Long-term Outcome After Acute Peripheral Facial Palsy

Impact of Botulinum Toxin Injections on Quality of Life of Patients with Long-Standing Peripheral Facial Palsy

(1) Background: Sequels of facial palsy lead to major psychosocial repercussions, disrupting patients' quality of life (QoL). Botulinum toxin (BoNT) injections can permit us to treat long-standing facial palsy, improving facial symmetry and functional signs including synkinesis and contractures. (2) Methods: The main aim of this study was to assess the evolution of the QoL for patients with long-standing facial palsy before, at 1 month, and at 4 months after BoNT injections by using three questionnaires (HFS-30, FaCE, and HAD). The other goals were to find clinical factors associated with the improvement in the QoL and to assess the HFS-30 questionnaire for patients with unilateral facial palsy (3) Results: Eighty-eight patients were included in this study. There was a statistically significant improvement in QoL at 1 month after injections, assessed using the three questionnaires. This improvement was sustained at 4 months after the injections, with a statistically significant difference for the HFS-30 and FaCE questionnaires. (4) Conclusions: This study showed that the BoNT injections lead to a significant increase in the QoL of patients with unilateral facial palsy. This improvement is sustained 4 months after the injections.

Bell's palsy in a patient after contracting COVID-19 with signs of aberrant nerve regeneration

Purpose

To report a 56-year-old male in Saudi Arabia who developed signs of aberrant facial nerve regeneration after recovering from Bell's palsy associated with COVID-19 infection.

Observations

The patient presented, months following recovery from Bell's palsy associated with COVID-19, with symptoms of aberrant seventh nerve regeneration in the form of tearing with eating “crocodile tears” and synchronous right eyelid closure with the jaw movement.

Conclusions and Importance

Case reports of Bell's palsy associated with COVID-19 are emerging, but association does not mean causation. That said, we need to report these cases to draw attention to the possible neuroinvasive propensity of this virus. It is also imperative to recognize Bell's palsy as a possible symptom of COVID-19.

Enhancement of cranial nerves in Lyme neuroborreliosis: incidence and correlation with clinical symptoms and prognosis

PURPOSE

Symptoms of cranial neuritis are a common presentation of Lyme neuroborreliosis (LNB). Imaging studies are scarce and report contradictory low prevalence of enhancement compared to clinical studies of cranial neuropathy. We hypothesized that MRI enhancement of cranial nerves in LNB is underreported, and aimed to assess the prevalence and clinical impact of cranial nerve enhancement in early LNB.

METHODS

In this prospective, longitudinal cohort study, 69 patients with acute LNB were examined with MRI of the brain. Enhancement of cranial nerves III-XII was rated. MRI enhancement was correlated to clinical findings of neuropathy in the acute phase and after 6 months.

RESULTS

Thirty-nine of 69 patients (57%) had pathological cranial nerve enhancement. Facial and oculomotor nerves were most frequently affected. There was a strong correlation between enhancement in the distal internal auditory canal and parotid segments of the facial nerve and degree of facial palsy (gamma = 0.95, p < .01, and gamma = 0.93, p < .01), despite that 19/37 nerves with mild-moderate enhancement in the distal internal auditory canal segment showed no clinically evident palsy. Oculomotor and abducens nerve enhancement did not correlate with eye movement palsy (gamma = 1.00 and 0.97, p = .31 for both). Sixteen of 17 patients with oculomotor and/or abducens nerve enhancement had no evident eye movement palsy.

CONCLUSIONS

MRI cranial nerve enhancement is common in LNB patients, but it can be clinically occult. Facial and oculomotor nerves are most often affected. Enhancement of the facial nerve distal internal auditory canal and parotid segments correlate with degree of facial palsy.