The Double Bell's: Unraveling Idiopathic Bilateral Facial Paralysis in a 31-Year-Old.

Bell's palsy, an acute, idiopathic, and typically unilateral facial nerve paralysis, represents a common cause of sudden facial weakness. The aetiology is often attributed to viral infections. This case report discusses the presentation, diagnosis, and management of a rare case of idiopathic bilateral Bell's palsy. We present a case of a 31-year-old male who presented to the emergency department with a one-week history of progressive bilateral facial weakness following initial neck and jaw pain. Despite the resolution of pain, the patient experienced complete facial paralysis on both sides, including the inability to raise eyebrows, close eyes fully, and numbness over the lips. The patient presented with no complaints of headache, trauma, vision changes, or recent travel history. Examination and routine blood tests yielded normal results, and a head CT scan showed no abnormalities. As a result, the diagnosis of idiopathic bilateral Bell's palsy was confidently confirmed. This case highlights the clinical presentation, diagnostic approach, and management of a rare bilateral facial palsy, emphasizing the importance of a comprehensive evaluation and considering Bell's palsy in differential diagnoses of acute facial weakness.

Exploring Non-invasive Therapies for Bell's Palsy: A Case Report.

Unknown in origin, Bell's palsy is a common acute facial nerve paralysis that is usually characterized by unilateral facial weakening or paralysis. People of all ages are affected by this illness, which peaks in the fourth decade of life. Although the precise etiology is yet unknown, viral infections - particularly type 1 herpes simplex virus - are frequently linked to the problem. Based on the evidence of abrupt onset facial weakness and the elimination of other neurological diseases, the diagnosis is essentially clinical. The goals of management techniques are to lessen related symptoms, encourage nerve regeneration, and lessen inflammation. Corticosteroids, antiviral drugs, physical therapy, and supportive measures are available as treatment alternatives. The majority of patients experience spontaneous recovery within weeks to months, and the prognosis is generally excellent. Nonetheless, a portion may experience long-term consequences, highlighting the significance of individualized follow-up care. Bell's palsy is succinctly summarized in this abstract to aid in better comprehension and well-informed clinical practice decision-making.

Prevalence, Etiology, Risk Factors, and Complications of Facial Nerve Palsy at King Abdulaziz Medical City: A Multicenter Study.

BACKGROUND: Facial nerve palsy is a condition of nerve damage that results in impaired facial movement on one or both sides of the face. OBJECTIVES: This multicenter study aimed to determine the prevalence of facial nerve palsy and evaluate the association between its risk factors and complications to identify its etiology among patients admitted to King Abdulaziz Medical City in Jeddah and Riyadh, Saudi Arabia, between 2016 and 2023. METHODS: A retrospective cross-sectional study was conducted to obtain data from medical records using the best care system for patients with facial nerve palsy. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States), Chi-square test, t-test, and ANOVA. The level of statistical significance was set at p<0.05. RESULTS:  The study involved 123 patients, with 0.0164% prevalence. Bell's palsy was the most common etiology, accounting for 81.8% of cases, followed by head injuries, dental trauma, otitis media, stroke, and head and neck tumors. Obesity was the most significant risk factor, followed by upper respiratory problems. Hypertension and diabetes exert similar effects. Facial asymmetry, ophthalmic complications, and eye twitching were the most common complaints followed by speech difficulties, psychological and social effects, mouth twitching, and synkinesis. CONCLUSION:  Facial nerve palsy is common in this region. We recommend health education sessions to increase public awareness and provide preventive strategies to reduce the complications of facial nerve damage. We recommend further research on the association between the risk factors and complications of facial nerve palsy.

Primary Central Nervous System Lymphoma Presenting as Isolated Multiple Cranial Neuropathies: An Extremely Rare Case.

Primary central nervous system lymphoma (PCNSL) is an uncommon malignancy of B-cell origin that typically involves the brain, eyes, and spinal cord without systemic spread. PCNSL typically involves the cerebral hemispheres, basal ganglia, or periventricular region. Isolated leptomeningeal PCNSL without any evidence of parenchymal involvement is very rare. We present a very unusual case of PCNSL presenting as persistent bilateral Bell's palsy and trigeminal neuralgia with magnetic resonance imaging (MRI) brain showing significantly hypertrophied enhancing bilateral facial and trigeminal nerves.

Dynamic eyelid reconstruction in facial nerve palsy.

