Paralisia facial bilateral associada a neurosarcoidose

espanolIntroducao: A paralisia facial bilateral e uma condicao rara e representa menos de 2% de todos os casos de paralisias faciais. A sua etiologia pode ser neurologica, infeciosa, neoplasica, traumatica ou metabolica. A sarcoidose e uma doenca granulomatosa cronica multissistemica de etiologia desconhecida. Manifestacoes neurologicas ocorrem em aproximadamente 5% dos doentes com sarcoidose. A paralisia facial bilateral, quer sequencial, quer simultânea, ocorre entre 25 a 50% dos pacientes com sarcoidose. Objectivos: Documentacao de um caso de paralisia facial bilateral como manifestacao isolada de sarcoidose oculta. Caso Clinico: Mulher de 46 anos com quadro de paralisia facial bilateral simultânea e ausencia de sintomatologia adicional. A Telerradiografia do torax mostrou linfadenopatias hilares bilaterais e a puncao lombar com analise do liquido cefalorraquidiano evidenciou aumento das proteinas e pleocitose. Restante estudo hematologico e serologico sem alteracoes. A tomografia computorizada e a ressonância magnetica cranioencefalica foram inconclusivas assim como a analise do lavado bronquico e biopsias realizadas por broncoscopia. O diagnostico definitivo de sarcoidose foi estabelecido apos biopsia das adenopatias por mediastinoscopia. A doente apresenta uma paralisia discreta residual unilateral apesar de tratamento prolongado com corticosteroides. Conclusoes: Paralisia facial bilateral reflete habitualmente uma patologia subjacente necessitando de uma correta investigacao e acompanhamento. Este caso demostra que uma paralisia facial bilateral pode ser a unica manifestacao de uma sarcoidose oculta e que o seu diagnostico podera ser um desafio. EnglishIntroduction: Bilateral facial nerve palsy is a rare condition, representing less than 2% of all cases of all palsies. It may be caused by neurologic, infectious, neoplastic, traumatic or metabolic disorders. Sarcoidosis is a multisystemic chronic granulomatous disease of unknown etiology. Neurological manifestations occur in approximately 5 % of patients with sarcoidosis. Bilateral involvement, whether sequential or simultaneous, is seen in 25 to 50 % of patients with facial palsy associated with sarcoidosis. Objective: Case report of a simultaneous bilateral facial palsy as a sole manifestation of occult sarcoidosis and its diagnostic challenge. Case report: A 46 years old female with a simultaneous bilateral facial paralysis and no other symptomatology or complications reported. Chest X-ray revealed bilateral hilar lymphadenopathy. Lumbar puncture was performed and the cerebrospinal fluid (CSF) analysis showed elevated spinal fluid protein and a mild pleocytosis. All other CSF analysis was within the normal range. Computed tomography and magnetic resonance scans of the brain was nondiagnosis. Bronchoscopy biopsy and tracheal aspiration was performed with inconclusive results. Mediastinoscopic biopsy samples were diagnosed as sarcoidosis. All other hematological and serological exams were normal. Patient persists with a mild unilateral paralysis despite prompt corticoid treatment. Conclusion: Bilateral facial palsies usually reflect an underlying systemic pathology and need thorough assessment and follow-up. This report obtains evidence that bilateral facial nerve palsy can be the only manifestation in occult sarcoidosis and that it can be a challenging diagnosis.