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Peripheral facial palsy as the first symptom of advanced bronchial carcinoma
Background Bell’s palsy is the most frequent cranial nerve palsy, and in most cases has a good prognosis with complete recovery of facial nerve functions. The rarer secondary etiologies and central causes should be also considered as a possible diagnosis.
Study design and methods Case study of a 67-year-old patient with an acute-onset left side facial nerve paralysis Grade V in Hous-Brackman scale. The neck ultrasound was normal and serological findings (HSV 1/2, VZV, Borellia) were negative. Treatment with prednisone IV and further oral therapy, resulted in almost completele facial nerve function recovery. After 3 months the patient was admitted to ENT ward with recurrence of facial nerve paralysis.
Results Further diagnostic - cranial MRT and CT of the petrous bone, has revealed an intraosseous metastasis suspect infiltration with spreading in to tympanic cavity and intracranial to the middle and posterior cranial fossa. Additionaly, the CT imaging of thorax and abdominal cavity showed malignant suspicious lesion in left hilar with mediastinal lymph nodes metastases and further multiple lesions spread in the liver and suprarenal at both sides. The diagnose of bronchial carcinoma was confirmed by the bronchoscopy with biopsy. The palliative Chemotherapy was initiated, under which the patient died.
Conclusions In 25-40 % cases of Bell’s palsy a secondary cause may be found, so considering different possible diagnoses is necessary. This is important especially in prolonged cases, where there is a possibility of non-idiopathic cause.
10 June 2020 (online)
© Georg Thieme Verlag KG
Stuttgart · New York