Peripheral presentation of central facial palsy

Facial nerve palsy in children may be congenital or due to neoplastic, infectious or traumatic conditions. Although idiopathic (Bell’s palsy) facial nerve palsy is the most commonly encountered cause, facial nerve palsy may be the fi rst and only symptom of a severe underlying condition. Previous studies on pediatric populations have reported on a tumor cause of facial nerve palsy in 2%-12% of cases. One of the most important pitfalls for a clinician is to assume that a child with facial nerve palsy has Bell’s palsy and does not need complete and comprehensive evaluation for other etiologies. A case is described of an infant with oculocutaneous albinism who presented with persistent fi ndings of peripheral facial palsy in whom the cause was belatedly identifi ed as a brain tumor following magnetic resonance imaging. The most striking feature in our patient was the peripheral presentation of central facial nerve palsy, and if the magnetic resonance imaging had not been obtained, a potentially serious diagnosis may have been missed. Complete medical history and detailed physical examination should be obtained for every patient presenting with peripheral facial palsy, particularly in infants where cranial tomography or magnetic resonance imaging may be warranted to avoid misdiagnosis.

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