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Multiple sclerosis (MS) is an autoimmune demyelinating neurological disorder primarily manifesting with a range of neurological symptoms, with cardiovascular autonomic involvement being a rare occurrence. We report a case where a patient initially presented with Bell's palsy, without other notable symptoms or signs, and subsequently developed atrial fibrillation, hypertension, and hemiparesis. Magnetic resonance imaging (MRI) revealed extensive demyelination in the cerebral hemispheres, brainstem, and notably, the area postrema. The anatomy of the area postrema and its connections, in relation to neurogenic hypertension, are discussed. The demyelination in the area postrema was thought to be the cause of our patient's arrhythmias and acute hypertension. Furthermore, we discuss the cerebral origins of cardiac arrhythmias, with a focus on MS and other neurological conditions. This case underscores the rarity of isolated cranial neuropathies, such as Bell's palsy, as an initial sign of MS, marking the onset of a relapse., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Prentice et al.)

It is hypothesized that degenerative cervical myelopathy (DCM) may induce or exacerbate trigeminal neuralgia (TN) through mechanisms such as direct compression of the spinal trigeminal tract, inflammation, or vascular issues, leading to ischemia within cervical segments C3-C4, where the spinal trigeminal nucleus extends. Here, we report the potential therapeutic impact of chiropractic treatment in a 55-year-old female with TN resistance to medical therapy and DCM. The patient received targeted chiropractic care, consisting of high-velocity, low-amplitude (HVLA) spinal manipulation of the C3-C7 and T1-T4 vertebral segments to address joint dysfunction, coupled with intermittent mechanical cervical traction for 20-minute sessions, and focused radial shockwave therapy aimed at myofascial trigger points within the trapezius and levator scapulae muscles. After initiating the chiropractic care plan, the patient experienced a significant reduction in the frequency and severity of TN pain, which persisted throughout the treatment period. Notably, this alleviation in symptoms was maintained at the six-month follow-up, suggesting a sustained therapeutic effect rather than a transient improvement. The lasting nature of the pain reduction provides a compelling argument for the long-term benefits of chiropractic intervention in the management of TN, particularly in cases with concurrent DCM., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Chu et al.)

Peripheral facial paralysis refers to the involvement of the facial nerve (VII cranial nerve) at any point along its path, which starts from its nucleus, located in the pons, and extends to its most distal branches. The etiology is heterogeneous, including viral infections, bacterial infections, trauma, and neoplasms, among others. However, in the majority of cases, the cause is idiopathic, commonly referred to as Bell's palsy. The diagnosis is therefore one of exclusion, based in particular on the physical examination. Naturally, the diagnosis is decisive in directing the therapeutic approach. However, the signs/symptoms of the various primary pathological processes can appear late in the course of the disease. This is why the Physical Medicine and Rehabilitation specialist is particularly important, since, in addition to the initial assessment, he or she monitors the patient more closely and over a longer period of time, together with the team of therapists. New clinical findings and diagnostic tests requested accordingly can dramatically change the initial diagnosis and guide new treatments. We present the clinical case of a 60-year-old man initially diagnosed with Bell's palsy, whose poor clinical evolution and new clinical findings during the rehabilitation program led to the diagnosis of plasmablastic myeloma and a radically different therapeutic approach., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Dias et al.)

Guillain-Barré syndrome is an autoimmune condition typically characterized by progressive areflexic ascending motor deficit and paresthesia. However, atypical presentations, such as isolated facial diplegia, are rare and diagnostically challenging. We describe a unique case of Guillain-Barré syndrome in a 46-year-old male patient, presenting as isolated bilateral facial paralysis without preceding medical history. Symptoms included tongue heaviness, loss of taste, dysarthria, and inability to close eyelids. A neurological examination confirmed bilateral facial paralysis. Laboratory tests and cerebrospinal fluid analyses were unremarkable, except for albumin-cytological dissociation. Electromyography revealed severe demyelinating damage to facial nerves. The patient responded well to intravenous immunoglobulin therapy. This case highlights the necessity of considering Guillain-Barré syndrome in patients with isolated facial diplegia. A thorough clinical evaluation, supported by laboratory and electromyographic findings, is crucial for accurate diagnosis and effective treatment. Early identification and intervention are key for optimal outcomes in these atypical presentations., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Boubga et al.)

