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10 marksDrNB 2025NeurologyCranial Neuropathy
a) List the causes of facial diplegia. [4] b) Discuss in detail the approach, diagnosis and management of facial diplegia. [6]
Facial diplegia refers to bilateral paralysis or paresis of the facial nerves, resulting in weakness of both sides of the face. It is a rare neurological manifestation often indicating systemic or multifocal pathology (Harrison's 21e, Ch. 265).
Facial diplegia occurs due to bilateral involvement of the facial nerve nuclei, fascicles, or peripheral nerves. Causes can be broadly categorized into inflammatory, infectious, neoplastic, traumatic, metabolic, and idiopathic.
| Cause Category | Specific Etiologies |
|---|---|
| Infectious | Lyme disease, HIV, Tuberculosis, Herpes simplex/zoster, Leprosy |
| Inflammatory | Guillain-Barré syndrome (Miller Fisher variant), Sarcoidosis |
| Neoplastic | Brainstem glioma, Lymphoma, Parotid tumors (bilateral), leptomeningeal carcinomatosis |
| Traumatic | Bilateral temporal bone fractures, iatrogenic injury |
| Metabolic | Diabetic cranial neuropathy, Amyloidosis |
| Idiopathic | Bilateral Bell’s palsy (rare) |
Mnemonic for causes: “I I N T M I” (Infectious, Inflammatory, Neoplastic, Traumatic, Metabolic, Idiopathic) (Bradley's Neurology, 8e).
References
Bradley's Neurology, 8eHarrison's 21eHarrison's 21e, Ch. 265Harrison's 21e, Ch. 265; Bradley’s Neurology, 8e