SHM Converge Scientific Abstract ePoster Gallery-Bilateral Facial Nerve Palsy: An Unusual Presentation of Guillain-Barré Syndrome

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This case describes a rare presentation of bilateral cranial nerve VII palsy caused by Guillain-Barré syndrome (GBS), likely triggered by cytomegalovirus (CMV), in a 33-year-old Native American woman. Bilateral facial palsy is uncommon, accounting for only 0.3–2% of all facial palsies, and has a broad differential including Bell’s palsy, sarcoidosis, GBS, trauma, Lyme disease, and various infections.<br /><br />The patient initially developed right-sided facial weakness and was diagnosed with Bell’s palsy at an outside hospital, where she received steroids and valacyclovir. Two days later, she developed left-sided facial weakness, along with upper and lower extremity paresthesias, altered taste, facial and neck pain, and difficulty chewing due to poor lip closure. She had recently had a cough and had been camping in northern Arizona. Imaging studies, including CT and MRI of the head and neck, showed no acute intracranial abnormality.<br /><br />On admission, neurologic exam showed bilateral CN VII palsy with inability to fully close her eyes, but otherwise preserved strength, sensation, gait, and coordination. Lumbar puncture revealed albuminocytologic dissociation, with elevated CSF protein (114) and normal cell counts, supporting GBS. CSF testing was positive for CMV IgM, while extensive infectious and autoimmune workup was otherwise negative.<br /><br />Her presentation was most consistent with the rare GBS variant bifacial weakness with paresthesias (BFP), which accounts for less than 1% of GBS cases. Treatment included plasma exchange, IVIG, and antimicrobial therapy. Valacyclovir was stopped once CMV results returned, and valganciclovir was started. The patient was discharged but lost to follow-up.

Asset Subtitle

Cole Syverson

Meta Tag

Author List Anna Schwab, Cole Syverson, Karen Purewal, Michelle Sobotka

Category Clinical Vignettes

Concept Bilateral Cranial Nerve VII Palsy

Concept Guillain-Barré Syndrome

Concept Bifacial Weakness with Paresthesias

Concept Albuminocytologic Dissociation

Concept Differential Diagnosis

Distinguished Non-Finalist

Presenter Organization Abrazo Internal Medicine Residency Program

Presenting Author Cole Syverson

Track Adult

Keywords

Guillain-Barré syndrome

bilateral cranial nerve VII palsy

bilateral facial palsy

cytomegalovirus

albuminocytologic dissociation

bifacial weakness with paresthesias

Bell’s palsy differential

CSF protein elevation

plasma exchange

IVIG

Bilateral Cranial Nerve VII Palsy

Guillain-Barré Syndrome

Bifacial Weakness with Paresthesias

Albuminocytologic Dissociation

Differential Diagnosis