Melkersson-Rosenthal syndrome with coeliac and allergic diseases

A 45-year-old man presented with a 10-year history of relapsing oedema of the lips. Moreover, he exhibited recurrent facial nerve palsy since the age of 10 years, coeliac disease since the age of 12 years, atopic eczema, allergic rhinitis and asthma. Physical examination revealed lip swelling and lingua plicata. Thus, he presented the classic triad of Melkersson-Rosenthal syndrome which includes recurrent orofacial oedema, facial nerve palsy and fissured tongue. A lip biopsy confirmed our clinical diagnosis.This case is particularly rare, as the classic triad is seen only in a minority of the cases. Moreover, allergic and coeliac diseases were observed concomitantly. This paper illustrates a potential pathophysiological interconnection between these pathologies in which interferon gamma could play a key role. To our knowledge, this is the first case report in which Melkersson-Rosenthal syndrome has been observed concurrently with coeliac disease.

Download Full-text

Sequential contralateral facial nerve palsies following COVID-19 vaccination first and second doses

BMJ Case Reports ◽

10.1136/bcr-2021-243829 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243829

Author(s):

Abigail Burrows ◽

Theo Bartholomew ◽

James Rudd ◽

David Walker

Keyword(s):

Emergency Department ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Case Reports ◽

Bell’S Palsy ◽

First Episode ◽

Bell's Palsy ◽

First Case ◽

History Of

A 61-year-old man presented to the ENT emergency clinic with a history of unilateral facial nerve palsy occurring shortly after each dose of the Pfizer-BioNTech COVID-19 vaccine. The first episode developed 5 hours after administration of the first dose and the second 2 days after administration of the second dose. Investigations at initial presentation to the emergency department were unremarkable, and the patient was diagnosed with Bell’s palsy on both occasions. We describe the first case of Bell’s palsy occurring after each dose of any UK-approved COVID-19 vaccine. Single episodes of unilateral facial nerve palsies have been reported in clinical trials and in subsequent case reports. There has been no evidence, however, of an episode after each dose. We also describe the earliest onset of symptoms from timing of administration of the vaccine, further suggesting the Bell’s palsy was associated with the vaccine.

Download Full-text

Predicting Factors Influencing Visual Function of the Eye in Patients with Unresolved Facial Nerve Palsy after Upper Eyelid Gold Weight Loading

Journal of Clinical Medicine ◽

10.3390/jcm10040578 ◽

2021 ◽

Vol 10 (4) ◽

pp. 578

Author(s):

Izabela Nowak-Gospodarowicz ◽

Marek Rękas

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Upper Eyelid ◽

Patient Age ◽

Corneal Sensation ◽

History Of ◽

Gold Weights ◽

Bell's Phenomenon ◽

Bell’S Phenomenon

Implantation of gold weights into the upper eyelid is a proven method of treating lagophthalmos and exposure keratopathy in patients with unresolved facial nerve palsy. The aim of this study was to evaluate the factors affecting visual acuity and corneal complications in patients after upper eyelid gold weight lid loading. Material and methods: This prospective consecutive clinical study was conducted in years 2012–2018. In total, 59 people (40 women, 19 men aged 55.5 ± 17.4 years) meeting the inclusion criteria were treated with gold weights. The ordered multinomial logit model was used to analyze the factors affecting best-corrected visual acuity (BCVA) and degree of exposure keratopathy after surgery. The influence of the following variables was analyzed: patient age, etiology and duration of the facial nerve palsy, history of the previous eyelid surgery, degree of lagophthalmos in mm, presence of Bell’s phenomenon, and corneal sensation, Schirmer test results. Results: Implantation of gold weights into the upper eyelid effectively reduced lagophthalmos and exposure keratopathy in the study group (p < 0.001). BCVA was maintained or better in 95% of patients after surgery. Patient age, presence of the Bell’s phenomenon, and corneal sensation significantly affected the final BCVA (p < 0.1). The presence of Bell’s phenomenon and corneal sensation had a positive effect on the degree of keratopathy after surgery (p < 0.1). In turn, patient age and history of tarsorrhaphy were significant negative prognostic factors of exposure keratopathy and BCVA after surgery (p < 0.05). Etiology and duration of facial nerve palsy, degree of corneal exposure in mm, and results of the Schirmer test did not have a significant impact on the outcome after surgery (p > 0.1). Conclusions: The results of our study may help to answer the question of how to direct ophthalmologists and other specialists who refer to ophthalmologists for management advice in patients with facial nerve palsy. Elderly patients with a history of tarsorrhaphy who present with poor Bell’s phenomenon and/or a lack of corneal sensation should be the first candidates for immediate correction of lagophthalmos.

Download Full-text

A case of idiopathic oculostapedial synkinesis without history of facial nerve palsy

The Journal of Laryngology & Otology ◽

10.1017/s0022215116005338 ◽

2016 ◽

Vol 130 (S3) ◽

pp. S164-S165

Author(s):

Keishi Fujiwara ◽

Yasushi Furuta ◽

Shinya Morita ◽

Atsushi Fukuda ◽

Akihiro Homma ◽

...

