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Clinical Observation
November 22, 2004

The Spectrum of Cranial Neuropathy in Patients With Bell’s Palsy

Author Affiliations

Author Affiliations: Departments of Neurology (Dr Benatar) and Emergency Medicine (Dr Edlow), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Mass. Dr Benatar is now with the Department of Neurology, Emory University, Atlanta, Ga.

Arch Intern Med. 2004;164(21):2383-2385. doi:10.1001/archinte.164.21.2383

Background  There is controversy regarding whether, and how frequently, other cranial nerve deficits accompany Bell’s palsy. We sought to determine prospectively the presence of signs indicating an associated cranial neuropathy in patients with Bell’s palsy.

Methods  All subjects presenting to an emergency department with Bell’s palsy over a 2-year period were evaluated. The study included 51 consecutive patients. One patient with Bell’s palsy was not examined by a neurologist at the time of presentation and was excluded. The main outcome measure was presence of other cranial nerve deficits.

Results  We identified 4 patients with additional cranial neuropathies (contralateral trigeminal [n=1], glossopharyngeal [n=2], and hypoglossal [n=1]). We also identified 13 patients with ipsilateral facial sensory loss, suggesting an ipsilateral trigeminal neuropathy; 3 patients with a contralateral facial palsy; and 3 patients with hearing impairment.

Conclusion  This prospective study indicates that a small percentage (approximately 8%) of patients with otherwise typical Bell’s palsy may harbor additional cranial neuropathies.