The consequences of facial nerve palsy and the secondary inability of eyelid closure and blink may lead to devastating complications for the patient, including blindness. Reconstruction techniques to improve eyelid position and function can be broadly classified into 'static' and 'dynamic' techniques. Generally, ophthalmologists have been familiar with static procedures such as upper eyelid loading, tarsorrhaphy, canthoplasty, and lower eyelid suspension. Recently, dynamic techniques are being increasingly described for patients who require definitive strategies to improve eyelid function, once the initial critical goals of corneal protection and vision preservation have been achieved. The choice of technique(s) is dependent upon the status of the main protractor of the eyelid region, as well as the age of the patient, the patient's morbidities and expectations, and surgeon preference. This review shall first describe the clinical and surgical anatomy relevant to the ophthalmic consequences of facial paralysis and discuss methods of defining function and outcomes. A comprehensive review of dynamic eyelid reconstruction is then presented with a discussion of the literature. These various techniques may not be familiar to all clinicians. It is important that ophthalmic surgeons are aware of all options available for their patients. Furthermore, eye care providers must have an understanding of when referral may be appropriate to provide timely intervention and optimal chances of recovery.

Incidence rate, risk factors, and management of Bell's palsy in the Qurayyat region of Saudi Arabia.

Background: Bell's palsy is an idiopathic facial nerve dysfunction causing temporary paralysis of muscles of facial expression. This study aimed to determine the incidence rate, common risk factors, and preferred treatment by the Saudi patients with Bell's palsy. Method: This cross-sectional study was carried out in the Qurayyat region of Saudi Arabia. The retrospective medical records were searched from 2015-2020 of patients diagnosed with Bell's palsy at Qurayyat General Hospital and King Fahad hospital. A 28-item questionnaire was developed by a team of experts and pre-tested among patients with Bell's palsy before being sent to the eligible participants. The data were analyzed using summary statistics, Chi-square test, Fisher exact test and Likelihood ratio test. Results: We identified 279 cases of Bell's palsy from the medical records of the hospitals from the years 2015 to 2020, accounting for 46.5 cases per year and an incidence rate of 25.7 per 100,000 per year. Out of 279 patients with Bell's palsy, only 171 returned the questionnaire accounting for a response rate of 61.2%. Out of 171 patients with Bell's palsy, females (n = 147, 86.0%) accounted for the majority of cases. The most affected age group among participants with Bell's palsy was 21-30 years (n = 76, 44.4%). There were 153 (89.5%) cases who reported Bell's palsy for the first time. The majority of the participants experienced right-sided facial paralysis (n = 96, 56.1%). Likelihood ratio test revealed significant relationship between exposure to cold air and common cold with age groups (χ 2(6, N = 171) = 14.92, p = 0.021), χ 2(6, N = 171) = 16.35, pp = 0.012 respectively. The post hoc analyses revealed that participants in the age group of 20-31-years were mostly affected due to exposure to cold air and common cold than the other age groups. The main therapeutic approach preferred was physiotherapy (n = 149, 87.1%), followed by corticosteroids and antivirals medications (n = 61, 35.7%), acupressure (n = 35, 20.5%), traditional Saudi herb medicine (n = 32, 18.7%), cauterization by hot iron rod (n = 23, 13.5%), supplementary therapy (n = 2, 1.2%), facial cosmetic surgery (n = 1, 0.6%) and no treatment (n = 1, 0.6%). The most preferred combined therapy was physiotherapy (87.6%) with corticosteroid and antiviral drugs (35.9%), and acupressure (17.6%). Conclusion: The rate of Bell's palsy was approximately 25.7 per 100,000 per year in the Qurayyat region of Saudi Arabia. Exposure to cold air and common cold were the significant risk factors associated with Bell's palsy. Females were predominantly affected by Bell's palsy in the Qurayyat region of Saudi Arabia. Bell's palsy most commonly occurred in the age group 21-30 years. The most favored treatment was physiotherapy following Bell's palsy.

A Rare Case of Dilated Cardiomyopathy, Focal Segmental Glomerulosclerosis, and Bell's Palsy in a 29-Year-Old Male After Coxsackievirus Infection.

Dilated cardiomyopathy (DCM) is a severe myocardial disease with diversified etiologies. Coxsackievirus serotype B (CV-B) is a known cause of infectious myocarditis that leads to DCM. The pathogenesis of CV-B myocarditis is complex and involves a combination of tissue destruction from viral proliferation and host immune response. Diagnosis is based on clinical findings and the presence of post-infection elevated titers of IgM antibodies to CV-B. Echocardiography is an important imaging modality that plays a key role in diagnosing DCM. Rare complications of coxsackievirus infection may include facial paralysis and chronic kidney disease with nephrotic syndrome. Here we present a rare case of a 29-year-old-male with recent Bell's palsy who presented with new-onset heart failure with left ventricular ejection fraction of 5% and focal segmental glomerulosclerosis nephrotic syndrome in the setting of elevated antibodies to CV-B.

