Central facial palsy revisited: A clinical‐radiological study

Cattaneo, Luigi; Saccani, Elena; Giampaulis, Piero De; Crisi, Girolamo; Pavesi, Giovanni

doi:10.1002/ana.22069

Cited by 20 publications

(4 citation statements)

References 23 publications

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“…Additionally, a radiologic analysis of stroke syndromes further challenges the dogma that dual facial innervation leads to sparing of the upper face with upper motor neuron lesions. 26 With these caveats in mind, detailed history and neurological examination is typically sufficient to evaluate unilateral facial paralysis and rule in or out Bell’s palsy in the vast majority of cases.…”

Section: Discussionmentioning

confidence: 99%

Potential Misdiagnoses of Bell's Palsy in the Emergency Department

Fahimi¹,

Navi²,

Kamel³

2014

Annals of Emergency Medicine

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Study Objective We evaluate the incidence of potentially incorrect emergency department (ED) diagnoses of Bell’s palsy and identify factors associated with identification of a serious alternative diagnosis on follow-up. Methods We performed a retrospective cohort study from California’s Office of Statewide Health Planning and Development (OSHPD) for 2005–2011. Subjects were adult patients discharged from the ED with a diagnosis of Bell’s palsy. Information related to demographics, imaging use, and comorbidities were collected. Our outcome was one of the following diagnoses made within 90 days of the index ED visit: stroke, intracranial hemorrhage, subarachnoid hemorrhage, brain tumor, central nervous system infection, Guillain-Barre syndrome (GBS), Lyme disease, otitis media/mastoiditis, or herpes zoster. We report hazard ratios (HR) and 95% confidence intervals (CI) for factors associated with misdiagnosis. Results A total of 43,979 patients were discharged with a diagnosis of Bell’s palsy. Median age was 45. On 90-day follow-up 356 patients (0.8%) received an outcome diagnosis, and 39.9% were made within 7 days. Factors associated with the outcome included increasing age (HR 1.11, 95% CI 1.01–1.21, every 10 years), black race (HR 1.68, 95% CI 1.13–2.48), diabetes (HR 1.46, 95% CI 1.10–1.95), computed tomography or magnetic resonance imaging use (HR 1.43, 95% CI 1.10–1.85). Private insurance was negatively associated with an alternative diagnosis (HR 0.65, 95% CI 0.46–0.93). Stroke, herpes zoster, GBS, and otitis media accounted for 85.4% of all alternative diagnoses. Conclusion Emergency providers have a very low rate of misdiagnosing Bell’s palsy. The association between imaging use and misdiagnosis is likely confounded by patient acuity. Increasing age and diabetes are modest risk factors for misdiagnosis.

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Section: Discussionmentioning

confidence: 99%

Potential Misdiagnoses of Bell's Palsy in the Emergency Department

Fahimi¹,

Navi²,

Kamel³

2014

Annals of Emergency Medicine

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“…Central facial paralysis can also follow a CVA in the territory of the middle cerebral artery (MCA) or anterior cerebral artery (ACA) [32]. In the case of MCA stroke, patients can present with contralateral upper and lower extremity hemiparesis, contralateral hemianesthesia, and eye deviation towards the side of the infarct.…”

Section: Disorders Of the Facial Nervementioning

confidence: 99%

Imaging the Facial Nerve: A Contemporary Review

Gupta

Mends

Hagiwara

et al. 2013

Radiology Research and Practice

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Imaging plays a critical role in the evaluation of a number of facial nerve disorders. The facial nerve has a complex anatomical course; thus, a thorough understanding of the course of the facial nerve is essential to localize the sites of pathology. Facial nerve dysfunction can occur from a variety of causes, which can often be identified on imaging. Computed tomography and magnetic resonance imaging are helpful for identifying bony facial canal and soft tissue abnormalities, respectively. Ultrasound of the facial nerve has been used to predict functional outcomes in patients with Bell's palsy. More recently, diffusion tensor tractography has appeared as a new modality which allows three-dimensional display of facial nerve fibers.

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“…In general, Bell palsy is considered first if there is acute peripheral facial palsy and no other neurological symptoms. [ 1 , 2 ] However, hemifacial muscle palsy, including the forehead and muscles around the eyes, does not always indicate peripheral palsy, [ 5 ] and it is sometimes difficult to differentiate based on clinical findings alone. The blink reflex test, facial nerve conduction study, and facial electromyography are performed as additional diagnostic tests, [ 1 ] and brain MRI also shows abnormal findings, which is helpful in diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Contrast-enhanced MRI findings of patients with acute Bell palsy within 7 days of symptom onset: A retrospective study

Seok,

Park,

Park

et al. 2023

Medicine

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The brain magnetic resonance imaging (MRI) findings seen in patients with Bell palsy are abnormal contrast enhancement of affected facial nerves. Previous studies were conducted on a few patients, mainly those who had experienced palsy for several weeks. This study investigated the diagnostic usefulness of MRI by examining MRI findings of acute Bell palsy (within 7 days of symptom onset) in a large cohort. Among the patients with Bell palsy (idiopathic unilateral facial palsy) who visited the hospital, 123 patients who underwent contrast-enhanced MRI of the internal auditory canal within 7 days of symptom onset were reviewed retrospectively. MRI examination results were investigated along with the patient’s clinical symptoms and electrodiagnostic test results. Based on the MRI results, the frequency of abnormal contrast enhancement and contrast-enhanced areas were investigated. Of the 123 patients, 13 (11%) had normal brain MRI results, and 110 (89%) had abnormal findings. The frequency of abnormal contrast enhancement was not significantly associated with test timing (P = .56). Of the 110 patients with abnormal findings, 65 (59%) showed contrast enhancement in the labyrinthine segment and 36 (33%) in both the labyrinthine segment and geniculate ganglion. Most patients with Bell palsy who are in the acute phase showed abnormal contrast enhancement in their facial nerves, and similar findings were even observed in the examination conducted on the day of symptom onset. Brain MRI helps in the diagnosis of acute Bell palsy.

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Central facial palsy revisited: A clinical‐radiological study

Cited by 20 publications

References 23 publications

Potential Misdiagnoses of Bell's Palsy in the Emergency Department

Potential Misdiagnoses of Bell's Palsy in the Emergency Department

Imaging the Facial Nerve: A Contemporary Review

Contrast-enhanced MRI findings of patients with acute Bell palsy within 7 days of symptom onset: A retrospective study

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