Bilateral facial palsy, which is usually combined with other diseases, occurs infrequently. It may imply a life-threatening condition. Therefore, the differential diagnosis of bilateral facial palsy is important. However, the etiology is variable, which makes diagnosis challenging. We report a rare case of progressive bilateral facial palsy as a manifestation of granulomatosis with polyangiitis (GPA). A 40-year-old male with otitis media and right facial palsy was referred for electroneurography (ENoG), which showed a 7.7% ENoG. Left facial palsy occurred after 2 weeks, and multiple cavitary opacities were noted on chest images. GPA was diagnosed by lung biopsy. His symptoms deteriorated and mononeuropathy multiplex developed. The possibility of systemic disease, such as GPA, should be considered in patients presenting with bilateral facial palsy, the differential diagnosis of which is summarized in this report.
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To assess the practical diagnostic value of facial nerve antidromic evoked potential (FNAEP), we compared it with the diagnostic value of the electroneurography (ENoG) test in Bell's palsy.
In total, 20 patients with unilateral Bell's palsy were recruited. Between the 1st and 17th days after the onset of facial palsy, FNAEP and ENoG tests were conducted. The degeneration ratio and FNAEP latency difference between the affected and unaffected sides were calculated in all subjects.
In all patients, FNAEP showed prolonged latencies on the affected side versus the unaffected side. The difference was statistically significant. In contrast, there was no significant difference between sides in the normal control group. In 8 of 20 patients, ENoG revealed a degeneration ratio less than 50%, but FNAEP show a difference of more than 0.295±0.599 ms, the average value of normal control group. This shows FNAEP could be a more sensitive test for Bell's palsy diagnosis than ENoG. In particular, in 10 patients tested within 7 days after onset, an abnormal ENoG finding was noted in only four of them, but FNAEP showed a significant latency difference in all patients at this early stage. Thus, FANEP was more sensitive in detecting facial nerve injury than the ENoG test (p=0.031).
FNAEP has some clinical value in the diagnosis of facial nerve degeneration. It is important that FNAEP be considered in patients with facial palsy at an early stage and integrated with other relevant tests.
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Objective: The purpose of this study was to observe the characteristics of the clinical improvement and the electrodiagnostic study in non-traumatic facial nerve palsy.
Method: The clinical observation and the electrodiagnostic study were done in 57 of 266 patients who were treated at the Kyunghee Medical Center from December 2000 to July 2001. The initial study was done at 2 weeks from the onset time, and the follow-up study was done at 3 months later. The blink reflex, nerve conduction study and needle EMG were done, and made a statistical comparison between the initial and follow-up study.
Results: The clinical improvement and the change of the electrodiagnostic study between the initial and follow-up study were remarkable in the patients with expected to be good and fair prognosis. In the electrodiagnosis study, there were no statistical correlations on the % degeneration of the CMAP amplitude in the patients with expected to be poor prognosis.
Conclusion: Although the ideal electrodiagnostic study does not yet exist, the best method of evaluating the facial nerve is side-to-side evoked amplitude comparison, and not only the initial study but also the follow-up, this method would be very useful. (J Korean Acad Rehab Med 2002; 26: 420-425)
Melkersson-Rosenthal (M-R) syndrome consists of a triad of (1) recurrent peripheral facial nerve paralysis which develops alternatively on both sides of face, (2) non-inflammatory facial edema, and (3) furrowed tongue.
Since the cause of M-R syndrome is unknown, various forms of therapy have been tried, but there were no conclusive evidence that they altered the course of the disease.
A 27-year-old female and a 44-year-old male patient with recurrent facial nerve paralysis were diagnosed with M-R syndrome.
We report the two cases of M-R syndrome with the brief review of literatures.
Leprosy is an infectious disease caused by Mycobacterium leprae and characterized by dermal and peripheral nerve lesions. The facial nerve is also frequently involved in leprosy. There are a few electrophysiologic studies on the facial nerve involvement in leprosy patients, but there is no electrophysiologic study on the facial nerve involvement in cured leprosy patitents. So we performed facial nerve conduction study and Blink reflex study in 19 cured leprosy patients who have been managed with Dapsone for a long time. Facial motor latencies were prolonged in 11 patients(57.9%).: 10 of 15 patients in lepromatous type; 1 of 4 patients in tuberculoid type. Prolonged latencies were shown in temporal branch, zygomatic branch, buccal branch, and mandibular branch in 9(47.4%), 6(31.6%), 5(26.3%), and 3(15.8%), respectively. Blink reflex study suggests combined facial nerve and trigeminal nerve lesion in 2 patients.
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