 years (n = 76, 44.4%). There were 153 (89.5%) cases who reported Bell’s palsy for the first time. The majority of the participants experienced right-sided facial paralysis (n = 96, 56.1%). Likelihood ratio test revealed significant relationship between exposure to cold air and common cold with age groups (χ2(6, N = 171) = 14.92, p = 0.021), χ2(6, N = 171) = 16.35, pp = 0.012 respectively. The post hoc analyses revealed that participants in the age group of 20–31-years were mostly affected due to exposure to cold air and common cold than the other age groups. The main therapeutic approach preferred was physiotherapy (n = 149, 87.1%), followed by corticosteroids and antivirals medications (n = 61, 35.7%), acupressure (n = 35, 20.5%), traditional Saudi herb medicine (n = 32, 18.7%), cauterization by hot iron rod (n = 23, 13.5%), supplementary therapy (n = 2, 1.2%), facial cosmetic surgery (n = 1, 0.6%) and no treatment (n = 1, 0.6%). The most preferred combined therapy was physiotherapy (87.6%) with corticosteroid and antiviral drugs (35.9%), and acupressure (17.6%).ConclusionThe rate of Bell’s palsy was approximately 25.7 per 100,000 per year in the Qurayyat region of Saudi Arabia. Exposure to cold air and common cold were the significant risk factors associated with Bell’s palsy. Females were predominantly affected by Bell’s palsy in the Qurayyat region of Saudi Arabia. Bell’s palsy most commonly occurred in the age group 21–30 years. The most favored treatment was physiotherapy following Bell’s palsy.

MRI of a middle ear cholesteatoma in a cat

A 9-year-old Maine coon cat presented with right-sided Horner and facial nerve paralysis. Magnetic resonance imaging (MRI) showed a heterogeneously contrast-enhancing mass occupying the right dorsolateral compartment of the tympanic cavity and extending into the ventromedial compartment, which was expanded and fluid filled. A ventral bulla osteotomy was performed to debulk the soft tissue mass. Histopathology revealed a cholesteatoma. The cat showed slow improvement of clinical signs and was euthanized eleven months postoperatively for unrelated causes. The MRI characteristics of middle ear cholesteatoma in the present case varied from those described in humans and dogs.

Neonate with Respiratory Distress, Bilateral Microtia, Hypocalcemia, and Lymphopenia.

Neonate with Respiratory Distress, Bilateral Microtia, Hypocalcemia, and Lymphopenia.

An Interesting Case of Bell’s Palsy in Pregnancy Associated with COVID-19 Infection

Recent studies have reported that Coronavirus Disease 2019 (COVID-19) can be the cause of peripheral facial paralysis and neurological symptoms may be the only manifestation of the disease. Hereby, the authors report an interesting case of a pregnant COVID-19 positive female with Bell's palsy, in third trimester of pregnancy. A 33-year-old female, G3P0L0A2, presented with left-side deviation of angle of mouth, excessive lacrimation and redness of right eye for the past three days. She had involuntary drooling on right and left side labial commissural deviation, absence of forehead frowning, inability to close her right eye (positive Bell’s phenomena), and ipsilateral lagophthalmos. No lesions were seen on the external ear and otoscopy was normal. She was confirmed to have right-sided facial nerve palsy. She had an uneventful course of pregnancy till term and underwent caesarean section at 40 weeks, in view of foetal distress. Pregnancy and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, both are immunocompromised state, and hence could be a risk factor for Bell’s palsy. But larger studies with more cases are required to prove the causal association.

Case of multiple sclerosis presenting as unilateral internuclear ophthalmoplegia

A 30-year-old female presented with complaints of decreased vision and diplopia since 1 week along with headache and gait disturbances. Examination revealed medial restriction of ocular movements in the right with left abducting nystagmus suggestive of right-sided internuclear ophthalmoplegia and right-sided facial palsy. The patient was admitted under neurology as a suspected case of demyelinating disorder. Magnetic resonance imaging with gadolinium contrast revealed features suggestive of probably multiple sclerosis (MS). The patient was given 5 days of high-dose intravenous steroids following which the patient showed improvement and was discharged on multivitamins. Subsequent follow-up showed significant improvement in symptoms, visual acuity, and ocular movements. Hereby presenting a rare case of MS presenting as unilateral internuclear ophthalmoplegia.

Peripheral Facial Palsy after Dental Procedure

Peripheral facial palsy is often reported after surgery for head or neck tumors and otolaryngologic surgery, but the occurrence of facial nerve palsy after dental procedures is very rare. A 29-year-old man visited our clinic with right-side facial asymmetry and right facial weakness 7 days before. The patient underwent dental treatment 8 days ago. He exhibited weakness of the right side of his face and was unable to close his right eye. He was diagnosed with right-sided peripheral type facial nerve paralysis and treated with an antiviral agent and prednisolone, and the symptoms gradually improved. Facial nerve palsies after dental procedures have been reported in foreign countries, but these cases have been very rarely reported in Korea. We also reported on the efficacy of the conventional treatment of facial nerve palsy after a dental procedure.

Interposition Grafting of the Facial Nerve After Resection of a Large Facial Nerve Schwannoma: 2-Dimensional Operative Video

Abstract Facial nerve schwannomas can develop at any portion of the facial nerve. 1 When arising from the mastoid portion of the facial nerve, the tumor will progressively erode the mastoid, giving the schwannoma an aggressive radiological appearance. 1,2 The facial nerve is frequently already paralyzed, or no fascicles can be saved during resection. In these cases, end-to-end interposition grafting is the best option for facial reanimation. 1,3-5 The healthy proximal and distal facial nerves are prepared prior to grafting. The great auricular nerve is readily available near the surgical site and represents an excellent graft donor with minimal associated morbidity. 4,6 We demonstrate this technique through a case of a 48-yr-old male who presented with a complete right-sided facial nerve palsy due to a large facial schwannoma that invaded the mastoid and extended to the hypoglossal canal, causing hypoglossal nerve paralysis, and petrous carotid canal. His 4-yr follow-up showed no recurrent tumor with restored facial nerve function palsy to a House-Brackman grade III, and full recovery of his hypoglossal nerve function. The patient consented to the surgery and the publication of his image.

Symptom: Unilateral Facial Paralysis

Symptom: Unilateral Facial Paralysis