Tuyển tập báo cáo các nghiên cứu khoa học quốc tế ngành y học dành cho các bạn tham khảo đề tài: Pontine stroke presenting as isolated facial nerve palsy mimicking Bell’s palsy: a case report. | Agarwal et al. Journal of Medical Case Reports 2011 5 287 http content 5 1 287 JOURNAL OF MEDICAL CASE REPORTS CASE REPORT Open Access Pontine stroke presenting as isolated facial nerve palsy mimicking Bell s palsy a case report Rishi Agarwal Lochana Manandhar Paramveer Saluja and Bala Grandhi Abstract Introduction Isolated facial nerve palsy usually manifests as Bell s palsy. Lacunar infarct involving the lower pons is a rare cause of solitary infranuclear facial paralysis. The present unusual case is one in which the patient appeared to have Bell s palsy but turned out to have a pontine infarct. Case presentation A 47-year-old Asian Indian man with a medical history of hypertension presented to our institution with nausea vomiting generalized weakness facial droop and slurred speech of 14 hours duration. His physical examination revealed that he was conscious lethargic and had mildly slurred speech. His blood pressure was 216 142 mmHg. His neurologic examination showed that he had loss of left-sided forehead creases inability to close his left eye left facial muscle weakness rightward deviation of the angle of the mouth on smiling and loss of the left nasolabial fold. Afferent corneal reflexes were present bilaterally. MRI of the head was initially read as negative for acute stroke. Bell s palsy appeared less likely because of the acuity of his presentation encephalopathy-like imaging and hypertension. The MRI was re-evaluated with a neurologist s assistance which revealed a tiny 4 mm infarct involving the left dorsal aspect of the pons. The final diagnosis was isolated facial nerve palsy due to lacunar infarct of dorsal pons and hypertensive encephalopathy. Conclusion The facial nerve has a predominant motor component which supplies all muscles concerned with unilateral facial expression. Anatomic knowledge is crucial for clinical localization. Bell s palsy accounts for around 72 of facial palsies. Other causes such as tumors and .
