MyMedR

Delayed facial palsy in Miller Fisher syndrome

Tan CY, Yuki N, Shahrizaila N

J Neurol Sci, 2015 Nov 15;358(1-2):409-12.

PMID: 26277343 DOI: 10.1016/j.jns.2015.08.009

Miller Fisher syndrome is characterised by the triad of ophthalmoplegia, ataxia and areflexia. However, facial palsy can occur during the course of the illness although development of facial palsy when other cardinal signs of Miller Fisher syndrome have reached nadir or improving, is unusual. This delayed appearance of facial palsy can be easily overlooked by the treating clinician. Here, we report four patients with Miller Fisher syndrome and delayed-onset facial palsy. We discuss the possible underlying reasons behind the delay in facial palsy.

Matched MeSH terms: Bell Palsy

Fulltext The use of nerve conduction studies in determining the short-term outcome of Bell's palsy

Prakash KM, Raymond AA

Med J Malaysia, 2003 Mar;58(1):69-78.

PMID: 14556328

Bell's palsy is a common neurological problem causing considerable loss of self-esteem among patients. A prospective observational study was conducted to determine the short-term outcome of Bell's palsy at 1 month and 2 months after the onset and the relationship between these outcomes with facial nerve degeneration. We also determined if gender, age, diabetes, systolic and diastolic blood pressure influence the severity of facial nerve degeneration and the clinical outcome at 2 months after the onset. After clinically grading the newly diagnosed unilateral Bell's palsy patients using the House-Brackmann facial nerve grading system, nerve conduction studies of the facial nerve were done to determine the severity of facial nerve degeneration. The recovery of the facial paralysis was clinically graded again at the end of 1 month and 2 months from the onset. A total of 37 patients were recruited. There was a strong positive correlation between facial nerve degeneration and the clinical outcome of Bell's palsy at 1 month (r = 0.794; p < 0.0005) and 2 months (r = 0.732; p < 0.0005) after the onset. There was no significant correlation between either the facial nerve degeneration or the clinical outcome at 2 months with the patients' age (p = 0.288 and p = 0.799 respectively), systolic blood pressure (p = 0.425 and p = 0.933 respectively) or diastolic blood pressure (p = 0.243 and p = 0.579 respectively). Neither the severity of facial nerve degeneration nor the clinical outcome at 2 months were significantly different between male and female patients (p = 0.460 and p = 0.725 respectively) or diabetic and non-diabetic patients (p = 0.655 and p = 0.655 respectively).

Matched MeSH terms: Bell Palsy/etiology; Bell Palsy/physiopathology*; Bell Palsy/therapy*

Fulltext Facial nerve palsy in otitis externa: A red flag?

Badaruddin A, Choo MM

Malays Fam Physician, 2021 Mar 25;16(1):117-120.

PMID: 33948150 DOI: 10.51866/cr1108

Otitis externa is an infection of the external auditory canal. It rarely results in facial palsy except in severe cases such as necrotizing otitis externa, which is a life-threatening invasive infection of the external auditory canal. Early recognition with prompt and appropriate treatment of necrotizing otitis externa is crucial to prevent more sinister complications. Here we report a case of an elderly gentleman who presented with otitis externa and developed facial palsy a month later. We identified possible problems that may have led to the complication so that such an occurrence can be prevented in the future.

Matched MeSH terms: Bell Palsy

Fulltext Risk of serious adverse events after the BNT162b2, CoronaVac, and ChAdOx1 vaccines in Malaysia: A self-controlled case series study

Ab Rahman N, Lim MT, Lee FY, Lee SC, Ramli A, Saharudin SN, et al.

Vaccine, 2022 Jul 30;40(32):4394-4402.

PMID: 35667917 DOI: 10.1016/j.vaccine.2022.05.075

BACKGROUND: Rapid deployment of COVID-19 vaccines is challenging for safety surveillance, especially on adverse events of special interest (AESIs) that were not identified during the pre-licensure studies. This study evaluated the risk of hospitalisations for predefined diagnoses among the vaccinated population in Malaysia.

METHODS: Hospital admissions for selected diagnoses between 1 February 2021 and 30 September 2021 were linked to the national COVID-19 immunisation register. We conducted self-controlled case-series study by identifying individuals who received COVID-19 vaccine and diagnosis of thrombocytopenia, venous thromboembolism, myocardial infarction, myocarditis/pericarditis, arrhythmia, stroke, Bell's Palsy, and convulsion/seizure. The incidence of events was assessed in risk period of 21 days postvaccination relative to the control period. We used conditional Poisson regression to calculate the incidence rate ratio (IRR) and 95% confidence interval (CI) with adjustment for calendar period.