Lyme disease (LD) is a highly prevalent infection in the northern hemisphere, with an estimated incidence of 450,000 new annual cases in the United States and 65,000 new annual cases in Europe. Transmitted by the bite of a tick contaminated with a spirochete, the disease has three distinct stages. In the second phase of the disease, there may be neurological impairment, and the involvement of cranial nerve pairs occurs in this phase. Neuropathy of the seventh cranial nerve can occur in around 10% of adults with neurological involvement by Borrelia; in children, this incidence can reach 50%. A 32-year-old female patient presented with an abrupt facial paralysis that evolved into a difficult-to-resolve condition. With the appearance of probable contralateral involvement, LD was diagnosed. After the established treatment, the patient presented a good evolution of the symptoms., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Levischi Jr et al.)

Diagnosing B-cell lymphoma-associated mononeuritis multiplex is challenging due to its rarity and the potential co-existence of other causes of mononeuritis multiplex. Here, we report a case of a 74-year-old male who initially presented with left cranial neuropathies followed by right-sided extremity weakness with hyporeflexia, right facial involvement, and subsequently asymmetric weakness and multifocal muscle wasting. Minor improvements were observed with multiple rounds of steroid treatment. The diffuse large B-cell lymphoma diagnosis was eventually established six months later upon a repeat mediastinal lymph node biopsy and cerebrospinal fluid cytology. A nerve biopsy demonstrated severe axonal neuropathy with loss of axons in all fascicles without evidence of vasculitis. A muscle biopsy showed atrophy in both type 1 and type 2 fibers. A presentation of mononeuritis multiplex warrants concern for B-cell lymphoma, mainly when other mechanisms of peripheral neuropathy are less likely., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Chen et al.)

Sarcoidosis is an immune-mediated disease that can involve multiple systems. Sarcoidosis of the nervous system or neurosarcoidosis may present as cranial mononeuropathy, hypothalamic involvement, aseptic meningitis, granulomatous inflammation in the brain parenchyma or spinal cord, peripheral neuropathy, and, in rare cases, as myopathy and benign intracranial hypertension. The most common cranial nerve involvement is the facial nerve, which can present as unilateral or bilateral facial nerve palsy, often with recurrent episodes. Involvement of other cranial nerves such as the second and eighth cranial nerves has also been reported. Granulomatous inflammation in the spinal cord presents as myelopathy or radiculopathy. Peripheral neuropathy can manifest as mononeuropathy, mononeuritis multiplex, or generalized sensory-motor neuropathy. Carpal tunnel syndrome is more common in patients with sarcoidosis compared to the general population. Here, we describe the case of a 40-year-old female who presented with heaviness of the head and blurred vision, with a prior history of left-sided Bell's palsy. Bilateral papilledema was observed during the fundus examination. MRI of the brain revealed signs suggestive of benign intracranial hypertension. The cerebrospinal fluid (CSF) opening pressure was measured at 40 cmH2O. Biopsy of bilateral hilar lymphadenopathy indicated granulomatous inflammation consistent with sarcoidosis. The patient was started on steroids and acetazolamide, and she had a dramatic improvement in symptoms., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Dubey et al.)

