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Medical Student Research Case Reports

28 A CASE OF RECURRENT BILATERAL BELL'S PALSY

Zaineb Saeed, OMS-III; Leona Jafari, OMS-III, Joy Elliott, DO Corresponding author: zsaeed@vcom.edu

VCOM-Virginia, Blacksburg, Virginia

for 10 days, which showed resolution of symptoms. Approximately one year later, in February 2025, our patient presented for a similar episode– this time with a sensation of facial swelling and paralysis over the left side of her face of one week duration. She was then subsequently treated with the same regimen. Comments: Aside from the novelty of general recurrence of the condition, according to Chweya et al., at a single tertiary academic center between the years 2000 and 2017, only 53 patients were documented to have experienced recurrence of their idiopathic facial paralysis, with 22 of the recurrence cases being strictly ipsilateral and the remaining 31 patients having experienced at least one episode of contralateral recurrent Bell's palsy. Generally, the condition presents as a sudden, unilateral weakness of facial muscles clinically distinguished due to mouth drooping, inability to wrinkle the forehead or close the eye, or presence of paresthesias. It is possible that these symptoms are

preceded by dysgeusia, drooling, hyperacusis, and decreased ability to form tears. Though Bell's palsy is often regarded as a diagnosis of exclusion, there are several theories behind its etiology: anatomic causes, acute/latent viral infection, ischemia, inflammation, and cold stimulation (Zhang et. al). Goals of this case study include exploration of comorbidities and pertinent history that may have impacted the contralateral nature of this patient's second instance of Bell's palsy. Diagnosis: Bilateral Bell's palsy, with the second instance occurring contralaterally to the first.

Context: Bell's palsy, a form of acute peripheral facial palsy, typically presents as unilateral facial paralysis or weakness due to dysfunction of the facial nerve. This report discusses the unique case of a 62-year-old African American female presenting with two separate instances of Bell's palsy, with the second episode occurring contralaterally to the side affected in the primary episode. Report of Case: In January of 2024, this patient presented with a past medical history of systemic lupus erythematosus, in addition to end-stage renal disease, hypertension, congestive heart failure, anemia of chronic disease, hypercholesterolemia, and left upper arm AV fistula. Upon review of systems, the patient endorsed right-sided facial droop with watery discharge to her right eye with slight pressure behind the eye, but denied any vision changes. On physical exam, the right eye showed injection, but no notable purulence. This patient was then discharged on 20mg of oral prednisone daily

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66 Edward Via College of Osteopathic Medicine (VCOM)