Bilateral seventh nerve palsy: analysis of 43 cases and review of the literature.

Among inpatients with facial diplegia, one-half (22 patients) had benign, self-limited causes, including Bell's palsy (10), Guillain-Barré syndrome (5), multiple idiopathic cranial neuropathies (3), brainstem encephalitis (2), Miller Fisher syndrome (1), and association with benign intracranial hypertension (1). Nine patients had tumors: four meningeal, three prepontine, and two intrapontine. Syphilis (2 patients), Hansen's disease (1), cryptococcal meningitis with acquired immunodeficiency syndrome (1), and tuberculous meningitis (1) constituted those with an infectious etiology, while miscellaneous causes included one patient each with diabetes, sarcoidosis, head trauma, pontine tegmental hemorrhage, undiagnosed Möbius syndrome in an adult, systemic lupus erythematosus with severe neuropathy, and slowly progressive degeneration--possibly bulbospinal neuronopathy. Bilaterality makes facial neuropathy a more ominous sign with widely varying causes that requires prompt investigation.