Introduction
Facial Nerve palsy is a neurological condition in which the function of
the facial nerve is partially or completely impaired. The most common
presentation is unilateral with an incidence of around 25 per 100,000
population, of which about 70% can be attributed to Bell’s palsy
[1]. Lower motor neuron (LMN) facial diplegia represents a very
small portion (about 2%) of all facial nerve palsy cases. Facial
diplegia has an incidence of 1 per 5,000,000 population. The etiologies
of this diplegia include Bell’s palsy, Guillain-Barré syndrome (GBS),
idiopathic cranial neuropathies, Lyme disease, sarcoidosis, brainstem
encephalitis, Miller Fisher syndrome, idiopathic intracranial
hypertension, intracranial tumors, Syphilis, Hansen’s disease,
cryptococcal meningitis with acquired immunodeficiency syndrome and
tuberculous meningitis [2]. One study of 43 patients with bilateral
facial nerve palsy showed that ten cases were attributed to Bell’s palsy
and five were due to GBS [3]. There are several variants of GBS and
among these, facial diplegia with paresthesia is a rare variant. It is
characterized by simultaneous facial diplegia, distal paresthesia and
minimal or no motor weakness. In defining facial diplegia, it is
simultaneous if both sides are involved within 30 days of the initial
onset of unilateral facial paralysis [4]. We present a unique case
of a young man with sudden-onset isolated bilateral facial diplegia as
an atypical presentation of Guillain-Barré Syndrome.