Figure - available from: Journal of Neurology
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Diagnostic flow-chart for patients presenting with bilateral facial palsy (BFP). CT computed tomography, ENT ear nose thorat specialist, CSF cerebrospinal fluid, MRI magnetic resonance imaging
Source publication
Objective
To systematically review the published cases of bilateral facial palsy (BFP) to gather evidence on the clinical assessment and management of this pathology.
Methods
Following PRISMA statement recommendations, 338 abstracts were screened independently by two authors. Inclusion criteria were research articles of human patients affected by...
Citations
... A second point is that bilateral facial palsy is not an extremely rare disease, as stated in the article (1). Bilateral facial palsy occurs in 0.3 to 2% of patients with facial palsy (3). In half of patients with bilateral facial palsy, other cranial nerves are involved (3). ...
... Bilateral facial palsy occurs in 0.3 to 2% of patients with facial palsy (3). In half of patients with bilateral facial palsy, other cranial nerves are involved (3). It should be clearly stated whether the index patient was thoroughly examined for involvement of cranial nerves other than the facial nerves. ...
Bilateral facial palsy with paresthesia (FDP) is a rare variant of GBS, characterized by simultaneous bilateral facial palsy and paresthesia of the distal limbs. Mounting evidence indicates that the presence of anti-GT1a IgG has a pathogenic role as an effector molecule in the development of cranial nerve palsies in certain patients with GBS, whereas anti-GT1a antibody is rarely presented positive in FDP. Here, we report the case of a 33-year-old male diagnosed with FDP presented with acute onset of bilateral facial palsy and slight paresthesias at the feet as the only neurological manifestation. An antecedent infection with no identifiable reason for the fever or skin eruptions was noted in the patient. He also exhibited cerebrospinal fluid albuminocytologic dissociation and abnormal nerve conduction studies. Notably, the testing of specific serum anti-gangliosides showed positive anti-GT1a IgG/IgM Ab. The patient responded well to intravenous immunoglobulin therapy. This case brings awareness to a rare variant of GBS, and provides the first indication that anti-GT1a antibodies play a causative role in the development of FDP. The case also suggests that prompt management with IVIG should be implemented if FDP is diagnosed.
