Journal of General Internal Medicine

, Volume 21, Issue 7, pp C7–C10

Bilateral facial paralysis

Case presentation and discussion of differential diagnosis
Case Report


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 


  1. 1.
    Adour KK, Byl FM, Hilsinger RL, Kahn ZM, Sheldon MI. The true nature of Bell’s palsy: analysis of 1,000 consecutive patients. Laryngoscope. 1978;88:787–801.PubMedGoogle Scholar
  2. 2.
    Stahl N, Ferit T. Recurrent bilateral peripheral facial palsy. J Laryngol Otol. 1989;103:117–9.PubMedCrossRefGoogle Scholar
  3. 3.
    McIntosh WE, Brenner JF, Aschenbrenner JE. Bilateral facial paralysis as the sole presenting feature of sarcoidosis: report of a case. J Am Osteopath Assoc. 1987;87:245–7.PubMedGoogle Scholar
  4. 4.
    George MK, Pahor AL. Sarcoidosis: a cause for bilateral facial palsy. Ear Nose Throat J. 1991;70:492–3.PubMedGoogle Scholar
  5. 5.
    Haydar A, Hujairi NM, Tawil A. Bilateral facial paralysis: what’s the cause? Med J Am. 2003;179:553.Google Scholar
  6. 6.
    Hoitsma E, Faber CG, Drent M, et al. Neurosarcoidosis: a clinical dilemma. Lancet Neurol. 2004;3:397–407.PubMedCrossRefGoogle Scholar
  7. 7.
    Zajicek JP, Scolding NJ, Foster O, et al. Central nervous system sarcoidosis—diagnosis and management. Q J Med. 1999;92:103–17.Google Scholar
  8. 8.
    Steenerson RL. Bilateral facial paralysis. Am J Otol. 1986;7:99–103.PubMedGoogle Scholar
  9. 9.
    Gevers G, Lemkens P. Bilateral simultaneous facial paralysis—differential diagnosis and treatment options. Acta Otorhinolaryngologica Belg. 2003;57:139–46.Google Scholar
  10. 10.
    Teller D, Murphy T. Bilateral facial paralysis: a case presentation and literature review. J. Otolaryngol. 1992;21:44–46.PubMedGoogle Scholar
  11. 11.
    May M. The Facial Nerve, Chapter 9. New York: Thieme Inc; 1986:181.Google Scholar
  12. 12.
    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
  13. 13.
    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
  14. 14.
    Stern BJ, Krumholz A, Johns C, et al. Sarcoidosis and its neurological manifestations. Arch Neurol. 1985;42:909–17.PubMedGoogle Scholar
  15. 15.
    Oksanen V, Fyhrquist F, Somer H, et al. Angiotensin converting enzyme in cerebrospinal fluid: a new assay. Neurology. 1985;35:1220–3.PubMedGoogle Scholar

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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