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Facial nerve palsy in giant-cell arteritis: case-based review

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Abstract

Acute peripheral facial nerve palsy is most frequently idiopathic (Bell’s palsy) or virally induced, but can also be due to several other conditions. A rare cause is underlying systemic or autoimmune disease. A 79-year-old man presented with peripheral facial nerve palsy, malaise, and fever. Physical examination revealed tenderness of the left temporal artery and reduced pulsatility. 18F-FDG-PET/CT and biopsy of the temporal artery confirmed the diagnosis of giant cell arteritis (GCA). Prompt institution of corticosteroid therapy produced rapid decrease in inflammatory markers and gradual improvement of the facial nerve palsy. We searched the MEDLINE, Embase, and Scopus databases to identify previous reports of peripheral nerve palsy in GCA, other vasculitides, and autoimmune diseases. Facial nerve palsy as the presenting symptom of GCA has very rarely been reported. Although temporal artery biopsy is the gold standard for diagnosis, it may be negative in up to one-third of cases. In doubtful cases, imaging can help establish the diagnosis. Ultrasound, 3 T MRI, and 18F-FDG-PET/CT have all been previously reported to be useful. Peripheral facial nerve palsy may very rarely be the presenting symptom of GCA. Early correct diagnosis is essential for starting appropriate therapy. In patients with atypical features, 18F-FDG-PET/CT may be useful for establishing the diagnosis.

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Author notes

  1. Olivier Gheysens

    Present address: Department of Nuclear Medicine, Cliniques Universitaires Saint-Luc, Brussels, Belgium

Authors and Affiliations

  1. Department of General Internal Medicine, Department of Microbiology, Immunology and Transplantation, KU Leuven, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    Eveline Claeys, Wouter Meersseman, Daniel Blockmans & Liesbet Henckaerts

  2. Department of Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, University Hospitals Leuven, Leuven, Belgium

    Eric Verbeken

  3. Katholieke Universiteit Leuven Universitaire Ziekenhuizen Leuven, Leuven, Belgium

    Eveline Claeys

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Contributions

EC and LH performed the literature search and wrote the manuscript in consultation with OG, BD, EV and WM. OG interpreted the PET-CT images and provided corresponding images and caption. EV interpreted the anatomopathological data and provided corresponding images and caption. All authors have read and approved the final version of the manuscript as submitted, and agree to be accountable for all aspects of the work.

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Correspondence to Eveline Claeys.

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Claeys, E., Gheysens, O., Meersseman, W. et al. Facial nerve palsy in giant-cell arteritis: case-based review. Rheumatol Int 41, 481–486 (2021). https://doi.org/10.1007/s00296-020-04673-7

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