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

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.

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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.

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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.

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Idiopathic intracranial hypertension presenting with isolated unilateral facial nerve palsy: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2060-5 ◽

2019 ◽

Vol 13 (1) ◽

Cited By ~ 2

Author(s):

Ahmad Samara ◽

Dana Ghazaleh ◽

Brent Berry ◽

Malik Ghannam

Keyword(s):

Case Report ◽

Facial Nerve ◽

Intracranial Hypertension ◽

Idiopathic Intracranial Hypertension ◽

Nerve Palsy ◽

Facial Nerve Palsy

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TRANSIENT FACIAL NERVE PALSY AFTER SCALP BLOCK FOR AWAKE CRANIOTOMY: A CASE REPORT

Indian Journal of Case Reports ◽

10.32677/ijcr.2018.v04.i05.011 ◽

2018 ◽

Vol 4 (5) ◽

pp. 369-371

Author(s):

Rajashree U Gandhe . ◽

Chinmaya P Bhave . ◽

Avinash S Kakde . ◽

Neha T Gedam .

Keyword(s):

Case Report ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Awake Craniotomy ◽

Scalp Block

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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.

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Acute Bilateral Ophthalmoparesis with Pupilary Areflexical Mydriasis in Miller-Fisher Syndrome Treated with Intravenous Immunoglobulin

Journal of Ophthalmology ◽

10.1155/2010/291840 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Theocharis Papanikolaou ◽

Cath Gray ◽

Bernard Boothman ◽

Gerald Naylor ◽

George Mariatos

Keyword(s):

Intravenous Immunoglobulin ◽

Nerve Palsy ◽

Rare Condition ◽

Miller Fisher Syndrome ◽

Uneventful Recovery ◽

Fisher Syndrome ◽

History Of ◽

Classical Triad ◽

Fourth Nerve Palsy ◽

Sixth Nerve

Miller-Fisher syndrome (MFS) is a rare condition characterized by the classical triad of ophthalmoplegia, ataxia, and areflexia (Fisher, 1956). It is considered a variant of Guillain-Barré syndrome (GBS) with which it may overlap, or it can occur in more limited forms. We report a case of a thirty-five-year-old male who presented with a six-day history of diplopia, following a recent chest infection. On examination, he was found to have bilateral sixth nerve palsy, bilateral fourth nerve palsy, bilateral areflexical mydriasis, ataxia and total absence of reflexes. After excluding other conditions, a diagnosis of Miller-Fisher syndrome was made. The patient was administered intravenous immunoglobulin and made an uneventful recovery.

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Obstructive hydrocephalus and facial nerve palsy secondary to vertebrobasilar dolichoectasia: Case Report

Surgical Neurology International ◽

10.4103/sni.sni_37_17 ◽

2018 ◽

Vol 9 (1) ◽

pp. 60 ◽

Cited By ~ 1

Author(s):

Hussein Kamel ◽

Kazim Mohammed ◽

Javeed Iqbal ◽

John Mathew ◽

Ghanem Al-Sulaiti

Keyword(s):

Case Report ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Obstructive Hydrocephalus ◽

Vertebrobasilar Dolichoectasia

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Isolated facial nerve palsy from intra-aural tick infestation – a case report

Pediatria i Medycyna Rodzinna ◽

10.15557/pimr.2020.0078 ◽

2020 ◽

Vol 16 (4) ◽

pp. 430-432

Author(s):

Thilaga Rajendran ◽

◽

Jeyasakthy Saniasiaya ◽

Yatiee Swany Lahuri ◽

Norhaslinda Binti Abdul Gani ◽

...

Keyword(s):

Case Report ◽

Facial Nerve ◽

Late Effects ◽

Nerve Palsy ◽

Tick Infestation ◽

Facial Nerve Palsy ◽

Outpatient Clinics ◽

Close Observation ◽

Tick Paralysis

The incidence of tick infestation reported by ear-nose-throat outpatient clinics is high, though the exact reason is unknown. Affected patients generally recover well without any local or systemic sequelae. Tick-induced facial nerve palsy is less commonly reported in the literature. In this case report, we present our experience in managing a case of delayed isolated facial nerve palsy from intra-aural tick infestation in a child. The case highlights the possibility of late effects of tick paralysis occurring hours after tick removal. Close observation and awareness are crucial to detect any signs of neurotoxicity associated with tick infestation.

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