Bilateral facial paralysis: case presentation and discussion of differential diagnosis.
Bilateral facial paralysis is a rare condition and therefore represents a diagnostic challenge. We report the case of a 34-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. Her physical examination and chest x-ray did not reveal any clinical evidence of sarcoidosis. After failing to respond to an empiric trial of intravenous ceftriaxone for a presumptive diagnosis of Lyme disease, computed tomography scan of the chest was ordered which demonstrated bilateral hilar lymphadenopathy. Bronchoscopic biopsy confirmed a diagnosis of sarcoidosis. The patient then made a complete recovery on steroid therapy. We discuss the differential diagnosis of facial diplegia and focus on the clinical presentation, diagnosis and treatment of neurosarcoidosis.
Jain
Vishal
V
Department of Internal Medicine, Lankenau Hospital, Wynnewood, PA 19096, USA. jainv@mlhs.org
Deshmukh
Anagha
A
Gollomp
Stephen
S
D000328:Adult; D020330:Bell Palsy; D001706:Biopsy; D001921:Brain / Q000000981:diagnostic imaging; D005158:Facial Paralysis / Q000209:etiology*; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008775:Methylprednisolone / Q000627:therapeutic use; D013902:Radiography, Thoracic; D017565:Sarcoidosis, Pulmonary / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D008775:Methylprednisolone