Journal of General Internal Medicine

, Volume 21, Issue 7, pp C7–C10

Bilateral facial paralysis

Case presentation and discussion of differential diagnosis
Case Report

Abstract

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.

Key words

neurosarcoidosis sarcoidosis bilateral facial palsy 

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Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  1. 1.Department of Internal MedicineLankenau Hospital, 100 Lancaster RoadWynnewood

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