A case of bilateral facial nerve palsy in a patient with diabetes mellitus

Bilateral facial nerve palsy is exceedingly rare, representing less than 2% of all facial palsy cases, and has an incidence of 1 per 5,000,000 population. The majority of patients with bilateral facial palsy have Guillain-Barre syndrome, sarcoidosis or Lyme disease. Other uncommon causes are multiple idiopathic cranial neuropathies, brain stem encephalitis, benign intracranial hypertension, leukemia, HIV infection, syphilis, infectious mononucleosis, vasculitis, bilateral neurofibromas and bilateral Ramsay Hunt syndrome. We report a case of a 31-year-old male who presented to our department with simultaneous bilateral lower motor type facial paralysis, who was found to have diabetes mellitus which was undiagnosed before. With insulin therapy and corticosteroids he made an uneventful recovery. Physicians should be aware of the various diagnostic possibilities of facial diplegia and should thoroughly investigate for all possible causes, some of which are life-threatening.