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Case Reports
. 2024 Mar 1;16(3):e55311.
doi: 10.7759/cureus.55311. eCollection 2024 Mar.

The Vital Role of Clinical Examination in Unmasking Bell's Palsy: Beyond Pattern Recognition

Ahmad B Abdelrehim  1 , Salman Kananeh  2 , Daniel Landau  3
Affiliations
Case Reports

The Vital Role of Clinical Examination in Unmasking Bell's Palsy: Beyond Pattern Recognition

Ahmad B Abdelrehim et al. Cureus. .

Abstract

While multiple sclerosis (MS) commonly manifests with optic nerve involvement, it can also masquerade as diverse cranial nerve (CN) palsies. We present the case of a young male initially diagnosed with Bell's palsy based on unilateral facial nerve paralysis. Despite the presence of typical clinical features, the patient's evaluation took an unexpected turn. Subsequent brain MRI revealed demyelinating lesions, ultimately confirming the diagnosis of MS. This case underscores the importance of maintaining vigilance in diagnosing atypical presentations of MS, illustrating how meticulous evaluation and neuroimaging play pivotal roles in uncovering underlying pathologies when conventional diagnoses such as Bell's palsy raise uncertainties.

Keywords: bell`s palsy; facial palsy; neuro deficits; neuro-imaging; s: multiple sclerosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. MRI brain FLAIR-weighted image lesion in sagittal view
Sagittal view MRI brain FLAIR-weighted image depicting a hyperintense lesion located at the level of the dorsal pons (indicated by the red arrow). The lesion appears as a bright area against the surrounding tissue, suggestive of increased fluid content or inflammation MRI: magnetic resonance imaging; FLAIR: fluid-attenuated inversion recovery
Figure 2
Figure 2. MRI brain FLAIR-weighted image in axial view
Axial view MRI brain FLAIR-weighted image displaying a hyperintense lesion situated at the level of the middle cerebellar peduncle. The lesion is depicted as a bright area against the surrounding tissue, suggestive of a potential pathology such as inflammation or demyelination MRI: magnetic resonance imaging; FLAIR: fluid-attenuated inversion recovery
Figure 3
Figure 3. Contrast-enhanced MRI in axial view at the level of middle cerebellar peduncle
Contrast-enhanced MRI displaying patchy abnormal enhancement on the left side of the dorsal pons, extending to the left brachium pontis (indicated by a red asterisk) MRI: magnetic resonance imaging
See this image and copyright information in PMC

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