CASE REPORT


https://doi.org/10.5005/jp-journals-10057-0212
Journal of Mahatma Gandhi University of Medical Sciences and Technology
Volume 7 | Issue 2 | Year 2022

Isolated Facial Nerve Palsy: A New Lacunar Syndrome


Vaishali Sharai1, Deepak Gupta2, Anchin Kalia3https://orcid.org/0000-0001-8869-9351, Anil Panwar4, Yudhishther Kuntal5, Naveen Yadav6, Navin Chhaba7, Pushpendra Chauhan8, Manjeet Meel9, Pruthvi Patel10, Shikha Yadav11, Piyush Batra12

1–12Department of Internal Medicine, Mahatma Gandhi Medical College & Hospital, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, Rajasthan, India

Corresponding Author: Deepak Gupta, Department of Internal Medicine, Mahatma Gandhi Medical College & Hospital, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, Rajasthan, India, Phone: +91 7597965979, e-mail: deepakguptamd@gmail.com

Received on: 12 May 2022; Accepted on: 11 August 2022; Published on: 22 February 2023

ABSTRACT

Most facial palsies are lower motor neuron lesions. Occasionally, however, an isolated facial palsy is seen, which appears to be upper motor neuron in nature. Computed tomography demonstrated small deep infarcts in the internal capsular/corona radiata regions. Pure upper motor neuron facial palsy may be another lacunar syndrome due to a lesion in the internal capsule or corona radiata.

How to cite this article: Sharai V, Gupta D, Kalia A, et al. Isolated Facial Nerve Palsy: A New Lacunar Syndrome. J Mahatma Gandhi Univ Med Sci Tech 2022;7(2):50-51.

Source of support: Nil

Conflict of interest: None

Patient consent statement: The author(s) have obtained written informed consent from the patient for publication of the case report details and related images.

Keywords: Corona radiata, Facial palsy, Internal capsule, Stroke.

INTRODUCTION

Stroke is the leading cause of morbidity and disability worldwide. The global burden of stroke is still high, with an estimated incidence of 15 million new cases per year, of which two-thirds occur in developing countries. The disability-adjusted life years of stroke patients were >87% in developing countries, and this was seven times higher than in developed countries. This is a case of a rare presentation of stroke with isolated facial nerve palsy.

CASE DESCRIPTION

A 54-year-old male patient presented to the hospital with complaints of slurring of speech for 4 days, change in voice with nasal intonation for 4 days and difficulty in swallowing for 2 days. He was a known case of (K/C/O) with diabetes mellitus, hypertension, and depression. He was also a beedi smoker—one bundle/day for the last 35 years and a tobacco chewer for the last 10 years.

There was no history of fever/trauma seizure—like activity/injury/morning fatigue/diplopia/hearing loss/vertigo/loss of consciousness/vomiting.

On examination, the patient was conscious and well-oriented to time, place, and person, with a regular heart rate of 70 beats/minute and blood pressure of 140/90 mm Hg. Neurological examination revealed that the angle of the mouth deviated to the left side and air was able to leak from the right side when the air was blown against the cheeks. Wrinkling was present on his forehead and he was able to raise both eyebrows. The plantar response was flexor on both sides. Fundus examination was normal. Another systemic examination was also normal. Electrocardiogram was suggestive of left ventricular hypertrophy. Biochemical investigations of stroke protocol revealed dyslipidemia. Magnetic resonance imaging (MRI) brain showed acute infarcts in the left centrum semiovale and corona radiate (Fig. 1).1,2

Fig. 1: Axial T2 weighted MRI showing infarct in left corona radiate

The patient was put on dual antiplatelets, statins, and physiotherapy. The patient showed improvement in facial weakness during a hospital stay.

DISCUSSION

Corona radiata is a white matter sheet that continues inferiorly as the internal capsule and superiorly as the centrum semiovale (Fig. 2). This sheet of both ascending and descending axons carries most of the neural traffic from and to the cerebral cortex.3

Fig. 2: Dissection showing the course of cerebrospinal fibers

We want to draw attention to a syndrome of sudden onset facio-bulbar weakness which may be confused with Bell’s palsy because of the relative sparing of the limbs and good outcome. It appears that such lesions, when bilateral, may cause both facial palsy and selective pseudobulbar palsy with sparing of limbs. The corona radiata may be the preferential site of lesions in such cases since the corticospinal projections are more separate and not as tightly packed together as in the internal capsule.

ORCID

Anchin Kalia https://orcid.org/0000-0001-8869-9351

REFERENCES

1. Harrison’s textbook of medicine.

2. May M, Hardin WB. Facial palsy: interpretation of neurologic findings. Laryngoscope 1978;88(8 Pt 1):1352–1362. DOI: 10.1288/00005537-197808000-00019

3. Puvenendren K. Wong PK, Ransome GA. Syndrome of Dejerine’s fourth reich. Acta Neurol Scand 1978;57(4):345–353. DOI: 10.1111/j.1600-0404.1978.tb04509.x

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