(Archieves of Neurology Vol 66 (No 4) Apr 2009
What is the diagnosis and what is the differentials for this ?
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17 comments:
DX: Myasthenia Gravis.
DIFF DX: Muscular Dystrophy.
Motor Neuron Syndromes.
Bilateral Partial Ptosis..
DD:
1. Myasthenia Gravis/ LEMS
2. Gullain Barre Syndrome (Miller-Fisher)
3. Dystrophic Myotonia
4. Fasciomusculoscapular dystrophy
5. Oculopharyngeal Muscular Dystrophy
myasthenia gravis
dd
bell palsy
gullain barre syndrome
muscular dysdrophy
Nope, it is not MG.
Dx: LMN 7th CN PALSY
DD: RAMSAY HUNT SYNDROME; LYME DISEASE.
bilateral facial nerve palsy of lower motor neurone type
Yes,, bilatearal facial nerve palsy.
So what are the differentials ?
D/D GBS
SARCOIDOSIS
MILKERSON ROTHENTHAL SYN
LYME DISEASE
CONGENITAL FACIAL DIPLEGIA
bell's palsy?
Where's the true answer???
Good. Diagnosis is Sarcoidosis
Botulism
it's seem to be a upper moter neuron letion of the 7 CN on right side but need more neurological examination of the CNs
finding:bilateral facial ptosis, lt UMNL, baldness
DD myotonia, stroke
CPA tumours
Neurosarcoidos
Mobius syndrome (in children)
Garin Bujadoux Bannwarth syndrome
April 2009, Vol 66, No. 4 >
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Images in Neurology | April 2009
Bilateral Facial Palsy in Neuroborreliosis
Georg Hagemann, MD; Ilia Mois Aroyo, MD
Arch Neurol. 2009;66(4):534-535. doi:10.1001/archneurol.2009.4. Text Size: A A A
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A 54-year-old forest worker experienced bilateral facial weakness. A few days later, he presented with an almost complete facial palsy without any disturbances of taste, hearing, or sensation. He had a marked Bell phenomenon (Figure). He was diagnosed some years before with Lyme disease without any clinical symptoms and was treated with oral antibiotics. Meanwhile, he received some new tick bites. A lumbar puncture revealed a lymphocyte count of 77/μL and an elevated protein level of 2.5 g/L. Serological testing revealed positive IgG results, a negative IgM borreliosis titer on an enzyme-linked immunosorbent assay, and multiple bands on Western blotting, suggestive of either remnants of an earlier asymptomatic contact with borrelia or a late or very recent infection with still-absent IgM antibodies. In cerebrospinal fluid, IgM antibodies were negative and the IgG antibody index was 1.4. Serological testing results for tick-borne encephalitis, listeriosis, cytomegalovirus, herpes virus, varicella-zoster virus, and human immunodeficiency virus were all negative. A cranial magnetic resonance image was normal. Lyme neuroborreliosis was clinically diagnosed and the patient was treated with intravenous ceftriaxone sodium. The symptoms gradually subsided. The only remaining symptom is the inability to play the hunting horn.
neuroberylosis , lyme disease is the answer
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