Ann Clin Neurophysiol.  2021 Oct;23(2):121-125. 10.14253/acn.2021.23.2.121.

Refractory Bell’s palsy responding to late treatment with high-dose intravenous steroids

• Kim B
• Jang SI
• Park SH
• Kim NH

• KMID: 2521890
• DOI: http://doi.org/10.14253/acn.2021.23.2.121

Abstract

Bell’s palsy is an acute peripheral facial paralysis with no detectable cause. Although the prognosis of Bell’s palsy is generally good, some patients experience poor recoveries and there is no established treatment for those that do not recover even after receiving the conventional treatment. Here we present two cases of refractory Bell’s palsy with facial nerve enhancement in magnetic resonance imaging who showed symptomatic improvement after the late administration of high-dose intravenous methylprednisolone.

Figure

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  Fig. 1. (A) Internal auditory canal magnetic resonance imaging (MRI) in case 1 (53 days after the onset): gadolinium-enhanced T1-weighted axial MRI exhibited prominent diffuse enhancement in the labyrinthine (white arrow), geniculate ganglion (blue arrow), and tympanic (yellow arrow) and mastoid segments (red arrow) of the left facial nerve. (B) Internal auditory canal MRI in case 2 (60 days after the onset): gadolinium-enhanced T1-weighted axial MRI exhibited abnormal enhancement along the labyrinthine segments (white arrow), geniculate ganglion (blue arrow), and tympanic segment (yellow arrow) of the left facial nerve.

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  Fig. 2. Recovery of facial nerve function over time. Intravenous (IV) steroid pulse therapy appeared to accelerate the recovery of facial weakness in refractory cases. M, months.

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