Publication: Bell Phenomenon with Normal Smile
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Date
2024
Journal Title
Neurology
Journal ISSN
Volume Title
Publisher
Lippincott Williams and Wilkins
Abstract
A 52-year-old man presented with insidious-onset progressive inability to close the right eyelid. He did not have drooling of saliva from the right corner of mouth, difficulty in blowing cheeks, loss of taste perception, or inability to frown. On neurologic examination, pinprick and temperature sensation was decreased overlying the right angle of mandible. He had the Bell phenomenon on the right side, thickened right greater auricular nerve, and bilateral palpable supraorbital nerve (Figure 1). The remainder of the neurologic examination was normal. The differential diagnosis included autoimmune, infectious, vasculitic, and neoplastic neuropathies. The clinical features of thickened peripheral nerves and patchy involvement of the facial nerve with an otherwise normal serologic and neurophysiologic evaluation in an area where leprosy is still endemic suggested the diagnosis of leprous cranial neuritis. The preferential involvement of the zygomatic branch of facial nerve by leprous bacilli is attributed to low temperature in the area.1 He was started on rifampicin 600 mg and clofazimine 300 mg once monthly and clofazimine 50 mg and dapsone 100 mg once daily. Right eye closure weakness improved at 3 months of follow-up (Figure 2). © American Academy of Neurology.