Pregnancy and Bilateral Bell's Palsy: A Case Report

Aims: Despite the increased predisposition of Bell's palsy during pregnancy, bilateral disease is extremely rare with only five cases reported in the medical literature. The aim of this report is to present a new case of bilateral Bell's palsy during pregnancy and to discuss its etiology, treatment, and prognosis, informing clinicians regarding the rehabilitation of afflicted women.

Material: A case of bilateral Bell's palsy in a 34-year-old pregnant woman at 32 weeks gestation is presented.

Method: Initially, right-sided facial nerve palsy developed without any other clinical symptoms or signs. Audiometry and electrical impedance testing was normal, while laboratory tests were unrevealing. A low dose of prednisolone was administered and on the third day of treatment, a left-sided facial nerve palsy also developed. A thorough investigation was undertaken (chest XR, MRI of the brain, bone marrow aspiration, lumbar puncture, VDRL, FTA-ABS, monotest, Lyme titer, CMV/EBV titers, angiotensin converting enzyme level) to confirm the diagnosis of Bell's palsy.

Results: On the ninth day of treatment, facial palsy began to resolve and 1 month later the left side resolved completely; whereas on the right side there was a slight mid-face weakness. The pregnancy progressed without further complications and at 38 weeks of gestation, a healthy boy was born. After 4 months, a full recovery was noted.

Conclusions: The clinical course of Bell's palsy in pregnancy is more severe and it is more likely to progress to a complete palsy. Recovery is also significantly more difficult, especially in the presence of a complete facial paralysis, bilateral involvement or presence of a similar episode in a previous pregnancy. This information should be taken into consideration by all clinicians involved in the counseling of these patients.