Bilateral facial nerve paralysis in the outpatient setting; the need for follow-up in the face of a serious pathology

Published:November 20, 2015DOI:https://doi.org/10.1016/j.ajem.2015.11.064
      Bilateral facial nerve paralysis is an extremely rare disease with an annual incidence of 1 in 5 million cases. Although unilateral facial nerve paralysis is often a benign illness, bilateral facial nerve palsy is a harbinger of more serious pathology. We present the case of a 25-year-old man who presented with alternating left then right facial weakness. We diagnosed him with bilateral facial nerve palsy and scheduled further diagnostic tests, but he was lost to follow-up. Given the severity of the differential diagnosis of bilateral facial nerve paralysis, diagnostic tests must be done at time of initial presentation. The self-resolving nature of this symptom makes follow-up difficult in this unique subset of patients.
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