RESULTS: There was no increase in the risk for myocarditis/pericarditis, Bell's Palsy, stroke, and myocardial infarction in the 21 days following either dose of BNT162b2, CoronaVac, and ChAdOx1 vaccines. A small increased risk of venous thromboembolism (IRR 1.24; 95% CI 1.02, 1.49), arrhythmia (IRR 1.16, 95% CI 1.07, 1.26), and convulsion/seizure (IRR 1.26; 95% CI 1.07, 1.48) was observed among BNT162b2 recipients. No association between CoronaVac vaccine was found with all events except arrhythmia (IRR 1.15; 95% CI 1.01, 1.30). ChAdOx1 vaccine was associated with an increased risk of thrombocytopenia (IRR 2.67; 95% CI 1.21, 5.89) and venous thromboembolism (IRR 2.22; 95% CI 1.17, 4.21).

CONCLUSION: This study shows acceptable safety profiles of COVID-19 vaccines among recipients of BNT162b2, CoronaVac, and ChAdOx1 vaccines. This information can be used together with effectiveness data for risk-benefit analysis of the vaccination program. Further surveillance with more data is required to assess AESIs following COVID-19 vaccination in short- and long-term.

Matched MeSH terms: Bell Palsy/chemically induced; Bell Palsy/epidemiology

Fulltext Bilateral facial nerve palsy secondary to an atypical presentation of Gullain-BarrÃ© syndrome

Azarisman, S.M.S., Shahrin, T.C.A., Marzuki, A.O., Fatnoon, N.N.A., Rathor, M.Y.

International Medical Journal Malaysia, 2009;8(1):41-44.

MyJurnal

Bilateral simultaneous facial nerve palsy is an extremely rare clinical entity and may occur in association with a variety of neurological, infectious, neoplastic or degenerative disorders. We describe a patient, who presented with facial diplegia and normal reflexes on examination. During the entire hospitalization, he developed no motor weakness and remained ambulatory. Whether treatment is warranted for this and other milder variants of Gullain-BarrÃ© syndrome is also discussed. Atypical presentations with preserved or brisk reflexes, can be a diagnostic dilemma.

Matched MeSH terms: Bell Palsy

Fulltext Ancient Schwannoma Of The Facial Nerve: An Unusual Histological Variant Of A Rare Disease

Baharudin, A., Din Suhaimi, S., Omar, E.

International Medical Journal Malaysia, 2006;5(2):1-4.

MyJurnal

Schwannomas are benign slow growing lesions arising from the Schwann cells that ensheath the axons of the peripheral, cranial and autonomic nervous systems. Intracranial schwannomas develop from the facial nerve much more rarely than from the vestibular or trigeminal nerves. Ancient schwannoma is an unusual histological variant of this rare disease. A 48 years old man who had recurrent facial nerve paralysis and right external auditory mass is presented in this case report.

Matched MeSH terms: Bell Palsy

Fulltext Retrospective review of facial nerve schwannomas: the universiti kebangsaan malaysia medical centre experience

Mazita, A., Zahirrudin, Z., Saim, L., Asma, A.

Medicine & Health, 2010;5(2):86-92.

MyJurnal

Facial nerve schwannoma is a rare slow growing benign tumour which arises from the Schwann cell of the neurilemma. A retrospective review of 6 patients who had been diagnosed with facial nerve schwannoma between 1998 and 2008 was conducted. There was equal distribution of male and female patients. The mean age was 42 years (range 19 to 66 years). The tumour originated in the internal auditory canal (2 patients), intra-temporal (3 patients) and intraparotid (1 patient) segments of the facial nerve. All tumours were successfully removed and facial nerve continuity was pre-served in 2 cases. The presenting symptoms of facial nerve schwannoma are non specific and dependent on the site of tumour origin. It is a great mimicker of other lesions that can present at the same location. The surgeon should have a high index of suspicion when patients present with progressive facial nerve palsy. Patients should always be counselled regarding risk of facial paralysis because the diagnosis of facial nerve schwannoma is often confirmed intra-operatively.

