Bilateral facial paralysis is a rare condition and therefore represents a diagnostic challenge. We report the case of a year-old healthy woman with sequential bilateral facial paralysis as a sole manifestation of sarcoidosis. She initially presented with an isolated left sided Bell's palsy without any symptoms to suggest alternative diagnoses. Within a month there was progression to peripheral facial paresis on the contra lateral side, prompting a diagnosis of Lyme disease.
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Approach to the Patient with Facial Numbness
Bilateral Facial Paralysis Case Presentation and Discussion of Differential Diagnosis
Majority of these patients have underlying medical conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic disorders. 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 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. 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.
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Bilateral facial paralysis: what’s the cause?
Love Marianna R. Beattie Isolated facial numbness often is descriptive of impairment of sensation of the face as a result of dysfunction of the trigeminal system or central trigeminal pathways. Patients may report unilateral or bilateral facial numbness, paresthesia a spontaneous abnormal sensation , or dysesthesia an unpleasant abnormal sensation produced by normal stimuli. There may be associated symptoms of altered sensation of the mucous membranes of the nose, mouth, gums, palate, or teeth.
The facial paralysis was not accompanied by hyperacusis, and taste sensation was preserved. No other central or peripheral neurological signs or symptoms were elicited during either presentation. As bilaterality makes facial neuropathy a more ominous sign of various known conditions, 1 , 2 we carried out prompt further investigation. Results of haematological and biochemical assays, including liver function tests, were unremarkable.