Cranial nerve VII palsy is one of the most common cranial nerve pathologies seen in clinical practice. In the vast majority of cases, the cause is thought to be idiopathic and is also referred to as Bell's palsy. These cases are normally self-limiting and often treated with a short course of corticosteroids for symptom management. However, prompt work-up and diagnosis are crucial, as non-idiopathic causes can often be life-altering and necessitate prompt intervention. Here, we report a unique case of a 43-year-old immigrant male who presented to the emergency department with a three-day history of worsening facial droop and slurred speech, with associated facial pain, headaches, and dizziness for the previous week. On exam, there was stark right facial weakness involving both the upper and lower portions of the face with no sensory deficits. The patient's right eye was erythematous and painful, with no ability to fully open or close the right eyelid. The initial workup showed minor transaminitis with pancytopenia. A thorough workup was initiated, and all testing and serology were normal, with the exception of initial HIV screening. This was then followed by polymerase chain reaction (PCR) and viral load testing, which confirmed a new diagnosis of acute HIV infection presenting with unilateral CN VII palsy. In this report, we discuss the etiology, clinical features, differentials, and treatment options for facial nerve paralysis, along with the subtle connection to acute HIV infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kandah et al.)

Spider bites, while rarely confirmed beyond a doubt, should always be in the differential for any severe symptoms or infection out of proportion to presentation with the suspected presence of appropriate vectors. While most arthropod bites will only result in mild localized irritation, the potential to cause severe cutaneous and systemic effects should not be overlooked. We present one such case, in which a presumed brown recluse ( Loxosceles reclusa ) bite on the neck resulted in severe illness with systemic manifestations. The patient presented to the emergency room minimally responsive with left-sided facial nerve palsy and septic shock. While the admitting physician initially prioritized stabilizing the patient, he noted the left-sided cervical cellulitis. Thorough history taking revealed that the patient had been worsening since being bitten by a spider three days prior to admission. After a month-long hospital stay and multidisciplinary treatment, the patient was transferred to a larger center with facial paralysis still present., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Stolzenberg et al.)

Twenty-seven months into the current pandemic and 18 months after vaccinations were made available, there are still relatively limited data on the incidence of recurrent Bell's Palsy after the administration of mRNA-based vaccines. The authors continue to believe that it is through rigorous reporting that the true incidence can be tabulated eventually., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Zhang et al.)

Acute myeloid leukemia (AML) is a disorder of the myeloid cell line that can manifest infrequently as a granulocytic sarcoma with infiltration into bone and soft tissue. Consequently, cranial nerve neuropathy due to AML infiltration can result in variable neurological deficits, including facial nerve palsy. Here, we present the case of a patient presenting with unilateral facial nerve palsy with evidence of AML in cerebrospinal fluid (CSF) cytology and bilateral opacification of the mastoid air cells suggestive of AML infiltration into the mastoid process. Patient demonstrated improvement of facial palsy after administration of intrathecal chemotherapy without need for surgical intervention. We further examine known cases reported to date on the use of chemotherapy and surgical intervention in management of facial nerve palsy as a consequence of AML infiltration of the mastoid bone. Notably, there appears to be a correlation between mastoid bone infiltration seen on imaging and facial nerve palsy in patients with known history of AML that may be treated without need for surgical intervention or biopsy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Fana et al.)

The Ad26.COV2.S vaccine, developed by Janssen (Beerse, Belgium), the pharmaceutical wing of Johnson & Johnson (JNJ), is one of the three vaccines approved for use against coronavirus disease 2019 (COVID-19) infection in the United States. We present a case of a 66-year-old female who presented to the emergency department with a one-day history of nausea, vomiting, room-spinning vertigo, and complete right facial weakness immediately after getting vaccinated with Ad26.COV2.S. Initial workup focused on uncovering a possible association between the vaccine and Bell's palsy. However, her prior history of stroke, presence of predisposing risk factors, and additional symptoms of nausea, vomiting, and vertigo prompted further neurological testing, which revealed an isolated right pontine lacunar infarct involving the right facial colliculus, mimicking Bell's palsy. Isolated dorsal pontine lesion presenting as hemifacial palsy is very rare and can be easily missed by clinicians. Relevant history and thorough neurological examination can help guide appropriate diagnostic testing and prevent potential biases. It is crucial for clinicians to know the distinguishing features between true Bell's palsy and acute brainstem infarction masquerading as Bell's., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Kundi et al.)

