Background The brain magnetic resonance imaging (MRI) findings seen in patients with Bell's palsy are abnormal contrast enhancement of affected facial nerves. Previous evaluation included mainly patients who had experienced palsy for several weeks and there are no studies to date on patients with late stage of Bell’s palsy. This study investigated the findings of MRI of Bell's palsy after 3 months of symptom onset to assess how long the enhancement last.
Methods Among the patients with Bell's palsy (idiopathic unilateral facial palsy) who visited the hospital, 9 patients who underwent contrast-enhanced MRI of the internal auditory canal after 3 months of symptom onset were reviewed retrospectively. MRI examination results were investigated along with the patient's clinical symptoms and electrodiagnostic test results. Based on the MRI results, the frequency of abnormal contrast enhancement and contrast-enhanced areas were investigated.
Results 9 patients were included. 6 of them did MRI imaging because of incomplete recovery of facial palsy and the others did because of complication of facial palsy including synkinesis and hemifacial spasm. Time interval between symptom onset and evaluation was 17 months (3-84). Of 9 patients, 2 showed abnormal enhancement of affected nerve and they performed MRI after 5 months and 12 months of symptom onset, respectively.
Conclusions Abnormal enhancement of facial nerve in Bell’s palsy could last up to one year. This awareness can be helpful in interpretation of MRI of Bell’s palsy.
Bell's palsy is one of the most common outpatient problems in neurologic clinics. The diagnosis of Bell's palsy is typically made through clinical evaluation. Characteristic findings include the acute onset of unilateral lower motor neuron facial paralysis, reaching its peak within 72 hours. However, there are numerous diagnostic pitfalls related to the differential diagnosis, including neoplasms, autoimmune disorders, trauma, and infections. For an accurate diagnosis, recognizing the anatomical background and identifying atypical clinical features of Bell's palsy is crucial. Oral steroids are considered the optimal treatment, and antiviral agents may play a beneficial role. Even without treatment, the prognosis for Bell's palsy is generally favorable, but long-standing sequelae are also possible and should be considered for functional, aesthetic, and psychological aspects.
Background Unilateral peripheral facial nerve palsy may have a detectable cause (secondary facial nerve palsy) or may be idiopathic (Bell’s palsy). Facial palsy is attributable to various causes ranging from mild infection to severe neurological disorders. We investigated the prevalence and types of serious neurological disorders in patients with unilateral facial palsy.
Methods We reviewed the medical records of patients with unilateral facial nerve palsy and identified patients diagnosed with facial palsy secondary to serious or life-threatening causes. We investigated the clinical characteristics, as well as electrodiagnostic and imaging findings in these patients.
Results Of 924 patients with facial palsy, 11 patients (1.2%) were diagnosed with the following serious neurological disorders: acoustic schwannoma in two patients, facial nerve schwannoma, glossopharyngeal schwannoma, meningioma, epidermoid cyst, parotid gland tumor, pontine infarct, skull base osteomyelitis, brain metastasis, and pachymeningitis.
Conclusions Although unilateral facial palsy is rarely associated with serious neurological disorders, early detection of the etiopathogenetic contributors is important for prompt initiation of optimal management. Therefore, clinicians should be mindful of disorders that can mimic Bell’s palsy.
Bell’s palsy is an acute peripheral facial paralysis with no detectable cause. Although the prognosis of Bell’s palsy is generally good, some patients experience poor recoveries and there is no established treatment for those that do not recover even after receiving the conventional treatment. Here we present two cases of refractory Bell’s palsy with facial nerve enhancement in magnetic resonance imaging who showed symptomatic improvement after the late administration of high-dose intravenous methylprednisolone.
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Saccades are rapid eye movements that shift the line of sight between successive points of fixation. The cerebellum calibrates saccadic amplitude (dorsal vermis and fastigial nucleus) and the saccadic pulse‐step match (flocculus) for optimal visuo‐ocular motor behavior. Based on electrophysiology and the pharmacological inactivation studies, early activity in one fastigial nucleus could be important for accelerating the eyes at the beginning of a saccade, and the later activity in the other fastigial nucleus could be critical for stopping the eye on target, which is controlled by inhibitory projection from the dorsal vermis. The cerebellum could monitor a corollary discharge of the saccadic command and terminate the eye movement when it is calculated to be on target. The fastigial nucleus and dorsal vermis also participate in the adaptive control of saccadic accuracy.
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Background: Bell’s palsy (BP) is the most common cause of unilateral lower motor facial palsy. Recurrent paralysis of the facial nerve is unusual and reported in only 7-8%. Methods: A total of 394 consecutive patients with acute BP patients were enrolled at Daegu Catholic University Hospital from July 2005 to September 2012. We classified the patients into two groups-single BP and recurrent BP-and compared them by patient characteristics, clinical features, MRI findings, electrophysiologic findings and prognosis. The degree of BP was graded according to the House and Brackmann facial nerve grading system. Results: Recurrent BP was observed in 31 (7.9%) patients. The number of recurrence was varied from 2 to 5. The recurrent BP (9.7%) had more incidence of family history and MRI enhancement than those of single BP (2.2%, p=0.047). The single BP (63.4%) had better recovery than recurrent BP (45.2%, p=0.045). Conclusions: The recurrent BP had more incidence of family history, MRI enhancement and poor prognosis than the single BP.
