title: Acute Isolated Central Facial Palsy as Manifestation of Middle Cerebral Artery Ischemia.
abstract: Isolated central facial palsy (I-CFP) is attributed to a lacunar syndrome affecting the corona radiata region or pons. We examined our acute stroke registry for patients presenting with I-CFP and localized their symptoms to a vascular lesion.
  
  
  
  Our database of consecutive patients with symptoms of acute cerebral ischemia admitted from January 2008 to December 2012 was reviewed for NIH Stroke Scale (NIHSS) scores and subcomponents. All patients with I-CFP ± dysarthria (total NIHSS ≤ 3) had contrast-enhanced MR-angiography and transcranial Doppler as standard of care. All ischemic lesions were localized by MRI within 72 hours from symptom onset.
  
  
  
  Of 2,202 patients with acute cerebral ischemia, 879 patients (35%) had NIHSS score ≤ 3 points (mean age 63 + 15 years, 46 % women). Nine patients (.4%) presented with I-CFP ± dysarthria. Of these, only 1 had a lesion in the corona radiata and patent MCA, 1 had a pontine lesion without proximal vessel occlusion (2/9, or 22%). Remaining 7 patients (78%) had flow-limiting thromboembolic mid-to-distal M1/proximal M2 MCA disease. Of these, 6 (86%) patients had a prominent early anterior temporal artery on MRA and nonlacunar ischemic lesions on MRI.
  
  
  
  Contrary to current teaching of lesion localization for an I-CFP, our study revealed the majority of acute patients presenting with this symptom had evidence of flow-limiting thromboembolic MCA disease rather than a lacunar lesion. Our findings underscore the essential role of comprehensive vascular imaging in patients presenting with I-CFP, which is commonly associated with acute flow-limiting thromboembolic MCA disease.
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Kara A
authors.initials: KA
authors.lastname: Sands
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Reza Bavarsad
authors.initials: RB
authors.lastname: Shahripour
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Gyanendra
authors.initials: G
authors.lastname: Kumar
authors.affiliation: Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany.
authors.forename: Kristian
authors.initials: K
authors.lastname: Barlinn
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.|Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lyerly
authors.affiliation: International Clinical Research Center, St. Anne's University Hospitaland Medical Faculty of Masaryk University, Brno, Czech Republic.|Department of Neurology, St. Anne's University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic.
authors.forename: Michal
authors.initials: M
authors.lastname: Haršány
authors.affiliation: Department of Neuroradiology, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Cure
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.|Department of Neurology, University of Tennessee Medical Center, Memphis, TN, USA.
authors.forename: Yuri L
authors.initials: YL
authors.lastname: Yakov
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.|Department of Neurology, University of Tennessee Medical Center, Memphis, TN, USA.
authors.forename: Anne W
authors.initials: AW
authors.lastname: Alexandrov
authors.affiliation: Comprehensive Stroke Center, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.|Department of Neurology, University of Tennessee Medical Center, Memphis, TN, USA.
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004401:Dysarthria / Q000209:etiology; D005158:Facial Paralysis / Q000209:etiology*; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D012189:Retrospective Studies; D013923:Thromboembolism / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial
keywords: Stroke; isolated central facial palsy; middle cerebral artery ischemia