SARS-CoV-2 Vaccination-Induced Transverse Myelitis.

While mass immunization against coronavirus disease 2019 (COVID-19) rolls out around the globe, safety concerns and adverse events that need prompt evaluation are also emerging. We report a case of transverse myelitis and Bell's palsy after receiving Johnson and Johnson COVID-19 vaccination under the emergency use authorization in a healthy young woman with no past medical history. Other possible etiologies of her symptoms were ruled out, and she was treated successfully with steroids and plasma exchange.

High frequency of paediatric facial nerve palsy due to Lyme disease in a geographically endemic region.

INTRODUCTION: Idiopathic facial nerve palsy (FNP) is an uncommon but important presentation in children, with Lyme disease known to be a common cause. The UK county of Hampshire is a high incidence area of Lyme disease. We conducted a retrospective review of the investigation and management of paediatric FNP at a large University hospital, including serologic testing and treatment of Lyme disease. METHODS: We conducted a retrospective chart review of children under 18 presenting between January 1st, 2010 and December 31st, 2017 with a diagnosis of FNP. Patients with clear non-Lyme aetiology at presentation were excluded. Data was collected on demographics, initial presentation, investigations including Lyme serology, and management. RESULTS: A total of 93 children were identified, with an even proportion of male to female and median age 9.3 years (IQR 4.6-12 years). A history of rash was present in 5.4%, tick bite in 14% and recent travel to, or residence in the New Forest in 22.6%. Lyme serology was performed in 81.7% of patients, of which 29% were positive. Antibiotics were prescribed for 73.1% of patients, oral steroids for 44% and aciclovir for 17.2%. CONCLUSION: Lyme disease is a significant cause of FNP in this endemic area of the UK, and there was a large degree of variability in management prior to national guideline publication. Areas with endemic Lyme disease should consider introducing local guidelines supporting routine investigation and management for FNP, including empiric treatment for Lyme disease in accordance with NICE guidelines to improve care and reduce variability.

Bilateral Facial Nerve Palsy in Acute B Cell Lymphoblastic Leukemia: A Case Report and Review of the Literature.

Acute lymphoblastic leukemia (ALL) is a haematological malignancy that can involve the central nervous system (CNS). Less than 10 % of patients with ALL have CNS involvement at presentation. The cranial nerve most commonly affected is cranial nerve VII although bilateral involvement is rare. Management and outcomes of these patients are not well understood. Moreover bilateral Bells palsy as a presenting symptom of ALL is extremely uncommon. We report a very unusual presentation of ALL with bilateral facial nerve palsy, and discuss the management strategies and outcomes for patients with ALL that present with cranial nerve palsies.

Rehabilitation of Bells' palsy from a multi-team perspective.

Conclusions Defectively healed facial paralysis causes difficulties to talk and eat, involuntary spasms (synkinesis), and cosmetic deformities which can give rise both to severe psychological and physical trauma. A team consisting of Ear-Nose-Throat specialists, Plastic surgeons and Physiotherapists can offer better care, treatment and outcome for patients suffering from Bells' palsy. Objectives Patients suffering from Bells' palsy from all ENT hospitals in Sweden and the University Hospital in Helsinki has been included. Methods Results have been drawn and statistically processed for different outcomes from a prospective, double blind cross over study. Results from a pilot surgical study and therapeutic results from physiotherapy studies have been included. Ideas concerning different kinds of surgery will be reviewed and the role of physiotherapy discussed. Results According to common results, treatment with Prednisolone enhances the recovery rate and should, if possible, be used early in the course. Sunnybrook grading at 1 month after onset most accurately predicts non-recovery at 12 months in Bells' palsy and a risk factor curve will be presented in order to predict outcome and selection of patients for undergoing facial surgery. This report is focusing on how to handle patients with Bells' palsy from a multi-rehabilitation team point of view, and what will be recommended to provide these patients with the best clinical and surgical help.

