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Medical City Fort Worth
COVID-19, SARS-CoV-2, Bell palsy
Internal Medicine | Nervous System Diseases | Virus Diseases
Introduction: COVID-19 has been identified as primarily a respiratory illness, however, with its clinical manifestation of involvement with multiple organs, it is now considered a systemic illness. In particular, it also can elicit a broad spectrum of neurological symptoms. One of the proposed manifestations is Bell’s Palsy, an acute idiopathic facial nerve palsy that affects the lower motor neuron. Here we have a patient with recent COVID infection who presents with a unilateral facial droop along with unilateral weakness/tingling of extremities and was diagnosed with Bell’s Palsy.
Case Description: Patient is a 47-year-old male with a past medical history of alcohol and methamphetamine abuse who presented to the hospital for unresolved facial droop. Patient was seen at the emergency department with symptoms of left-sided eyelid droop and difficulty swallowing two days prior. CT head and CTA head/neck then were negative. Patient’s symptoms resolved and he left against medical advice. However, symptoms reappeared two days later and now with right-sided facial droop along with dysphagia,and left sided extremities with weakness/tingling sensation. Of note, the daughter stated that the patient was tested positive with COVID about 1.5 weeks ago and had upper respiratory infection symptoms that had resolved. Repeat CT head without contrast and MRI brain w/wo contrast were unremarkable. Transthoracic echocardiogram showed no patent foramen ovale. He was diagnosed with Bell's palsy and the MRI neck was done for his unilateral tingling, which showed minimal posterior disc bulging. Patient was recommended eye drops, eye patch and discharged on prednisone taper with valacyclovir and instructions to follow up outpatient
Discussion: Bell’s Palsy presents with a sudden onset of unilateral facial weakness. The hallmark to distinguish it from central pathology is the involvement of the forehead. However, because this patient also had unusual presentation of switching sides of facial droop along unilateral weakness/throbbing of extremities, cerebral vascular accident had to be ruled out as well as other etiologies. The annual incidence is 15 to 20 per 100,000 individuals with up to 12% recurrence rate. Interestingly, there is a higher incidence of Bell’s Palsy in those with COVID-19 and there is an increased relative risk with Bell’s Palsy in those with COVID-19 in comparison to those who were vaccinated. Of note, the patient is unvaccinated. We present this case in hope to bring awareness to the medical society on a possible COVID-19 Infection related neurological manifestation in hope that it can be recognized and intervened early.
HCA Healthcare Graduate Medical Education
Wang, Yen-Chung; Wang, Yen-Hsiang; and Sanchez, Christian, "An Interesting Occurrence Of Bell’s Palsy With Atypical Presentation After Contracting COVID-19 Infection" (2023). North Texas Research Forum 2023. 31.