Progressive Facial Nerve paralysis

[leeway]

Am a 77 yr old male who started with small area of numbness on left cheek. Intial diagnosis as it progressed was Bells Palsy. Had MRI in 7/01 neg. Numbness progressed saw neurologist 3/02.  MRI, CAT scan all neg. Progressed saw neuro 11/02 MRI-MRA all neg. Progressed left ear, head, eye muscle, gum and tongue. 8/04 MRI-MRA, CAT all neg. 10/04 saw neurologist at Shands, nerve and sinus scan w/dye. Differental diag. squamus cell cancer infiltrating nerves refered to ENT. 10/4 saw ENT said might be fat nerve did eye socket bio of 5th nerve - neg. 10/5 saw new neurologist did pet scan which showed small light area at base of brain no firm diog so another MRI and CAT was done W and W/0 contrast. Results as folows: "no discreet evidence of skull base destruction or mass is seen. Enhancement of the left facial nerve as well as the genu of the left facial nerve. Exact etiology of this finding is questioned although facial nerve neuritis cannot be excluded. Dolichoectasia of the vertebral artery."
This has been going on for four years involving CN7 & 5 now is in back of neck on left with the tingling, itching, etc. Nothing in lymph nodes. Nothing in skull bone. Pet Scan of body shows no primary.  All say I am a puzzle. Had face lift to correct droop,
gold weight in eye to help close. Surgery for eyelid droop.

[Ellie100]

Leeway, I agree with Carol.  Approximately 20 years ago, I developed Bell's Palsy.  I later found that I was in late stage Lyme Disease.  I first noticed it when I woke in the morning and took a sip of tea.  I couldn't understand why it dribbled down my chin.  By noon my left side of my face was completely paralyzed.  I had excruciating pain in my ear, couldn't close my eye, total numbness of the left side of my face, and drooping. Fortunately, the paralysis lasted for a week, then slowly began to mend.  With physical therapy, it took approximately six months before things were back in place.  I have some residual but most of the time I don't notice it.  Good luck.

[CCF-Neuro-M.D.-PW]

Bells palsy refers to a facial nerve (CN 7) damage that causes a facial droop. The facial nerve supplies a small area of skin sensation also around the ear (but not the cheek)
The cause is sometimes associated with a herpes virus infection but in most cases a direct cause is not found. Steriod and an anti-viral medication given in the first 2 weeks of the symptoms has some benefical effect. Recovery may be slow, and up to 1 year. The amount of nerve damage if it has not resolved can be assessed with an EMG needle study of teh facial muscles.
If CN 5 is involved also (sensory innvervation to the rest of the face) it is important to ruleout a lesion or growth where these two nerves run closely to each other - such as where they exit at the brainstem and at the skull base. You seem to have had this done already. MRI can also show enhancement of the nerve, again in most cases no cause is found.
Another step in the evaluation as more than one cranial nerve is involved is to look at the spinal fluid for evuidence of infection, malignancy or sarcoid. Sometimes vascular loops in arteries around the brainstem can compress nerves exitign the brainstem - this can be evaluated for with an angiogram - sometimes surgery is successful at freeign up the loop.