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Pontine stroke mimicking Bell’s palsy: a cautionary tale!
  1. Louise Dunphy1,
  2. Ravpreet Kaur2 and
  3. Enrico Flossmann2
  1. 1Department of Surgery, Royal Berkshire NHS Foundation Trust, Reading, UK
  2. 2Department of Neurology, Royal Berkshire NHS Foundation Trust, Reading, UK
  1. Correspondence to Dr Louise Dunphy; Louise.Dunphy{at}doctors.org.uk

Abstract

Stroke has been called apoplexy since the ancient times of Babylonia. Johann Jakob Wepfer, a Swiss physician, first described the aetiology, clinical features, pathogenesis and postmortem features of an intracranial haemorrhage in 1655. Haemorrhagic and ischaemic strokes are the two subtypes of stroke. Bell’s palsy usually presents with an isolated facial nerve palsy. A lacunar infarct involving the lower pons is a rare cause of solitary infranuclear facial paralysis. The authors present the case of a 66-year-old woman presenting with a 3-day history of headache, vertigo, nausea, vomiting and facial weakness. Her comorbidities included diabetes, hypertension and hypercholesterolaemia. It was challenging to identify the pontine infarct on MRI due to its small size and the confounding presentation of complete hemi-facial paralysis mimicking Bell’s palsy. Our case provides a cautionary reminder that an isolated facial palsy should not always be attributed to Bell’s palsy, but can be a presentation of a rare dorsal pontine infarct as observed in our case. Anatomic knowledge is crucial for clinical localisation and correlation.

  • emergency medicine
  • stroke

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Footnotes

  • Contributors LD: wrote the case report. RK: did the literature search. EF: edited the paper and gave final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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