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Case Reports
. 2024 Oct 14;16(10):e71445.
doi: 10.7759/cureus.71445. eCollection 2024 Oct.

Unraveling Facial Nerve Palsy: A Case Series Highlighting Diagnostic and Therapeutic Challenges

Deepankumar T  1 , Madhumitha Selvaraju  1 , Krishnaswamy Madhavan  1 , Janardanan Kumar  1
Affiliations
Case Reports

Unraveling Facial Nerve Palsy: A Case Series Highlighting Diagnostic and Therapeutic Challenges

Deepankumar T et al. Cureus. .

Abstract

Facial nerve palsy (FNP) may arise from multiple etiological reasons, including anatomical anomalies, circulatory complications, and infectious agents. This case series underscores the importance of a comprehensive diagnostic approach to identify the precise etiology, including structural abnormalities, vascular anomalies, or infectious illnesses. Here, we present three distinct occurrences of FNP, emphasizing the varied diagnostic difficulties and therapeutic strategies. It includes an arachnoid cyst, which when occurring at the cerebellopontine angle can affect multiple cranial nerves, specifically the seventh and eighth cranial nerve, a neurovascular compression syndrome, where the anterior inferior cerebellar artery loops around the facial nerve. Most often, this scenario causes hemifacial spasms, which in our scenario manifests as FNP. Lyme disease is a tick-borne disease that affects multiple cranial nerves, specifically the facial nerve. Effective management necessitates a focused treatment strategy that tackles the symptoms and the underlying disease. Advanced imaging techniques, serological tests, and a tailored treatment approach are essential for effective diagnosis, can have significant implications for patient well-being, and necessitate a thorough evaluation to identify underlying causes. This case series illustrates the diverse etiologies of FNP, emphasizing the need for comprehensive diagnostic strategies and targeted treatments. As clinicians encounter FNPs more often, this case series can help physicians understand facial palsy better. Continuous research and clinical awareness are vital for improving patient outcomes in cases of FNP.

Keywords: arachnoid cyst; lyme disease; seventh cranial nerve palsy; unilateral facial nerve palsy; vascular loop compression.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. MRI of the brain with MRA and MRV showing (A) CSF signal intensity area in the right CP angle (~2.1 × 1.2 × 0.9 cm) causing a widening of the lateral cerebellar medullary cistern abutting the seventh (red arrow) and eighth (blue arrow) cranial nerves, its inferior aspect, and AICA branches diagnostic of arachnoid cyst (green arrow in A and yellow arrow in B).
MRI: magnetic resonance imaging; MRA: magnetic resonance angiography; MRV: magnetic resonance venography; AICA: anterior inferior cerebellar artery; CSF: cerebrospinal fluid; CP: cerebellopontine
Figure 2
Figure 2. MRI of the brain revealing a (A) vascular loop (yellow arrow) of the AICA abutting the seventh (red arrow) and eighth (blue arrow) cranial nerve complexes on the right side in the CP angle cistern and (B) the AICA loop (green arrow).
MRI: magnetic resonance imaging; MRA: magnetic resonance angiography; MRV: magnetic resonance venography; AICA: anterior inferior cerebellar artery; CP: cerebellopontine
Figure 3
Figure 3. Contrast-enhanced T2-weighted MRI of the brain showing normal findings.
MRI: magnetic resonance imaging
See this image and copyright information in PMC

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