Table 3. Etiologies and Clinical Features of Facial Paralysis
(continued)
Type Condition Etiologic Agent Distinguishing Factors
Congenital Mobius syndrome Possibly viral Young age, bilateral in nature,
unable to move face or eyes
laterally
Endocrine Diabetes Microvascular
disease
Other signs and symptoms of
diabetes, laboratory testing
Idiopathic Acute facial nerve
paresis/paralysis
Unknown Classic Bell's palsy with other
etiologies excluded
Infectious Encephalitis/
meningitis
Fungal, viral, or
bacterial
Headache, stiff neck,
cerebrospinal fluid abnormalities
Herpes simplex Herpes simplex
virus along axons
of nerve residing
in the geniculate
ganglion
Fever, malaise
HIV HIV Fever, malaise, CD4 count
Lyme disease Spirochete
Borrelia
burgdorferi
May be bilateral, rash, arthralgias
Mononucleosis Epstein-Barr
virus
Malaise, difficult to distinguish
Otitis media Bacterial
pathogens
Gradual onset, ear pain, fever,
hearing loss
Ramsay Hunt
syndrome
Varicella zoster
virus
Pronounced prodrome of pain,
vesicular eruption in ear canal or
pharynx
Syphilis Treponema
pallidum
Other neurologic and cutaneous
manifestations
Inherited Heritable disorders Autosomal
dominant
inheritance
Family history as high as 4%;
may have other neurologic
disorders
Neoplastic Facial nerve tumor,
skin cancer, parotid
tumors
Multiple
carcinomas of the
head and neck
May involve only select branches
of the facial nerve or other
cranial nerves and present as
multiple cranial neuropathies
Neurovascular Stroke Ischemia,
hemorrhage
Forehead sparing most oen,
extremities oen involved
Traumatic Injury to facial
nerve
Trauma,
including forceps
delivery
Timing of injury coincides with
trauma
