Coexistent Hemifacial Dystonia and Bell’s Palsy in a Psychiatric Patient: a Case Report

Facial dystonia and peripheral facial nerve (Bell’s) palsy are essentially different in their etiology and pathogenesis. Combined facial dystonia and Bell’s palsy coexisting in the same patient have not been described. Presenting this case we used clinical examination, MRI scan, videotaping of the patient, and chart review. We present a 36-year-old psychiatric patient with simultaneous, bilateral disorders of the face: hemifacial dystonia on one side and peripheral facial nerve on the other. Structural MRI brain imaging was unremarkable except for inflammatory changes within the right facial nerve. At the height of her disorder, the patient’s attention was so focused on hemifacial dystonia that she did not notice the contralateral Bell’s palsy. Over the next 12 months, her hemifacial dystonia significantly improved under the treatment of neuroleptic, antidepressant, and botulinum toxin injections. Right Bell’s palsy regressed spontaneously with residual synkinesis. In the same patient, neuropsychiatric movement disorders may be unrelated to each other. In such a situation, a more obvious disorder should not distract attention and complicate accurate diagnoses despite misdirecting complaints of the patient.