# An Uncommon Diagnosis of Necrotizing Mastoiditis Presenting as Bell’s Palsy: A Case Report

## TL;DR

An 84-year-old woman initially diagnosed with Bell’s palsy was found to have a rare and severe infection of the mastoid bone.

## Contribution

This case highlights the importance of thorough evaluation to avoid missing serious conditions mimicking Bell’s palsy.

## Key findings

- The patient had bilateral necrotizing mastoiditis, not idiopathic Bell’s palsy.
- Unilateral facial weakness can be caused by severe infections requiring urgent treatment.
- A broad differential diagnosis is essential for accurate diagnosis.

## Abstract

The benign nature of Bell’s palsy has led to a lack of a standardized work-up, and dangerous underlying mimics are at risk of being missed.

An 84-year-old female with a history of vertigo presented to the emergency department with a left-sided facial droop consistent with Bell’s palsy. After further work-up, the patient was diagnosed with bilateral necrotizing mastoiditis.

Unilateral facial weakness involving the forehead and palpebral fissures is often diagnosed as idiopathic Bell’s palsy. Various pathologies can present with unilateral facial weakness, and the differential needs to remain broad.