Recurrent facial paralysis and weakness

A woman in her 50s presented with a history of at least five paroxysmal episodes of facial paralysis and weakness over 25 years. She first experienced symptoms at age 26, which were bilateral and more severe on the right. No other physical findings were documented during the initial presentation. The severity of symptoms increased with each episode along with complete facial paralysis and were not always followed by full recovery, with intervals between episodes lasting more than eight weeks.

About 48 hours before onset of facial paralysis and weakness, the patient usually experienced pain behind the left ear and on the lateral part of the neck. She did not report any skin lesions, fissured tongue, or swelling of the lips or tongue.

Box 1 summarises the neurological findings of the most recent presentation.