LETTER TO THE EDITOR
Year : 2020  |  Volume : 15  |  Issue : 3  |  Page : 341-342

Idiopathic facial nerve palsy in a 6-week-old infant

Kerry M Roberts¹, Matthew H Roberts², William R Cary¹, Claire Staley^3
1 College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
² Department of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
³ Department of Family Medicine, Medical University of South Carolina, Charleston, South Carolina, USA

Date of Submission	21-Aug-2019
Date of Decision	04-Nov-2019
Date of Acceptance	03-Jul-2020
Date of Web Publication	06-Nov-2020

Correspondence Address:
Dr. Matthew H Roberts
Department of Neurology, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, MSC 7883, San Antonio, TX.
USA

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jpn.JPN_103_19

How to cite this article: Roberts KM, Roberts MH, Cary WR, Staley C. Idiopathic facial nerve palsy in a 6-week-old infant. J Pediatr Neurosci 2020;15:341-2

How to cite this URL: Roberts KM, Roberts MH, Cary WR, Staley C. Idiopathic facial nerve palsy in a 6-week-old infant. J Pediatr Neurosci [serial online] 2020 [cited 2021 Jan 24];15:341-2. Available from: https://www.pediatricneurosciences.com/text.asp?2020/15/3/341/300031

Dear Editor,

We report a case of idiopathic seventh nerve (Bell’s) palsy in a 6-week-old infant. Although congenital and traumatic birth-trauma-related cranial nerve (CN) VII palsy are common in the neonatal period, cases of idiopathic facial palsy are scarcely reported in young infants. Within this age group, this case represents the first instance of complete Bell’s palsy without a prodromal illness and the shortest successful duration of steroid therapy to achieve remission in such a severe case.

Case Description

A previously healthy 6-week-old male presented to the hospital with a 5-day history of acute-onset right facial paralysis. The patient was born at 41 weeks with no complications during pregnancy or delivery.

The patient presented to an outside emergency department with the same complaint 4 days prior where he was prescribed valacyclovir and prednisone two mg/kg (12 mg total) for 5 days for a suspected diagnosis of Bell’s palsy. Patient presented to our hospital due to difficulties with medication administration, only having received two mg for 2 days, then 5 mg on day 3.

On admission, physical examination was remarkable for total right-sided loss of mouth, forehead, and eyelid motion, consistent with a grade VI/VI facial nerve palsy. Patient appeared healthy, was afebrile, and had reassuring vital signs. The remainder of his neurologic exam was unremarkable.

A thorough workup for infectious etiology (urinalysis, urine cultures, complete blood count, blood cultures, complete metabolic profile, C-reactive protein, lumbar puncture, magnetic resonance imaging, Lyme titers) was noncontributory, and patient was diagnosed with idiopathic CN VII palsy. After 2 days of intravenous steroids, he was successfully transitioned to crushed prednisone tablets dissolved in breast milk. The patient was discharged with a grade V/VI right facial nerve palsy where he completed the remaining steroids with a 4-day taper. In total, the patient received 14 days of prednisone at 2 mg/kg. On reassessment 4 weeks later, he had a grade II/VI slight facial palsy and total resolution of symptoms 2 months after discharge.

Discussion

Despite being the one of the most common pediatric mononeuropathies, little is known about the pathophysiology underlying Bell’s palsy. In early infancy, however, nearly all cases arise from congenital causes or birth-related trauma.^[1] Four previous cases of idiopathic cranial nerve palsy have been described in this age group.^{[2],[3],[4],[5]} In three of these cases, however, an upper respiratory infection (URI) was observed either several days prior to or during the onset of facial paralysis. As no specific pathogen was identified for the URIs, these cases were deemed to be idiopathic palsies despite the prodromal or concurrent illnesses.^[2],[3],[4]

Due to its rarity, no standardized treatment regimen has been established for this age group. Even short-term steroid use in the neonatal period is associated with significant potential for harm, with adverse reactions ranging from hypertension, hyperglycemia, hypertrophic cardiomyopathy, and growth failure. Given the dangers that severe facial palsy poses for successful breastfeeding, we elected to continue steroid therapy in this patient and feel that clinicians should consider treating more severe cases with only the shortest effective course of steroids. In the most recent reported case of grade IV Bell’s palsy in a neonate, 6 weeks of steroids were used.^[5] Here we document the shortest successful course of steroids (14 days) in the treatment of a complete idiopathic cranial nerve VII palsy in young infancy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 

References

1.	Shargorodsky J, Lin HW, Gopen Q Facial nerve palsy in the pediatric population. Clin Pediatr (Phila) 2010;49:411-7.
2.	McLellan MS, Parrino CS Bell’s palsy at 1 month 4 days of age. Am J Dis Child 1969;117:727-9.
3.	Saini A, Singhi P, Sodhi KS, Gupta A Bell palsy in a neonate with rapid response to oral corticosteroids: a case report. J Child Neurol 2013;28:506-8.
4.	Fishbein JF, Shadravan I, Hebert L, Funes R Idiopathic bell palsy in a 2-month-old child. Am J Dis Child 1974;128:112-3.
5.	Khair AM, Ibrahim K Idiopathic non-traumatic facial nerve palsy (bell’s palsy) in neonates: an atypical age and management dilemma. Oman Med J 2018;33:65-8.