Bell's palsy is a relatively rare neurologic disorder with a limited selection of helpful therapies. This case report describes the author's initial three-month experience living with severe Bell's palsy, including a detailed history and timeline of the initial development of symptoms, treatments pursued, and psychological stress during the disease progression. A particular focus is placed on the emotional burden Bell's palsy can have, exploring possible avenues to improve physician to patient education on mental health and well-being during initial and delayed recovery., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Cole et al.)

Bilateral facial nerve palsy is a rare condition, representing only 0.3-2.0% of all facial palsy cases. Facial paralysis constitutes the result of a diverse array of systemic disorders and heterogeneous aetiologies and thus represents a diagnostic challenge. This case report describes a previously healthy male who presented to the emergency department numerous times within a few weeks with unrelated non-specific symptoms. These symptoms could not be attributed to any specific aetiology after various radiological and laboratory examinations, and hence presented a diagnostic dilemma until he developed bilateral seventh nerve palsy and was admitted for a further workup., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Jha et al.)

Bell's palsy is a mononeuropathy of the facial nerve that typically causes unilateral facial paralysis. The incidence of unilateral Bell's palsy is not uncommon, but sequential or simultaneous bilateral Bell's palsy is exceedingly rare. While unilateral Bell's palsy is oftentimes idiopathic, bilateral Bell's palsy is almost exclusively explained by an identifiable trigger. In pre-clinical trials, Bell's palsy cases were recorded at higher rates in the vaccine cohort than the placebo cohort. Herein, we present a case of isolated sequential bilateral Bell's palsy that after an extensive workup, proved to be idiopathic. Notably, in the setting of a recent coronavirus disease 2019 (COVID-19) vaccine and absence of identifiable etiology, our case highlights a potential correlation of the COVID-19 vaccine and bilateral Bell's palsy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Mason et al.)

Coronavirus disease 2019 (COVID-19) has become the fastest-spreading pandemic of the 21st century. Various vaccines have been made available via emergency use authorization. Currently, two mRNA vaccines are being offered internationally, BNT162b2 and mRNA-1273. In randomized trials of these vaccines, the incidence of Bell's palsy in the vaccinated group does not statistically exceed the placebo group. The FDA recommends increased surveillance for Bell's palsy as a potential side effect with the administration of the vaccines among larger populations globally. There have been a few case reports of Bell's palsy associated with mRNA vaccines. Type I interferons have been proposed as the potential mechanism linking mRNA COVID-19 vaccines to Bell's palsy. Here, we report the case of a 36-year-old previously healthy patient who developed symptoms of Bell's palsy along with left-arm numbness, tingling, and subjective weakness masquerading as a subacute stroke after receiving the second dose of the mRNA-1273 vaccine. CT and MRI of the brain were unremarkable. He was discharged home with a diagnosis of Bell's palsy and improved on follow-up. mRNA COVID-19 vaccines may be considered a risk factor for Bell's palsy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Iftikhar et al.)

Bilateral facial palsy (BFP) is exceedingly rare, representing only 0.3%-2.0% of facial palsy cases. Unlike unilateral facial palsy, it is often caused by a serious underlying systemic disease and therefore warrants urgent medical intervention. The differential diagnosis is broad, and detailed history, physical examination, and investigations are essential for identifying the etiology. Common acquired causes in existing case series include Lyme disease, Guillain-Barré syndrome, sarcoidosis, trauma, and Bell's palsy. Palsy that develops rapidly is often caused by trauma, infections, or autoimmune disorders, whereas slow progressive palsy suggests neoplastic diseases. While management varies by etiology, the physician can consider early empiric corticosteroids given their efficacy in numerous differential diagnoses. Antivirals can be considered in those with a strong history of viral prodrome. In this paper, we present the case of a puerperal patient with BFP and discuss its differential diagnosis, diagnostic approach, and management., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Yang et al.)