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

History Of

Download Full-text

Miller Fisher syndrome with early intracranial hypertension and delayed bilateral simultaneous facial nerve palsy: a case report

Journal of International Medical Research ◽

10.1177/0300060519867490 ◽

2019 ◽

Vol 48 (3) ◽

pp. 030006051986749

Author(s):

Yu-Ming Liu ◽

Yan-Li Chen ◽

Yan-Hua Deng ◽

Yan-Ling Liang ◽

Wei Li ◽

...

Keyword(s):

Case Report ◽

Facial Nerve ◽

Intracranial Hypertension ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Miller Fisher Syndrome ◽

Ivig Treatment ◽

Fisher Syndrome ◽

Igm Antibodies ◽

History Of

Miller Fisher syndrome (MFS), a variant of Guillain–Barré syndrome, is characterized by ataxia, areflexia and ophthalmoplegia. This case report describes a 40-year old male that presented with a 3-day history of unsteady walking and numbness on both hands, and a 2-day history of seeing double images and unclear articulation. Lumbar puncture revealed an opening pressure of 260 mm H2O. Plasma serology was positive for anti-ganglioside M1-immunoglobulin M (anti-GM1-IgM) antibodies and negative for anti-ganglioside Q1b (anti-GQ1b) antibodies. The patient was diagnosed with MFS based on the clinical course and neurophysiological findings. On the 4th day of treatment with intravenous immunoglobulin (IVIG), his ataxia and unsteady walking improved, but his bilateral eyeballs were fixed, and over the next few days he developed bilateral peripheral facial paralysis. After 5 days of IVIG treatment, methylprednisolone treatment was offered and the patient's symptoms gradually improved. Early intracranial hypertension and delayed facial nerve palsy may be atypical presentations of MFS. Anti-GM1-IgM antibodies may be the causative antibodies for MFS. If the IVIG therapy does not stop the progression of the disease, the addition of corticosteroid therapy may be effective. However, the relationship between IgM type, anti-GM1 antibody and MFS remains unclear and requires further research.

Download Full-text

Child Neurology (Neurocritical Care/Neuro Trauma)

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2015.121 ◽

2015 ◽

Vol 42 (S1) ◽

pp. S24-S24

Author(s):

JA Mailo ◽

J Pugh ◽

FD Jacob

Keyword(s):

Bacterial Meningitis ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Neurological Deficits ◽

Search Terms ◽

History Of ◽

Streptococcal Meningitis ◽

The Brain ◽

New Onset

Background: Focal neurological deficits occur in approximately 15% of children with bacterial meningitis. However, cranial nerve involvement such as facial-nerve palsy is uncommon in non-tuberculous bacterial meningitis. Methods: Case Report. Review of the literature was conducted on Pubmed for the search terms: facial nerve palsy and meningitis. Results: We present the case of a 4-year old right-handed girl who presented with a new onset unilateral facial nerve palsy preceded by 5-day history of fever and headaches. The patient had meningeal signs and was identified to have Streptococcal Meningitis. MRI of the brain showed a large previously undiagnosed intranasal encephalocele. The facial palsy resolved within 7 days of antibiotic treatment. Conclusions: Our case represents an unusual combination of facial nerve palsy in context of Streptococcal Meningitis secondary to intranasal encephalocele.

Download Full-text

Kawasaki disease manifesting as bilateral facial nerve palsy and meningitis: a case report and literature review

Journal of International Medical Research ◽

10.1177/0300060519854287 ◽

2019 ◽

Vol 47 (8) ◽

pp. 4014-4018 ◽

Cited By ~ 2

Author(s):

Bo Zhang ◽

Yunpeng Hao ◽

Yanfeng Zhang ◽

Nuo Yang ◽

Hang Li ◽

...

Keyword(s):

Case Report ◽

Kawasaki Disease ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Brain Magnetic Resonance Imaging ◽

Neurological Complications ◽

Appropriate Treatment ◽

History Of ◽

The Right

Background Kawasaki disease (KD) is an acute multisystem vasculitic syndrome that predominantly affects infants and young children. Neurological complications are rare in patients with KD and the diagnosis is challenging. We report a case of KD that manifested as bilateral facial nerve palsy and meningitis. Case report A 6-month-old boy presented with a 10-day history of fever. Four days before admission, the patient developed a rash, conjunctival injection, perioral and perianal excoriation, and bilateral facial nerve palsy. Brain magnetic resonance imaging was normal. Echocardiography showed dilated coronary arteries and coronary artery aneurysms. A cerebrospinal fluid examination showed an elevated leukocyte count. A diagnosis of KD was made, and the patient was treated with gamma globulin and aspirin. The patient’s fever subsided on the following day and the right-sided facial nerve palsy was relieved 1 month later. An 18-month follow-up showed that the left-sided facial nerve palsy persisted and the patient’s condition remained stable. Conclusion KD manifesting as bilateral facial nerve palsy and meningitis is extremely rare. Clinicians should be aware of this condition, and early diagnosis and appropriate treatment should be emphasized.

