PARALISIA FACIAL PERIFÉRICA BILATERAL: UM DESAFIO DIAGNÓSTICO

Abstract

Introduction: Peripheral facial paralysis is a clinical entity with several possible etiologies; when the etiology is unknown, the condition is known as Bell’s palsy. It is characterized by the inability to close one eye, disappearance of the ipsilateral nasolabial fold, and deviation of the rima oris. Most cases are unilateral and idiopathic, but bilateral cases tend to be secondary to neurological disorders, infections, traumas, neoplasms, or metabolic disorders. The etiology is undefined in 23% of the cases. Objectives: The differential diagnosis of bilateral facial palsy is broad, and the physician should be aware of the various outcomes, considering that some of them are fatal. Case Report: A 35-year-old male was admitted to the emergency unit with paralysis of the right side of the face. He had hypertension, diabetes, and dyslipidemia; was under treatment for depression; and had a history of gastroplasty 14 months previously because of morbid obesity and had lost 72 kg since then. One month prior to admission, he had consulted a general practitioner because of peripheral facial palsy of the left side of the face. On admission, he presented with bilateral peripheral facial paralysis, Bell’s sign, slow speech, salivation, and bilateral facial hypoesthesia. He remained hospitalized for 8 days, received acyclovir and prednisone, underwent speech therapy, and received eye care. Despite extensive investigation, it was not possible to identify a precipitating factor for the symptoms, corroborating the fact that the etiological diagnosis of bilateral peripheral palsy is often challenging and complex. Discussion: Bell’s palsy is relatively common, with an incidence of 13–34 cases per 100,000, and the incidence rate of the bilateral type varies between 0.3% and 2%. In the latter, the symptoms are generally secondary to other diseases, including Guillain–Barré syndrome, sarcoidosis, meningitis (infectious or neoplastic), Lyme disease, idiopathic multiple cranial neuropathy, benign intracranial hypertension, diabetes mellitus, syphilis, HIV infection, mononucleosis, Melkersson–Rosenthal syndrome, Moebius syndrome, bilateral neurofibromas, leukemia, and pre- or intrapontine tumors. Treatment includes addressing the underlying diseases, and similar to the management of unilateral paralysis, corticotherapy with acyclovir is indicated in most situations.