- Clinical Images
- Open Access
Facial diplegia and deafness following a fall
© Springer-Verlag London Ltd 2010
- Received: 2 November 2009
- Accepted: 18 January 2010
- Published: 23 April 2010
- Facial Nerve
- Internal Auditory Canal
- Facial Canal
- Membranous Labyrinth
- Skull Base Fracture
A 45-year-old man presented to the emergency department (ED) after falling down two flights of stairs. He had bilateral raccoon eyes, subconjunctival haemorrhages and CSF otorrhoea suggestive of skull base fracture (SBF). Although he had difficulty speaking and responded inappropriately, giving the impression of mixed dysphasia, written communication was normal, and he complained of deafness and dizziness.
Post-traumatic facial nerve palsy complicates 1.5% of SBFs involving the temporal bones . Petrous temporal bone fractures may disrupt the facial nerve, membranous labyrinth and inner ear. While cranial nerves seven and eight may be injured by petrous temporal bone fractures, concomitant bilateral facial weakness and deafness in this setting is extremely rare . Most post-traumatic facial nerve injuries recover with conservative management and time [3, 4].
This case illustrates how bilateral facial weakness and deafness may be mistaken for mixed dysphasia and highlights the need to consider it in patients with apparent speech disturbances in the ED.
Conflicts of interest
- Devriese PP (1983) Facial paralysis after trauma of the skull. In:Samii M, Brihaye J (eds) Traumatology of the skull base. Springer, New York, pp 152–154Google Scholar
- Keane JR (1994) Bilateral seventh nerve palsy: analysis of 43 cases and review of the literature. Neurology 44:1198–1202PubMedView ArticleGoogle Scholar
- Odebode TO, Ologe FE (2006) Facial nerve palsy after head injury:case incidence, causes, clinical profile and outcome. J Trauma 61:388–391PubMedView ArticleGoogle Scholar
- Turel KE, Sharma NK, Verghese J, Desai S (2005) Post traumatic facial paralysis. Treatment options and strategies. Indian J Neurotrauma 2:33–34View ArticleGoogle Scholar