Matched MeSH terms: Bell Palsy

Fulltext Facial nerve paralysis: a rare complication of parotid abscess

Sabir Husin Athar PP, Yahya Z, Mat Baki M, Abdullah A

Malays J Med Sci, 2009 Apr;16(2):38-9.

PMID: 22589657

Benign parotid neoplasm and inflammatory processes of the parotid resulting in facial paralysis are extremely rare. We report a 72-year-old Malay female with poorly-controlled diabetes mellitus who presented with a painful right parotid swelling associated with right facial nerve palsy. The paralysis (Grade VI, House and Brackmann classification) remained after six months.

Matched MeSH terms: Bell Palsy

Fulltext Outcome of patients presenting with idiopathic facial nerve paralysis (Bell's palsy) in a tertiary centre--a five year experience

Tang IP, Lee SC, Shashinder S, Raman R

Med J Malaysia, 2009 Jun;64(2):155-8.

PMID: 20058577

This is a retrospective study. The objective of this study is to review the factors influencing the outcome of treatment for the patients presented with idiopathic facial nerve paralysis. The demographic data, clinical presentation and management of 84 patients with idiopathic facial nerve paralysis (Bell's palsy) were collected from the medical record office, reviewed and analyzed from 2000 to 2005. Thirty-four (72.3%) out of 47 patients who were treated with oral prednisolone alone, fully recovered from Bell's palsy meanwhile 36 (97%) out of 37 patients who were treated with combination of oral prednisolone and acyclovir fully recovered. The difference was statistically significant. 42 (93.3%) out of 45 patients who presented within three days to our clinic, fully recovered while 28 (71.8%) out of 39 patients presented later then three days had full recovery from Bell's palsy. The difference was statistically significant. The outcome of full recovery is better with the patients treated with combined acyclovir and prednisolone compared with prednisolone alone. The patients who were treated after three days of clinical presentation, who were more than 50 years of age, who had concurrent chronic medical illness and facial nerve paralysis HB Grade IV to VI during initial presentation have reduced chance of full recovery of facial nerve paralysis.

Matched MeSH terms: Bell Palsy/drug therapy*

Fulltext Recurrent Bell's palsy in a young woman

Ngow HA, Wan Khairina WM, Hamidon BB

Singapore Med J, 2008 Oct;49(10):e278-80.

PMID: 18946598

Bell's palsy is a benign lower motor neuron facial nerve disorder. It is almost always unilateral. We report a 20-year-old nulliparous woman with five episodes of recurrent Bell's palsy. A review of recent medical literature revealed a paucity of case reports involving an individual with five episodes of recurrent Bell's palsy, with none found in Asian neurology medical literature. Despite the multiple episodes of Bell's palsy recurrences, the patient did not suffer much neurological sequelae from the disease.

Matched MeSH terms: Bell Palsy/diagnosis*

Fulltext Embryonal rhabdomyosarcoma of the middle ear presenting with aural polyp and facial nerve palsy

Vasiwala R, Burud I, Lum SK, Saren RS

Med J Malaysia, 2015 Oct;70(5):314-5.

PMID: 26556123 MyJurnal

Rhabdomyosarcoma is a rare tumour in the middle ear and mastoid cavity in children and the diagnosis is difficult. Repeated histological examination may be essential to confirm the diagnosis. We report a 6 year old boy with a left aural polyp, otorrhoea and facial nerve palsy who was initially thought to have otitis media and mastoiditis. He had polypectomy and the tissue taken for histopathology suggested an inflammatory condition. Subsequently he had mastoidectomy. Tissue taken during mastoidectomy was however reported as rhabdomyosarcoma. The child developed a cerebral abscess and eventually succumbed. A literature review of the disease, radiological findings, immunohistochemical features and treatment options is described.

Matched MeSH terms: Bell Palsy

Fulltext Managing a Complicated Acute Otomastoiditis at Day Four of Life

Lim R, Zulkifli S, Hailani I, Hashim ND

Cureus, 2021 Jan 25;13(1):e12905.

PMID: 33654590 DOI: 10.7759/cureus.12905

Acute mastoiditis in a newborn complicated by the presence of facial nerve palsy is an alarming finding requiring rapid assessment and further investigation. Such an early presentation should point the clinician towards an underlying systemic pathology or congenital anatomical abnormality. Facial nerve involvement indicates severe infection and possible dehiscence of the facial canal. Although more frequent in children, it is rare in neonates. We would like to share our experience in managing the youngest known presentation of otomastoiditis at four days of life. The patient presented with otorrhea and facial paralysis and progressed to meningitis. He was finally diagnosed with chronic granulomatous disease.

