Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr;45(2):147-155.
doi: 10.1007/s15010-016-0933-8. Epub 2016 Aug 16.

Infections in the differential diagnosis of Bell's palsy: a plea for performing CSF analysis

Katrin Henkel  1   2 , Peter Lange  1 , Helmut Eiffert  3 , Roland Nau  4   5 , Annette Spreer  6   7
Affiliations

Infections in the differential diagnosis of Bell's palsy: a plea for performing CSF analysis

Katrin Henkel et al. Infection. 2017 Apr.

Abstract

Purpose: Peripheral facial nerve palsy (FP) is the most common single nerve affection. Most cases are idiopathic, but a relevant fraction is caused by potentially treatable aetiologies including infections. Not all current diagnosis and treatment guidelines recommend routine cerebrospinal fluid (CSF) analysis in the diagnostic workup of this symptom. In this study, we evaluated frequency of aetiologies and relevance of CSF analysis in an interdisciplinary cohort.

Methods: We retrospectively analysed all cases of newly diagnosed FP treated at a German university medical centre in a 3-year period. Diagnostic certainty was classified for infectious aetiologies according to clinical and CSF parameters.

Results: 380 patients with FP were identified, 63 children and 317 adults. Idiopathic Bell´s palsy was predominant in 61 %. 25 % of FP was attributed to infections, and other causes were identified in 14 %. Clinical presentation alone was not conclusive for infectious aetiology, in almost half of patients with infection-attributed FP the reported symptoms or clinical signs did not differ from common symptoms of idiopathic Bell`s palsy. Determination of C-reactive protein or white blood cell count was not helpful in the identification of infectious causes, and radiological imaging was performed in a high proportion of adult patients without conclusive results. Nuchal rigidity was found only in 7 % of patients with CSF pleocytosis. The predominant infectious agents were Borrelia burgdorferi, VZV and HSV, and in most of these cases diagnosis relied on the findings of CSF analysis.

Conclusions: This study outlines the importance of careful differential diagnosis to identify infectious causes of facial nerve palsy. The high incidence and frequent unspecific clinical presentation of infectious FP underlines the importance of including CSF analysis in the diagnostic routine workup of FP.

Keywords: Bell’s palsy; Cerebrospinal fluid; Facial nerve paralysis; HSV; Neuroborreliosis; VZV.

PubMed Disclaimer

References

    1. Clin Chem. 1991 Jul;37(7):1153-60 - PubMed
    1. Acta Otorhinolaryngol Ital. 2010 Aug;30(4):198 - PubMed
    1. Eur J Neurol. 2002 Jan;9(1):63-7 - PubMed
    1. N Engl J Med. 2004 Sep 23;351(13):1323-31 - PubMed
    1. Eur J Neurol. 2010 Jan;17(1):8-16, e1-4 - PubMed

LinkOut - more resources