Disclosures: Ayaz Khan, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 69-year-old female with idiopathic facial nerve paralysis and concurrent vestibular dysfunction.

Case Description: A female with a history of mantle cell lymphoma in remission was evaluated after multiple falls over the past 12 months. The patient reported having episodes of acute-onset dizziness, lightheadedness, and gait instability prior to each fall. On exam, she was found to have mild left facial asymmetry and had a positive Dix-Hallpike maneuver on exam. Magnetic resonance imaging (MRI) with contrast was obtained of the brain, which showed asymmetric enhancement, and thickening of the left facial nerve. Imaging showed no evidence of acute infarction.

Setting: Multidisciplinary Academic CenterAssessment/

Results: Imaging was reviewed with the Oncology team. It was determined that the MRI findings were unlikely leptomeningeal disease and the patient was diagnosed with idiopathic left facial nerve paralysis with concurrent vestibular dysfunction. The patient was referred to physical therapy for training in fall prevention.

Discussion: Idiopathic facial nerve paralysis or Bell’s palsy is a common neurological condition that results in unilateral paralysis of the facial nerve (cranial nerve VII). The etiology of Bell’s palsy remains unknown but suspected etiologies include reactivation of herpes simplex virus (HSV) or autoimmune conditions. In this case, we present a unique phenomenon of Bell’s palsy with concurrent vestibular dysfunction resulting in gait ataxia. Given the anatomical pathway of the facial nerve, occasionally, Bell’s palsy may present with altered facial sensation (cranial nerve V), vestibular dysfunction (cranial nerve VIII), or pharyngeal symptoms (cranial nerve IX and X). Also, histopathologic studies have shown latent HSV-1 infection in the geniculate ganglia as well as the vestibular ganglia suggesting that the infection may be the causality of both pathologies, but the evidence remains limited.

Conclusion: In this case, we describe a rarely reported phenomenon of Bell’s palsy with concurrent vestibular involvement, resulting in gait ataxia.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/atypical-presentation-of-idiopathic-facial-nerve-paralysis-with-gait-ataxia-a-case-report/