1Scuola di Specializzazione in Pediatria, Università di Ferrara
1UOC di Pediatria e Neonatologia, Ospedale di Ravenna, AUSL della Romagna
3UOC di Neuropsichiatria Infantile, IRCCS, Istituto di Scienze Neurologiche di Bologna, Ospedale di Bellaria
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Key words: Guillain-Barré syndrome, Facial diplegia, Bilateral facial palsy, Paresthesias, Case report
Acute bilateral facial nerve palsy is a relatively rare condition and often indicates a serious underlying medical condition. The paper reports a case of a 14-year-old girl who developed paresthesias in the distal limbs and subsequently bifacial weakness, dysphonia and dysphagia. She had had a preceding episode of upper tract respiratory infection. Neurological examination showed severe facial diplegia. Limb muscle power was preserved. Cerebrospinal fluid showed albumin cytological dissociation. Magnetic Resonance Imaging scan of the head was normal. Intravenous immunoglobulin (2 g/kg for a 5-day period) was started. The abnormal sensation in her lower limb almost disappeared, dysphonia and dysphagia rapidly improved after the second infusion. Oral steroid therapy was also added. The residual bilateral facial palsy recovered completely after 6 weeks. Bifacial weakness with paresthesias (BFP) is a subtype of Guillain-Barré syndrome and it is defined by rapidly progressive bilateral facial weakness in the absence of other cranial nerve involvement. Since this condition shows a rapid responsivity to immunogloubulins treatment, a prompt diagnosis is important.
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