Bell palsy

Case contributed by Francisco Jaldo Reyes
Diagnosis almost certain

Presentation

Acute right facial weakness, dysarthria, change in taste, right neck pain, and increased sensitivity to sounds. Although COVID-19 was suspected due to her history and close contact with a positive case, no microbiological confirmation was performed.

Patient Data

Age: 70 years
Gender: Female
mri

Post-contrast images show linear enhancement in the geniculate ganglion, labyrinthine, tympanic and mastoid segments of the right facial nerve.  No pathological enhancement of the left facial nerve was detected.

Annotated image

Coronal and axial MRI post-contrast images show vivid enhancement in the right geniculate ganglion (coronal image), tympanic, and mastoid segments (axial images) of the right facial nerve (red circles). In contrast, the segments of the left facial nerve in the same location do not enhance (green circles).

Case Discussion

Long segments of the facial nerve enhance uniformly in Bell palsy, especially around the geniculate ganglion. The mastoid and extratemporal segments are less frequently involved. It is important to differentiate this from normal facial nerve enhancement. A few cases of facial paralysis have been described in association with COVID-19.

This case is submitted in collaboration with Dr. Ana M. Quiles Granado.

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