March 11, 2020 marked the start of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19, caused by severe acute respiratory syndrome coronavirus 2, was being reported as a severe respiratory illness. However, since the recognition of this novel virus, there has been a constant realization that it may present or manifest in a multitude of ways. At first, the typical signs and symptoms were what one would expect from a respiratory virus: cough, shortness of breath, and fever. However, as the disease became more prevalent, neurologic symptoms were reported such as headaches, hypogeusia, and hyposmia. This case report aims to add to the growing body of neurologic manifestations by presenting two cases, Bell's palsy and Guillain-Barre syndrome. Each case involves flaccid paralysis as the primary presentation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Kaplan et al.)

Bell's palsy is acute peripheral facial nerve palsy; its cause is often unknown but it can be triggered by acute viral infection. Coronavirus disease 2019 (COVID-19) infection commonly presents with respiratory symptoms, but neurologic complications have been reported. A few studies have reported the occurrence of facial nerve palsy during the COVID-19 pandemic. We present a case of Bell's palsy in a 36-year-old man with COVID-19 infection and a past medical history of nephrolithiasis. He presented to the emergency room with a day history of sudden right facial weakness and difficulty closing his right eye four weeks following a diagnosis of COVID-19 infection. Physical examination revealed right lower motor neuron facial nerve palsy (House-Brackmann grade IV). Serologic screen for Lyme disease, human immunodeficiency virus (HIV), and herpes simplex virus (HSV) 1 and 2 were negative for acute infection; however, neuroimaging with MRI confirmed Bell's palsy. He made remarkable improvement following treatment with a course of valacyclovir and methylprednisolone. This case adds to the growing body of literature on neurological complications that should be considered when managing patients with COVID-19 infection., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Oke et al.)

Bell's palsy (BP) occurs when the facial nerve (CN VII) is swollen, inflamed, or compressed, resulting in facial weakness or paralysis; etiology is unknown. BP patients often succumb to a decreased quality of life due to the inability to make facial expressions, increased sensitivity to auditory stimuli, and dysregulation in tear and saliva production. Despite conventional examination and therapy options, the syndrome is majorly regarded as idiopathic and left unresolved for many patients. In this case of a patient with BP, treatment with osteopathic manipulative treatment (OMT) which focused on restoring a normal structure-function relationship resolved the patient's symptoms. The osteopathic manipulative procedures utilized findings from an osteopathic structural exam and addressed those somatic dysfunctions with OMT. The authors report that the patient's symptoms improved after the application of OMT and without the use of pharmaceuticals. The results of the case study suggest that treating BP with OMT can rapidly improve symptoms and can be used without or concurrently with other treatment modalities, if applicable. Patient's consent for this case report was obtained in written and verbal form., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Volokitin et al.)

Brainstem infarction typically presents with vague symptoms, including headache, nausea, vomiting, and vertigo. Rarely do patients present with complete unilateral facial paralysis, mimicking Bell's palsy. Here we report the case of a 40-year-old woman who presented to the emergency department with intractable nausea, vomiting, and vertigo upon waking along with left-sided upper and lower extremity numbness and right-sided facial paralysis. Her atypical presentation of unilateral facial nerve paralysis in the context of nausea, vomiting, and vertigo prompted neurological studies, which were significant for a small punctate infarct in the pons involving the right facial colliculus. ​History, physical examination, and clinical suspicion are important to prevent anchoring bias. Physicians rely on history and physical examination to help distinguish true Bell's palsy from other causes of facial nerve paralysis. Stroke and other clinically emergent etiologies should be considered high on the differential diagnosis when patients have neurological signs and symptoms in addition to facial nerve palsy., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Burson et al.)

March 11, 2020, marked the start of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was being reported as severe respiratory illness. However, since the recognition of this novel virus, there has been a constant realization that it may present or manifest in a multitude of ways. At first, the typical signs and symptoms were what one would expect from a respiratory virus: cough, shortness of breath, and fever. However, as the disease became more prevalent, neurologic symptoms were reported such as headaches, hypogeusia, and hyposmia. This case report aims to add to the growing body of neurologic manifestations by presenting two cases, Bell's palsy and Guillain-Barre Syndrome. Each case involves flaccid paralysis as the primary presentation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Elkhouly et al.)