Facial nerve palsy as an unusual presentation of orbital apex syndrome

Clinical cases of orbital apex syndrome are rare and most commonly manifested as a complication of fungal sinusitis, mainly in immunocompromised and poorly controlled diabetic patients. Rhino-orbital mucormycosis is a rare opportunistic, aggressive and fatal infection caused by mucor. The complex presentation of orbital apex syndrome not only poses a diagnostic challenge but also demands a multidisciplinary approach in patient management. Facial nerve palsy is an unusual presentation in orbital apex syndrome. We report the case of a 64-year-old diabetic patient presenting with ophthalmoplegia and visual loss associated with facial nerve palsy. Prompt ophthalmologic and otolaryngologic intervention with imaging and histologic confirmation, followed by early initiation of antifungal and antimicrobial therapy, were integral to preventing further complications, and reducing morbidity and mortality.

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Bilateral Facial Nerve Palsy: A Diagnostic Dilemma

Case Reports in Emergency Medicine ◽

10.1155/2012/458371 ◽

2012 ◽

Vol 2012 ◽

pp. 1-3 ◽

Cited By ~ 4

Author(s):

Sohil Pothiawala ◽

Fatimah Lateef

Keyword(s):

Differential Diagnosis ◽

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Rare Condition ◽

Facial Nerve Paralysis ◽

Diagnostic Challenge ◽

Radiological Investigation ◽

Diagnostic Dilemma ◽

Nerve Paralysis

Introduction. Bilateral facial nerve palsy (FNP) is a rare condition, representing less than 2% of all cases of FNP. Majority of these patients have underlying medical conditions, ranging from neurologic, infectious, neoplastic, traumatic, or metabolic disorders.Objective. The differential diagnosis of its causes is extensive and hence can present as a diagnostic challenge. Emergency physicians should be aware of these various diagnostic possibilities, some of which are potentially fatal.Case Report. We report a case of a 43-year-old female who presented to the emergency department with sequential bilateral facial nerve paralysis which could not be attributed to any particular etiology and, hence, presented a diagnostic dilemma.Conclusion. We reinforce the importance of considering the range of differential diagnosis in all cases presenting with bilateral FNP. These patients warrant admission and prompt laboratory and radiological investigation for evaluation of the underlying cause and specific further management as relevant.

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Congenital unilateral facial nerve palsy as an unusual presentation of BOR syndrome

European Journal of Pediatrics ◽

10.1007/s00431-012-1795-4 ◽

2012 ◽

Vol 172 (2) ◽

pp. 273-275 ◽

Cited By ~ 1

Author(s):

Augustina Jankauskienė ◽

Karolis Azukaitis

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Unusual Presentation ◽

Bor Syndrome

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Bilateral facial nerve palsy as the sole initial symptom of syphilis: a case report

CJEM ◽

10.1017/cem.2015.83 ◽

2015 ◽

Vol 17 (5) ◽

pp. 576-581 ◽

Cited By ~ 3

Author(s):

Chi-Hsin Ting ◽

Chih-Wei Wang ◽

Jiunn-Tay Lee ◽

Giia-Sheun Peng ◽

Fu-Chi Yang

Keyword(s):

Facial Nerve ◽

Nerve Palsy ◽

Facial Nerve Palsy ◽

Rare Condition ◽

Complete Recovery ◽

High Serum ◽

Penicillin G ◽

Initial Symptom ◽

Rapid Plasma Reagin ◽

Diagnostic Challenge

AbstractBilateral facial nerve palsy is an exceedingly rare condition and presents a diagnostic challenge. Bilateral facial nerve palsy may result from cranial trauma, congenital abnormalities, inflammation, infiltration, or infection, but is rarely associated with syphilis. Here, we report a case of syphilis in which bilateral facial nerve palsy was the only initial symptom.A 22-year-old man presented at our emergency department with isolated bilateral facial nerve palsy. Results for initial serum and cerebrospinal fluid examinations were normal, including the rapid plasma reagin titer. One week later, the patient developed rashes on the torso, palms, and soles. At this time, a high serum rapid plasma reagin titer was detected, and the Treponema pallidum particle agglutination test was positive. Once the tests were confirmed, the patient admitted to a history of unprotected sexual behavior. Penicillin G treatment was effective, and a 3-month follow-up examination demonstrated a complete recovery.We recommend that syphilis be considered when diagnosing sexually experienced young men presenting with bilateral facial nerve palsy, even in the absence of skin manifestations. Failure to recognize facial signs of syphilis could result in inappropriate management, affecting the patient’s clinical outcome.

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Orbital apex syndrome: An unusual complication of invasive mucormycosis

Proceedings of Singapore Healthcare ◽

10.1177/2010105818758089 ◽

2018 ◽

Vol 27 (4) ◽

pp. 287-289 ◽

Cited By ~ 1

Author(s):

W J Quah ◽

M Gunavathy

Keyword(s):

Diabetic Patient ◽

Antimicrobial Therapy ◽

Multidisciplinary Approach ◽

Vision Loss ◽

Surgical Intervention ◽

Unusual Complication ◽

Orbital Apex ◽

Orbital Apex Syndrome ◽

Diagnostic Challenge ◽

Rare Manifestation

Orbital apex syndrome is a rare manifestation of invasive mucormycosis. We report a case of orbital apex syndrome in a diabetic patient which not only posed a diagnostic challenge but also required a multidisciplinary approach in treatment and management. Prompt imaging followed by early initiation of antimicrobial therapy along with timely surgical intervention were integral in preventing further complications and reducing mortality. However, despite these measures, the patient sustained partial vision loss due to endophthalmitis as a complication.

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