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Posttraumatic Bell’s Palsy

To the Editor: Although Bell’s paralysis is common, in many instances its pathogenesis remains unknown. We report on an unusual case with a possible psychological origin.

Mr. A, a 36-year-old train driver, accidentally ran over a suicidal man as the train pulled into a station. Mr. A reacted with horror but continued working. Six weeks later he suddenly noticed two young men standing on the tracks, obviously testing their courage, a few hundred yards in front of his train. No accident occurred, but he was unable to work and called in sick. He felt weak and noticed a prickling on the right side of his face, followed by numbness. The next morning he noticed that his right lip was drooping, saliva was dripping out of the right side of his mouth, and he was unable to blink his right eye. Two days later a neurologist discovered hypoesthesia of his right cheek, Bell’s phenomenon on his right side, and a loss of taste on the right side of his tongue; the neurologist diagnosed Bell’s paralysis on his right side. Total recovery took 3 weeks. During this period Mr. A did not go to work; he suffered from nightmares and depression and persistently relived the trauma.

Then left facial paralysis appeared. Mr. A was admitted to a university hospital, where peripheral facial palsy on the left side was confirmed. An electrophysiological examination by means of neurography and testing of the orbicularis oculi reflex revealed an incomplete lesion. The results of a lumbar puncture and extensive laboratory tests were negative, as were the results of magnetic resonance imaging. Examinations of serum and CSF provided no evidence of an infectious etiology (e.g., Lyme borreliosis, herpes simplex, varicella-zoster virus, HIV, cytomegalovirus, or Epstein-Barr virus). Recovery took 2 months. In the meantime, posttraumatic stress disorder was diagnosed.

Once during psychotherapy in a rehabilitation clinic, Mr. A was filled with tremendous fear before a treatment session in which he expected to be confronted with what had happened to him. A prickling sensation on the right side of his face reappeared, and according to his and his therapist’s reports, temporary right facial paralysis remained for a couple of hours.

To the best of our knowledge, the study by Goldberg and Harte (1) is the only report to systematically focus on emotional factors as a possible cause for Bell’s paralysis. The authors reported that facial paralysis resulting from severe emotional trauma might range from a simple conduction block to almost complete neural degeneration. They assumed that such palsy might result from a spasm of the vasa nervorum in the fallopian canal. In cases of otherwise unknown pathogenesis, a past history of severe emotional trauma should be suspected.

References

1. Goldberg MJ, Harte S: Emotional factors contributing to facial paralysis. J Am Geriatr Soc 1972; 7:324–329

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