Precentral gyrus infarct presenting as isolated contralateral peripheral-type facial palsy

A case of lenticulostriate artery infarction presenting with peripheral type facial palsy

An 82-year-old woman developed a droopy right eyelid with ipsilateral hemiparesis. Her ocular symptom was caused by weakness of the right frontalis, which is usually seen in patients with peripheral facial nerve palsy. However, head MRI showed acute cerebral infarction of the left lenticulostriate artery, and electroneurography did not detect damage to the right facial nerve. To explain the pathophysiology in this patient, asymmetrical bilateral cortex innervation to the right upper face was hypothesized. This case suggested that patients with some hemispheric strokes could develop upper facial weakness mimicking facial nerve palsy, and clinicians should pay attention to this potential pitfall in the differential diagnosis of facial nerve palsy.

Isolated peripheral-type facial palsy due to contralateral precentral gyrus cavernoma hemorrhage

Facial palsy is a condition frequently encountered in neurological daily practice. Typically, telling apart peripheral facial palsy (PFP) from central facial palsy is easy, and depends on the presence of the upper face involvement. However weakness of eye closure can be seen also in cases of central facial palsies, making the diagnosis more difficult. When the facial involvement is isolated, that constitutes a crucial diagnosis challenge because it can be misdiagnosed as Bell's palsy, particularly in young patients. However, subtle clinical findings such as a predominant involvement of the lower face and the presence of a dissociation of emotional and volitional facial movements points towards a central etiology as in our patient. We report here a case of isolated peripheral-type facial palsy due to acute bleeding of supratentorial cavernoma. To our knowledge, such case has not yet been reported.