Matched MeSH terms: Bell Palsy

Fulltext A Rare Case of an Undiagnosed Middle Ear Tumor Due to Late Referral

Ng JJ, Ong HY, Nasseri Z, Azmi MI, Abdullah A

Cureus, 2021 Jan 08;13(1):e12584.

PMID: 33457146 DOI: 10.7759/cureus.12584

Facial nerve tumors constitute about 5% of all facial nerve paralysis. As it is relatively uncommon, it could be misdiagnosed. We encountered an 18-year-old girl who had right facial weakness since the age of four, referred to otorhinolaryngology clinic for further evaluation only when her hearing deteriorated and the facial weakness worsened. Further investigation revealed facial nerve schwannoma. Facial nerve paralysis in the pediatric age group is uncommon and should be examined in detail to rule out other possible etiologies besides Bell's palsy.

Matched MeSH terms: Bell Palsy

Fulltext Antidepressant induced Mania and Steroid Psychosis in a Patient with Bell’s Palsy

Tan, C.L., Anne Yee, H.A., Majid, S.M., Koh, O.H., Ng, C.G.

Malaysian Journal of Psychiatry, 2010;19(2):1-5.

MyJurnal

Steroid is commonly used for various connective tissue diseases and immunological related disorders. Psychiatric side effects are common in patient with systematic treatment of steroid. The reported prevalence ranges from 6% to 28%. Antidepressant-induced mania occurs when the mood of a patient switches to manic or hypomanic from depression after the use of antidepressant. We reported a case of a 55 year old lady, who presented with agitation and grandiosity after the treatment with antidepressant. She was initially diagnosed as having Bell’s palsy with unilateral facial muscle weakness. Oral prednisolone was prescribed for seven days where she became depressed, having auditory hallucination and delusion of guilt. She was then started on antidepressant where she became irritable, agitated and developed grandiose delusion. The antidepressant was withheld and she was started on atypical antipsychotic. Her condition improved and discharged well after three days of stay in the ward.

Matched MeSH terms: Bell Palsy

Acute Ischemic Stroke and Acute on Chronic Kidney Disease

Aftab RA, Khan AH, AbdulRazzaq HA, Adnan AS

JNMA J Nepal Med Assoc, 2016 12 10;54(202):85-87.

PMID: 27935930

Ischemic stroke is due to either local thrombus formation or emboli that occlude a cerebral artery, together with chronic kidney disease represent major mortality and morbidity.Here we present a case of 53 years old Malay man, admitted to a hospital in Malaysia complaining of sudden on set of weakness on right sided upper and lower limb associated with slurred speech. Patient was also suffering from uncontrolled hypertension, hyperlipidemia, chronic kidney disease stage 4, and diabetes mellitus (uncontrolled). He was diagnosed with acute ischemic stroke with cranial nerve 7 palsy (with right hemiparesis), acute on chronic kidney disease precipitated by dehydration and ACE inhibitor, and hyperkalemia. Patients with ischemic disease and chronic kidney disaese require constant monitering and careful selected pharmacotherapy. Patient was placed under observation and was prescribed multiple pharamacotherpay to stabalise detoriating condition.

Matched MeSH terms: Bell Palsy/diagnosis

Myeloid Sarcoma of Temporal Bone: A Rare Manifestation of Relapse Acute Myeloid Leukemia

Goh BS, Tang CL, Tan GC

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 2):1023-1026.

PMID: 31750119 DOI: 10.1007/s12070-015-0930-8

Myeloid sarcoma is a rare malignant extramedullary neoplasm of myeloid precursor cells. This disorder may occur in concomitance with or precede development of acute or chronic myeloid leukemia. Sometimes, it is the initial manifestation of relapse in a previously treated acute myeloid leukemia. We report a case of 11 years old boy with acute myeloid leukemia in remission state, presented with short history of right otalgia associated with facial nerve palsy. Diagnosis of right acute mastoiditis with facial nerve palsy as complication of acute otitis media was made initially. Patient underwent simple cortical mastoidectomy but histopathology from soft tissue that was sent revealed diagnosis of myeloid sarcoma. A leukemic relapse was confirmed by paediatric oncologist through bone marrow biopsy. Chemotherapy was commenced but patient responded poorly to the treatment.

Matched MeSH terms: Bell Palsy

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