How to differentiate bilateral umn and bilateral lmn facial palsy with taste se na sensation?
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Bilateral Facial Nerve Palsy: A Diagnostic Dilemma
Sohil Pothiawala and Fatimah Lateef
Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608
Received 5 October 2011; Accepted 27 November 2011
Academic Editors: P. Iannone, W. Mauritz, M. Sand, and C. Vorwerk
Copyright © 2012 Sohil Pothiawala and Fatimah Lateef. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Introduction. Bilateral facial nerve palsy (FNP) is a rare condition, representing less than 2% of all cases of FNP. Majority of these patients have underlying medical conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic disorders. Objective. The differential diagnosis of its causes is extensive and hence can present as a diagnostic challenge. Emergency physicians should be aware of these various diagnostic possibilities, some of which are potentially fatal. Case Report. We report a case of a 43-year-old female who presented to the emergency department with sequential bilateral facial nerve paralysis which could not be attributed to any particular etiology and, hence, presented a diagnostic dilemma. Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant.
1. Introduction
Unilateral facial nerve palsy (FNP), with an incidence of around 25 per 100,000 population, is a common neurologic disorder mimicking a stroke. It often leads to emergency department visits. Bell’s palsy, also known as idiopathic facial paralysis, is the most common cause of unilateral facial paralysis, accounting for approximately 70% of these cases [1].
Bilateral FNP is exceedingly rare, representing less than 2% of all the facial palsy cases, and has an incidence of 1 per 5,000,000 population [2, 3]. Majority of these patients have serious underlying medical conditions and need to be admitted for evaluation of the underlying cause and further management. Bell’s palsy accounts for only 23% of bilateral facial paralysis [1].
We report a case of a 43-year-old female who presented to our department with sequential bilateral facial paralysis, in which unilateral FNP was followed by contralateral FNP in the next 2 days before complete resolution of symptoms on the side affected first. We also discuss her evaluation and the possible differential diagnoses. As few cases have been reported, the literature review serves as an important point of discussion for bilateral facial palsy.
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