Tricky cases - Bilateral facial nerve palsy

A 16 years old boy presented with 2 days history of perioral numbness and difficulty in speaking. He denied having carpopedal spasms. There were no other complaints.

Mother was concerned that the child was moody for the last two days. He was no smiling and appeared very grumpy. When he spoke he hardly opened his mouth and was staring at the doctor during the entire consultation.

Chvostek's and Trousseaus signs were negative. Basic investigations including electrolytes and calcium were normal.

Like always, the consultant made a spot diagnosis next morning.

Bilateral facial nerve palsy!

Lesson

It is easy to miss bilateral facial palsy as there may not be an obvious asymmetry.

Google and see some pictures of bilateral facial palsy.

Known causes are
  • Guillain Barre Syndrome
  • Sarcoidosis
  • Diabetes
  • Vasculitic conditions
  • Bilateral bells palsy!
Is there a way to differential bilateral lower motor neuron facial palsy from bilateral upper motor neuron facial palsy??



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