Spectrum of Peripheral Facial Involvement in Central Demyelinating Diseases

Objective: To share our experience with 4 cases of central demyelinating diseases (CDD) with infranuclear facial palsies either on initial presentation or as an acute CDD exacerbation. We will provide an insight on the pathogenesis and management of facial palsies based on clinico-imaging correlation. Background: Facial palsies in MS and NMOSD are heterogeneous and may involve the nerve at its nucleus, the genu and fascicle as well as the periphery, including the intra-temporal bone segment. Here we report four cases with precise lesion localization and varied clinical findings Design/Methods: Case series Results: Case 1: 18 yo female presenting with acute right peripheral facial weakness. Diagnosed with Bell’s Palsy. Treated with steroids. 3 weeks later returns with facial diplegia, bilateral abducens palsy. MRI Brain: lesion in bilateral abducens nuclei and facial colliculi. work up confirmed diagnosis of MS. Case 2: 30 yo man presenting with left peripheral facial weakness with a history of chiasmitis two years earlier. NMO Ab negative; initially misdiagnosed Bell’s Palsy and treated with steroids. 10 days later, facial numbness and nausea. MRI lesion left pons at location of facial nerve fasciculus. Diagnosed with NMOSD. Case 3: 42 yo female, history of MS and history of left facial palsy, presenting with a recurrence of left facial palsy 8 years later. MRI brain showed enhancement of the intra-temporal bone segment of the facial nerve. Case 4: 50 yo female, history of MS, presenting with left hemifacial spasm. MRI brain showed lesion affecting fascicular seventh cranial nerve in the pons. Conclusions: Even though Bell’s palsy (idiopathic variant) is the most common peripheral facial palsy, other etiologies should be considered and patients must be monitored closely. CDD lesions affecting segments of the facial fasciculus can cause hemifacial palsy, facial diplegia or hemifacial spasm. In CDD, The different segments of facial fasciculus have specific clinical and imaging characteristics. Study Supported by: MRI brain images: Case 1: lesion in bilateral abducens nuclei and facial colliculi. Case 2: lesion left pons at location of facial nerve fasciculus. Case 3: enhancement of extra cranial segments of nerve 7. Case 4: lesion affecting fascicular seven in pons. Disclosure: Dr. Samaha has nothing to disclose. Dr. Mancera Paez has nothing to disclose. Dr. Kattah has nothing to disclose.