Paralisia de Bell subsequente a ritidoplastia / Bell’s palsy subsequent to rhytidectomy

A paralisia facial periférica é uma entidade que pode deixar sequelas estéticase funcionais importantes nos pacientes. De acordo com a literatura, a paralisia de Bell (PB) é a causa mais comum, representando de 50 a 80% dos casos. Porém deve ser considerada como diagnóstico de exclusão. Estima-se uma prevalência ligeiramente maior entre as mulheres e sua incidência é bimodal, com picos na terceira e oitava décadas de vida. A maioria dos pacientes evolui para a recuperação dentro de algumas semanas, embora seja comum uma piora do quadro nas primeiras 48 horas. O tratamento deve ser realizado no sentido de prevenir complicações e as condutas medicamentosas não estão consagradas. Como fatores de risco para a PB têm sido relatados hipertensão arterial, diabete mellitus, gravidez, puerpério e infecção pelo vírus herpes tipo I. Embora existam vários fatores de risco associados à PB, em relação à cirurgia de face-lifting existe apenas um caso relatado na literatura. Relato do Caso: No presente estudo, os autores descrevem o segundo caso de paralisia de Bell após a cirurgia de face-lifting.

The peripheral facial palsy is a disease that can leave significant aestheticaland functional sequelae in patients. According to medical literature, Bell’s palsy (BP) is the most common cause, representing from 50 to 80% of the cases. However, it must be considered as an exclusion diagnosis. A slightly higher prevalence is estimated in women and its incidence is bimodal with peaks in the third and eighth life decades. Most patients recover within weeks, though a worsening degree may be common in the first 48 hours. Treatment must be performed to prevent complications and the medical procedures are not universally accepted. The following have been mentioned as BP risk factors: arterial hypertension, mellitus diabetes, pregnancy, puerperium and infection caused by type I herpesvirus. Although there are several BP associated risk factors, regarding face-lifting surgery there is only one reported case in medical literature. Case Report: In the present study, the authors describe the second case of Bell’s palsy after face-lifting surgery.

An unusual presentation of Bell's palsy: A case report and review of literature.

In clinical medicine there may be times when clinical conditions manifest differently both when they present individually or concomitantly. Such scenarios warrant a broader differential diagnosis with thorough investigations. We present one such case of a patient of Bell's palsy with unexplained eye pain on the ipsilateral side. The patient had a chronic retinal detachment which became worse due to the concomitant Bell's palsy.

Fisioterapia na paralisia facial periférica: estudo retrospectivo / Physical therapy in peripheral facial paralysis: retrospective study

A paralisia facial periférica requer tratamento especializado. A fisioterapia tem como objetivo restabelecer a mímica facial. O objetivo deste estudo foi descrever e analisar os resultados da fisioterapia para indivíduos com paralisia facial periférica. FORMA DE ESTUDO: Retrospectivo. MÉTODO: Foi realizado um estudo retrospectivo em um Hospital Universitário, com autorização do Serviço de Atendimento Médico e Estatístico, no período de 1999 a 2003. Os dados são apresentados em forma descritiva, com utilização de média e mediana para variáveis numéricas e freqüência para variáveis categóricas. RESULTADOS: Foram analisados 23 prontuários durante quatro anos. Foi identificado o predomínio do sexo feminino e a média de idade foi de 32,3 anos (DP±16,5); 14 casos idiopáticas e cinco traumáticas; 12, com comprometimento motor total e 11, parcial; nos 12 casos com avaliação final, sete evoluíram para recuperação parcial e cinco para total. A fisioterapia utilizada foi cinesioterapia e orientações. CONCLUSÃO: Neste estudo os indivíduos são similares a outras populações. Foram tratados com cinesioterapia, como sugerido pela literatura científica e evoluíram com recuperação.

Peripheral facial paralysis requires specialized treatment. Physical therapy aims at reestablishing facial movements. The aim of this study was to describe and to analyze physical therapy results for individuals with peripheral facial paralysis. STUDY DESIGN: Retrospective study. METHOD: A retrospective study was carried out at the University Hospital, authorized by the Statistics and Medical File Services, from 1999 to 2003. Data are presented in descriptive form with mean and median values for numeric variables and frequency for categorical variables. RESULTS: Twenty-three files were analyzed during four years. Females predominated and the average age was of 32.3 years (SD±16.5); 14 idiopathic and five trauma cases; 12 with total motor deficit and 11 with partial motor deficit; in the 12 cases that underwent final evaluation, seven had partial and five had total recovery. The physical therapy program used was kinesiotherapy and patient education. CONCLUSION: In this study, individuals were similar to individuals in other populations. They were treated with kinesiotherapy, as suggested by the scientific literature and recovered.