Bilateral facial paralysis is a rare condition and therefore represents a diagnostic challenge. We report the case of a 34-year-old healthy woman with sequential bilateral facial paralysis as a sole manifestation of sarcoidosis. She initially presented with an isolated left sided Bell’s palsy without any symptoms to suggest alternative diagnoses. Within a month there was progression to peripheral facial paresis on the contra lateral side, prompting a diagnosis of Lyme disease. Her physical examination and chest x-ray did not reveal any clinical evidence of sarcoidosis. After failing to respond to an empiric trial of intravenous ceftriaxone for a presumptive diagnosis of Lyme disease, computed tomography scan of the chest was ordered which demonstrated bilateral hilar lymphadenopathy. Bronchoscopic biopsy confirmed a diagnosis of sarcoidosis. The patient then made a complete recovery on steroid therapy. We discuss the differential diagnosis of facial diplegia and focus on the clinical presentation, diagnosis and treatment of neurosarcoidosis.
Gevers G, Lemkens P. Bilateral simultaneous facial paralysis—differential diagnosis and treatment options. Acta Otorhinolaryngologica Belg. 2003;57:139–46.Google Scholar
Teller D, Murphy T. Bilateral facial paralysis: a case presentation and literature review. J. Otolaryngol. 1992;21:44–46.PubMedGoogle Scholar
May M. The Facial Nerve, Chapter 9. New York: Thieme Inc; 1986:181.Google Scholar
Mayock RL, Bertrand P, Morrison CE, et al. Manifestations of sarcoidosis: analysis of 145 patients with a review of nine series selected from the literature. Am J Med. 1963;35:67–89.PubMedCrossRefGoogle Scholar
Delaney P. Neurologic manifestations in sarcoidosis: review of the literature, with a report of 23 cases. Ann Intern Med. 1977;87:336–45.PubMedGoogle Scholar
Stern BJ, Krumholz A, Johns C, et al. Sarcoidosis and its neurological manifestations. Arch Neurol. 1985;42:909–17.PubMedGoogle Scholar
Oksanen V, Fyhrquist F, Somer H, et al. Angiotensin converting enzyme in cerebrospinal fluid: a new assay. Neurology. 1985;35:1220–3.PubMedGoogle Scholar