Title : Bilateral Facial Palsy: A case study to exceedingly rare and difficult diagnosis
Abstract:
Unilateral facial palsy is a fairly common diagnosis with an incidence of 20-25 per 100,000 population, whereas Bilateral facial nerve palsy (FNP) is exceedingly rare and only accounts for less than 2% (0.3%- 2%) all facial palsy cases. Facial paralysis depicts the result of a diverse array of disorders and heterogeneous aetiologies and thus represents a diagnostic challenge. Bilateral facial palsy entails several etiologic causes, most of which are secondary to underlying medical conditions. The list is exhaustive, leading to a diagnostic challenge, and hence clinicians should be aware of ruling out a wide range of differential diagnosis, some of which are potentially fatal. We report a case of a previously healthy 32-year-old male who presented to the emergency department with simultaneous bilateral facial weakness, slurring of speech and numbness of both lips and cheek, which could not be attributed to any specific aetiology after a repeated CT scan, MRI brain with contrast, lumbar puncture and an EMG study and, hence presented a diagnostic dilemma. In this paper, we emphasise the need of investigating the full spectrum of possible diagnosis in all instances presenting with bilateral facial nerve palsy. These patients require hospitalisation and immediate laboratory and radiographic testing to determine the underlying aetiology and, if necessary, specific additional treatment.