Download Full-text

Non-cholesteatomatous suppurative otitis media: facial nerve palsy in an immunocompromised patient

The Journal of Laryngology & Otology ◽

10.1017/s0022215100131238 ◽

1995 ◽

Vol 109 (8) ◽

pp. 755-758 ◽

Cited By ~ 1

Author(s):

C. Hartley ◽

S. R. Saeed ◽

T. J. Lyons

Keyword(s):

Renal Transplantation ◽

Facial Nerve ◽

Otitis Media ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Immunocompromised Patient ◽

Horizontal Segment ◽

Suppurative Otitis Media ◽

History Of

AbstractA 47-year-old man developed a complete facial nerve palsy secondary to non-cholesteatomatous suppurative otitis media. At operation, this was seen to be due to destruction of the nerve from halfway along the horizontal segment to a point just distal to the second genu. The history of recent renal transplantation and subsequent immunosuppression was judged to be significant in the pathogenesis of the palsy.

Download Full-text

Melkersson-Rosenthal Syndrome with Orofacial Swelling and Recurrent Lower Motor Neuron Facial Nerve Palsy: A Case Report and Review of the Literature

Case Reports in Otolaryngology ◽

10.1155/2015/214946 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Jerome Okudo ◽

Yemi Oluyide

Keyword(s):

Case Report ◽

Facial Nerve ◽

Motor Neuron ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Lower Motor Neuron ◽

Facial Swelling ◽

Motor Neuron Facial Nerve ◽

History Of ◽

Multiple Treatments

Melkersson-Rosenthal Syndrome (MRS) is a rare otoneurologic condition, which is poorly understood and often underdiagnosed. Etiology and incidence are unclear, although infectious, inflammatory, and genetic causes have been implicated. Recurrent facial nerve palsy, facial swelling, and fissured tongue are the symptoms and signs of this condition. However, this triad is not typical in all patients as patients may present with one or more of the symptoms, which makes management of this condition difficult. Steroids may prove to be useful especially in patients who have facial nerve palsy. In this case report, we have described a 46 year-old Caucasian male who presented to the clinic for the evaluation of orofacial swelling and left facial deviation with a history of multiple treatments for recurrent lower motor neuron type facial nerve palsy.

Download Full-text

A report on a rare case of Kearns Sayre-like syndrome

Nepalese Journal of Ophthalmology ◽

10.3126/nepjoph.v2i2.3725 ◽

1970 ◽

Vol 2 (2) ◽

pp. 160-163

Author(s):

Y Gupta ◽

M Gupta ◽

K Sambhav ◽

A Phougat ◽

A Varshney

Keyword(s):

Facial Nerve ◽

Short Stature ◽

Rare Case ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Past History ◽

Pigmentary Retinopathy ◽

Kearns Sayre Syndrome ◽

History Of

Purpose: To report the presentation of a rare case of Kearns-Sayre-like syndrome (KSS) Case: A 14-year-old boy presented with progressive drooping of both upper eyelids for 10 years. Past history of right sided hemi-plegia and left facial nerve palsy was present. Examination (OU) showed total external ophthalmoplegia, ptosis and pigmentary retinopathy. The patient also had a short stature (height 121.9 cm) for his age. Keywords: Kearns Sayre syndrome; total external ophthalmoplegia; ptosis DOI: 10.3126/nepjoph.v2i2.3725 Nep J Oph 2010;2(2) 160-163

Download Full-text

Non-small Cell Lung Cancer (NSCLC) Presenting as Isolated Facial Nerve Palsy from Metastasis to Temporal Bone: A Report Discussing Unique Presentation and Evolution with Diagnostic and Management Dilemmas

Indian Journal of Clinical Medicine ◽

10.4137/ijcm.s4894 ◽

2010 ◽

Vol 1 ◽

pp. IJCM.S4894

Author(s):

Manpreet Singh Tiwana ◽

Shrinivas Rathod ◽

Tejpal Gupta ◽

Jai Prakash Agarwal

Keyword(s):

Bone Metastasis ◽

Facial Nerve ◽

Temporal Bone ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Acute Mastoiditis ◽

Literature Report ◽

Facial Neuralgia ◽

History Of ◽

The Right

We present the case of a 67-year-old man with a three month history of right sided facial nerve palsy reporting to our clinic for evaluation of a recently seen suspicious mass in the right lung. Subsequently he was diagnosed with advanced NSCLC right lung and started on palliative chemotherapy. Furthermore, temporal bone metastasis was discovered on radiological imaging while investigating symptoms of acute mastoiditis and persisting facial neuralgia, a symptom completely overlooked at first as Idiopathic Bell's palsy. This presentation is exceptionally unique, although temporal bone metastasis arising from established primary lung or other malignancies is itself rare, and predilect to a later onset in the natural history of the disease, as reported in the literature. None of the published literature report neither addresses the optimal management course nor its subsequent impact on quality of life of patients with temporal bone metastasis.

Download Full-text