article · Clinical Case Reports
Bilateral facial nerve palsy is an uncommon neurological condition in children that rarely occurs following primary varicella infection. A previously healthy ten-year-old child developed acute bilateral lower motor neuron facial weakness three weeks after experiencing a self-limiting episode of chickenpox, by which time the characteristic rash had resolved. Symptoms included an inability to close both eyes, difficulty smiling, drooling, and loss of facial tone. Diagnostic tests and brain magnetic resonance imaging showed no abnormalities, allowing the exclusion of alternative causes and confirming a diagnosis linked to the varicella-zoster virus. Management comprised intravenous aciclovir, corticosteroids, supportive eye care, and targeted facial physiotherapy. After six weeks of multidisciplinary treatment, the patient exhibited significant clinical recovery, regaining facial symmetry, smiling ability, normal eye closure, and control over drooling. Early clinical identification and intervention remain vital for favourable recovery.
Varicella is a common childhood infection that usually resolves without complication. Recognising rare neurological outcomes such as bilateral facial nerve palsy enables healthcare professionals to diagnose the condition promptly. Implementing early multidisciplinary treatment with antivirals, steroids, and physiotherapy helps prevent lasting facial weakness and supports complete recovery in affected paediatric patients.
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Bilateral facial nerve palsy is a rare neurological condition in children and is infrequently associated with primary Varicella (chickenpox) infection. We report the case of a 10-year-old previously healthy girl who developed simultaneous bilateral lower motor neuron facial weakness 3 weeks after a self-limiting varicella infection. The patient presented with acute onset inability to close both eyes, difficulty smiling, drooling of saliva, and impaired oral competence. At presentation, the characteristic vesicular rash had completely resolved. Neurological examination demonstrated bilateral lower motor neuron facial nerve palsy with loss of forehead creases, lagophthalmos, flattening of the nasolabial folds, inability to puff the cheeks, and bilateral Bell's phenomenon, without additional neurological deficits. Laboratory investigations and brain magnetic resonance imaging (MRI) were unremarkable. Based on the temporal relationship with recent varicella infection and exclusion of alternative etiologies, a diagnosis of bilateral facial nerve palsy secondary to varicella-zoster virus infection was established. The patient was treated with intravenous aciclovir, corticosteroids, supportive eye care, and facial physiotherapy. Follow-up after 6 weeks demonstrated marked clinical improvement, including restoration of facial symmetry, improved eye closure, recovery of smiling ability, and resolution of drooling. This case highlights a rare neurological complication of primary varicella infection and emphasizes the importance of early recognition and multidisciplinary management to achieve favorable neurological outcomes.
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DOI: 10.1002/ccr3.73345
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