Bell's palsy and infection with rubella virus.

Abstract

SUMMARY Viral antibody-titres were measured in 28 patients with Bell's palsy seen in Baghdad. These cases were selected to include only those seen within 24 hours from onset. No association with recent viral infection other than rubella virus was demonstrated. Four cases showed immunological evidence of simultaneous rubella virus infection but without other clinical evidence of the disease.The cause of Bell's palsy is unknown and the disease is still labelled "idiopathic" .1 Park and Watkins2 analysed 500 cases of Bell's palsy. They suggested that an inflammatory process was the essential part as evidenced by the clinical course, pleocytosis and elevated protein in the CSF in some cases. Other causes such as vasospasm, secondary ischaemia, viral infection or immunological disturbances have been postulated.' 3 The present study was designed to detect those patients with serological evidence of simultaneous infection with a number of viruses including rubella, mumps, measles, herpes simplex, varicella-zoster, cytomegalovirus and influenza viruses. Patients, materials and methodsThe material of our study consisted of all patients with Bell's palsy seen in the first 24 hours after onset of symptoms. Patients seen after 24 hours, or those who had an obvious cause for the facial palsy (such as trauma, Guillain-Barr6 syndrome or middle ear disease), were excluded from the study. An 18-year-old woman with bilateral simultaneous facial palsy was included after exclusion of Guillain-Barre syndrome by repeated CSF examination over 3 weeks, and by electromyography and nerve conduction studies. Of the 28 patients, 14 were male and 14 female. Ages ranged between 11-70 years with a mean age of 39-6 years.All patients had a full blood count, ESR and blood chemistry (including fasting blood sugar, serum creatinine, blood urea, liver function tests, serum electrolytes, serum cholesterol and serum uric acid). Skull radiology with special views of petrous bone and internal auditory meatus on the affected side, and electromyographic and nerve con- duction studies also were performed. All patients had their serum estimated for viral antibody titres on presentation and in the third week after presentation. Antibody titres to herpes simplex, mumps, meales, rubella, varicella-zoster, cytomegalovirus and influenza A and B viruses were measured. A four-fold or more rise in the titre was regarded as evidence for recent infection with the virus concerned. Rubella virus isolation was not performed for technical reasons. All patients were monitored daily during the first week for clinical evidence of infection with these viruses. Thereafter, they were followed up at fortnightly intervals for at least 6 months and a few of them for up to one year.

Comparisons of steroid, acyclovir, lipoprostoglandin E1 and steroid+acyclovir treatments in facial paralysis: A rat study

“…The viral hypothesis for development of Bell's palsy has been widely accepted, because acute facial paralysis can occur concomitantly with many viral infections [20][21][22]. Several serologic studies have demonstrated a higher percentage of positive HSV antibody titer in patients with Bell's palsy than in matched controls [9][10][11].…”

Differential diagnosis of recurrent or bilateral peripheral facial palsy

“…† Borrelia burgdorferi , 17 Treponema pallidum , 11 , 17 , 49 Mycobacterium tuberculosis , 11 Mycobacterium leprae , 11 Mycoplasma pneumoniae , 50 Leptospira interrogans , 51 Clostridium tetani 52 and bacterial otitis caused by other bacteria 11 26 ‡ Epstein– Barré virus, 17 , 28 herpes simplex virus, 53 human immunodeficiency virus, 11 , 17 varicella zoster virus, 28 rubella virus 54 and poliovirus 55 …”

Bell’s palsy during interferon therapy for chronic hepatitis C infection in patients with haemorrhagic disorders

“…Bell’s palsy is often idiopathic with an incidence in the Western world of about 23 per 100 000 annually, or about one in 60 or 70 persons in a lifetime [ 1]. It has been reported in association with some viral infections, particularly herpesviruses [ 2, 3]. It is not a recognized complication of chronic hepatitis B or C infection.…”