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Characteristics and Treatment Methods of Bell’s Palsy in Patients Visiting Korean Medicine Hospitals From August 2018 to July 2021 Hyeon Kyu Choi, Min Ju Kim, Young Rok Lee, Hyun Ji Cha, Hyun Jin Jang, So Jeong Kim, Ju Hyun Jeon, Young Il Kim Journal of Acupuncture Research.2022; 39(2): 122. CrossRef
Correlation of Internal & External Factors with the Beginning Period of Improvement in Idiopathic Facial Paralysis※ Hee Jin Sung, Su Sie Lim, Hyun Young Choi, Eun Yong Lee, Jung Du Roh, Cham Kyul Lee The Acupuncture.2016; 33(1): 57. CrossRef
A Clinical Study on Children and Adolescents Who Visited the Hospital of Korean Medicine for 284-Peripheral Facial Palsy Ki Yeon Kang, Hye Lim Lee, Jae Kyung Han, Yun Hee Kim The Journal of Korean Oriental Pediatrics.2014; 28(4): 45. CrossRef
Backgrond : Bell's palsy(BP) is defined as an idiopathic peripheral facial paralysis of acute onset, accounting for more than 50% of all cases of facial parlysis. Different theories on the etiology of BP have been proposed. Herpes simplex virus-1(HSV) has been the most suspicious causative agent, but varicella zoster virus(VZV) also is suspected. Objectives : We evaluated the serological changes of IgG and IgM titer of HSV and VZV to know the causative agent of BP. Materials and Methods : Subjects consisted of 35 patients who developed acute idiopathic unilateral facial palsy(16 men and 19 women from 9 to 78 years old) within a week of onset. We took the serum of the acute and convalescent stages, respectively. Serum IgG and IgM titer of HSV and VZV were measured in acute and convalescent stages by EIA method. Results : Only the HSV IgG titer showed statistically significant elevation in the convalescent stage(p=0.0291). Others did not show any significant changes between the acute and convalescent stage. Conclusion : We concluded that HSV may be related to the causative agent of BP.
Background : Bell's palsy(BP) is defined as an idiopathic peripheral facial paralysis of sudden onset and account more than 50% of facial paralysis. It's etiology is unclear, but herpes simplex virus type-1 (HSV-1) has been the most suspicious causative agent of BP that over been studied. We evaluated the effect of add-on acyclovir in acute stages of BP. Methods : Subject consisted of 35 patients who developed acute within 10 days after onset of BP. Facial nerve function was assessed by the House-Brackman facial nerve grading scale and facial nerve conduction study including blink reflex. Follow-up evaluation were made 2 month after onset. Twenty of 35 patients were treated with combined therapy of acyclovir and prednisone. As a control group, 15 patients were treated with prednisone only. We compared the improvement of neurologic defects at recovery phase. Results : Compared with two groups, difference in grading scale at recovery phase is statistically significant(p<0.01). So, acyclovir-prednisone group showed a significant improvement in grading at recovery phase compared with prednisone group. Conclusion : We identified the benefit of add-on acyclovir in the acute stage of BP
Background Electrophysiologic study accurately predicts the degree of degenerated motor axons but cannot giveprecise information on the type of injury that occurred in Bell
Background s: Electrodiagnostic tests have been developed to estimate the degree of facial nerve injury during theacute phase. Side-to-side amplitude comparison with the affected side expressed as a percentage of the nonaffected sidehas been one of the most valuable electrophysiologic methods of assessing facial nerve functioning. This study wasdesigned to know whether there is any difference in the side-to-side comparison of amplitudes and terminal latencies ofthe compound muscle action potentials (CMAP) of the facial muscles in the patients with Bell
Background: Bell's palsy (BP) is a self-limited rapid onset facial palsy that is non-life-threatening and has a generally favorable prognosis. Facial paralysis can be caused by numerous conditions, all of which should be excluded before thediagnosis of BP is reached. The etiopathogenesis and clinical course of BP are uncertain. So we analyzed the epidemiology and clinical course of BP patients.
Methods: The subjects include 100 cases of BP examined during the period of 18 months. Careful clinical history, neurologic examinations, laboratory tests, electrophysiologic studies, and brain imaging were performed. Follow-up examinations were done once a week during the first month and subsequently once a month until normal function was restored or for up to 3 months. Facial nerve function was assessed by House-Brackman (HB) facial nerve grading scale and electrophysiologic studies. Results: Except 13 recurrent BP patients, we analyzed 87 BP patients. Forty-four (50.6%) were men and 43(49.4%) were women and the mean age was 51.0(
Department of Neurology, Eulji Hospital Eulji University College of Medicine, Seoul, KoreaSpinocerebellar ataxia type 2 (SCA2) is characterized by progressive cerebellar ataxia and slow saccades. A 40-year-old woman presented with progressive gait disturbance and ataxia over 15 years. Neurologic examination revealed scanning speech, ataxia, and hyporeflexia. Brain CT showed diffuse atrophy of the cerebellum. Electronystagmography demonstrated slowed saccades with normal accuracy and delayed latency. The diagnosis of SCA2 was confirmed by the genetic test. Documentation of slow saccades may help differentiation among SCA subgroups.
Yong-Shik Park, Bum Chun Suh, Yong Bum Kim, Pil-Wook Chung, Heui-Soo Moon, Won Tae Yoon, Bong-Je Kim, Byung-Suk Yoon, Yong-Gyun Jung, Ha-Neul Jeong, Kun-Hyun Kim
Neurolymphomatosis is a complication of lymphoma and initial presentation of cranial nerve involvement has been rarelyreported. We describe a patient with neurolymphomatosis who presented as facial palsy mimicking steroid responsive Bell
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