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. 2019 Oct 11;116(41):692–702. doi: 10.3238/arztebl.2019.0692

Table 2. The differential diagnosis of peripheral facial nerve palsy (modified from [10, 15, 23]).

Cause Remarks
idiopathic
idiopathic facial nerve palsy (Bell’s palsy) common
traumatic
petrous bone fracture surgery may be indicated
infectious
borreliosis lumbar puncture; antibiotic treatment tailored to the stage and extent of the ‧infection
HIV in the seroconversion phase with lymphocytic pleocytosis, also in the late phase with meningeal lymphomatosis
herpes zoster oticus lumbar puncture; virostatic agents
other viral pathogens: cytomegalovirus, rubella virus, mumps virus, influenza B virus, Coxsackie virus; pathogens of other types: rickettsia, ehrlichiosis rare
Guillain-Barré syndrome lumbar puncture, with determination of ganglioside autoantibodies when indicated; treatment: intravenous immunoglobulin (IVIG), possibly plasmapheresis
acute and chronic otitis media otological consultation
neoplastic
schwannoma facial n. (rare), vestibular n.
meningioma, glomus tumor originating in the cerebellopontine angle, often with further cranial nerve deficits
malignant tumors skull base tumors, parotid carcinoma
cholesteatoma slow onset, gradual worsening
metabolic
diabetes mellitus mainly in association with arterial hypertension
pregnancy increased risk mainly in the last trimester
rare sporadic cases sarcoidosis, Wegener disease, Sjögren syndrome, Melkersson-Rosenthal ‧syndrome, acute lymphatic leukemia, carotid artery dissection in the neck