Bilateral Facial Paralysis - Can it be Bell's?

Objective: Bilateral simultaneous facial palsy is an extremely rare clinical entity. The uneven manifestation of the two sides may make it very difficult to identify a partial paralysis on one side resulting in an underestimation of the true incidence. Here we present a representative case and discuss the most common causes of bilateral facial palsy as they relate to this particular case. Intervention: Because of the clinical presentation compatible with Bell's palsy and exclusion of other possible causes she was diagnosed as B/L Bell's palsy and valacyclovir with prednisone was advised. She improved on this regimen and is under regular follow up. Conclusion: Diagnosis workup for a patient presenting with bilateral facial paralysis depends upon the history and careful clinical examination. Bell's palsy must be considered as a diagnosis in bilateral facial palsies after excluding serious underlying medical conditions.