# Stressful Symmetry: Bilateral Bell’s Palsy Potentially Induced by Extreme Stress

## TL;DR

This paper reports a rare case of bilateral Bell's palsy potentially triggered by extreme stress, after ruling out other common causes.

## Contribution

The novelty lies in suggesting extreme stress as a possible cause of bilateral Bell's palsy.

## Key findings

- Bilateral Bell's palsy is rare and can be caused by extreme stress after excluding other known causes.
- The patient's symptoms occurred after experiencing extreme stress, suggesting a possible link.
- Common causes like infections and neurological conditions were ruled out in this case.

## Abstract

Facial nerve palsy (FNP) of idiopathic origin is commonly called Bell's palsy. Bilateral FNP represents an exceptionally rare subset of all Bell's palsy cases. It may manifest either synchronously or sequentially, with one side initially affected, followed by involvement of the opposite side within the initial 30 days of symptom onset. Common etiologies of FNP encompass infections such as infectious mononucleosis, influenza, Lyme disease, and meningitis. Non-infectious causes comprise neoplasms, multiple sclerosis, and Guillain-Barre syndrome. In this particular case, our patient experienced extreme stress prior to the onset of symptoms. Following the exclusion of common causes of secondary FNP, the patient was diagnosed with bilateral Bell's palsy. We have explored the consideration that extreme stress may serve as a precipitating factor for bilateral Bell's palsy.