Abstract
Background/Objectives Facial diplegia as a presenting neurological symptom has a specific set of differential diagnoses. These differential diagnoses can have subtle systemic or peripheral features that may enable the elucidation of the underlying aetiology.
Methods A case is presented in which a patient presented with facial diplegia. Careful physical examination was able to ascertain the underlying diagnosis.
Results A 24-year-old female presented to the emergency department with left facial droop. This had developed over the course of 3–4 days and was then followed by right facial weakness. The patient also had a headache and peripheral paraesthesia. They had a past medical history only significant for migraine. Physical examination was otherwise normal aside from mild ankle dorsiflexion weakness and left extensor hallucis longus weakness. Lumbar puncture showed 1 mononuclear cell, 0 polymorphonuclear cells, and 0 red blood cells, with a protein of 1.14 and glucose 4.1. She had progressive appendicular weakness and treatment with intravenous immunoglobulin was commenced. MRI brain and spine demonstrated smooth enhancement of the cauda equina nerve roots, consistent with the suspected diagnosis of Guillain-Barre syndrome manifesting with facial diplegia and peripheral paraesthesia.
Conclusion This case provides an opportunity to revisit the differential diagnoses that may be responsible for facial diplegia. Subtle and systemic examination findings are discussed.
