BELL’S PALSY AND COVID-19
Érica Barata, Filipa Monteiro, Elena Pirtac, Francisca Delerue
INTRODUCTION: Bell’s palsy, also known as
acute peripheral facial palsy of unidentified
reason, is caused by the acute onset of problems
with the facial nerve’s lower motor neuron
(LMN). Several etiologies have been proposed to
explain facial nerve palsy (FNP).
Some emphasize that this is due to a viral
infection that results in inflammation. Some
studies revealed herpes simplex virus (HSV) as
the likely cause of most cases of Bell’s palsy.
However, other viruses might be responsible for
this phenomenon. Furthermore, recent studies
have shown that COVID-19 or SARS-CoV-2
infection might also lead to neurological
symptoms.
In the course of the COVID-19 pandemic, several
neurological manifestations of the disease have
been reported, and there are still many unknown
aspects. The possibility of COVID-19 as a cause of
Bell’s palsy should be considered. The neurologic
manifestations of COVID-19 most commonly
include myalgia, headache, altered sensorium,
hyposmia or anosmia, and hypogeusia or
dysgeusia.
But, COVID-19 can also present with other central
nervous system manifestations such as stroke,
encephalo-myelitis, or peripheral nervous
manifestations such as Guillain-Barré syndrome
(GBS) and Bell’s palsy.
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Favorable Outcomes in Adults With Bell Palsy. JAMA Otolaryngol Head Neck Surg 2020.
Mar;146(3):256-263. 10.1001/jamaoto.2019.4312
Female, 32 years old, healthy. History of the
current illness: Patient diagnosed with
COVID-19 with 5 days of evolution, starts
with abrupt onset left hemifacial weakness.
She did not gastrointestinal symptoms, but
she complained of a new-onset headache.
On admission, her vital signs were stable,
with oxygen saturation (SpO2) of 97%. On
exam, her left hemifacial expression ability
was impaired so that her face seemed
asymmetrical during smiling, and numbness
around the left nasolabial fold was detected
[Figure 1]. Her ability to wink was impaired,
and her eyebrow drooped, but her speech
had not changed. No lymphadenopathy or
rigor was found. Other neurological exams Figure 1 - 64-year-old patient who presented abrupt onset left hemifacial weakness.
were normal. Her extremities forces were of
full strength with no focal neurological A diagnosis of FNP in the setting of COVID-19 infection was made; therefore, the patient
deficit. was advised to take precautionary isolation measures, along with corticotherapy. At two
week follow-up, her symptom had improved significantly, with a reduced degree of her
HIV antibody and serologic tests of HSV and
facial weakness.
varicella-zoster virus were negative for active
disease
Conclusion: During the current COVID-19 epidemic, any newly occurred neurological
symptom or sign should raise the suspicion of COVID-19. Therefore, being aware of these
Brain computed tomography (CT) scans and complications is vital to prevent any delay in the diagnosis and treatment.
brain magnetic resonance imaging (MRI) did
not show abnormalities Disclosure
he patient gave his consent for the information about himself to appear in an article.
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