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. 2022 Oct 28;5(6):e887. doi: 10.1002/hsr2.887

Table 1.

Patient characteristics

Author Country Study type No of cases Patient No. Patient characteristics Age/Sex GB present Affected side of face Facial palsy as first sign or not Features related to facial palsy CSF results COVID‐19 related symptoms Other signs/symptoms Imaging Treatment Treatment outcome
Lima et al. Brazil Case series 8 1 None 43/F No Right Yes Moderate (HB Grade 3) NS Mild symptoms Ipsilateral abducent nerve palsy CT Scan normal Oral corticosteroids PR
2 None 25/F No Right Yes Mild (HB Grade 2) NS Mild None Brain MRI normal Oral corticosteroids +  acyclovir CR.
3 None 33/F No Right Yes Moderate (HB Grade 3) NS Mild None NA Oral corticosteroids + acyclovir PR
4 None 26/F No Left No (after 2–10 days for all Nos) Mild (HB Grade 2) NS Mild None MRI: left CN7 enhancement Oral corticosteroids CR
5 None 50/F No Left No Moderate (HB Grade 3) Protein: mildly elevated; WBC: normal; SARS‐COV: negative Mild None CT scan: normal Oral corticosteroids PR
6 None 38/F No Left No Mild (HB Grade 2) NS Mild None Brain MRI: normal Supportive (eye lubricant) CR
7 None 39/F No Right No Mild (HB Grade 2) NS Mild None Brain MRI: normal Oral corticosteroids CR
8 None 34/M No Left No Mild (HB Grade 2) NS Mild None Brain MRI: normal IV corticosteroids CR
Homma et al. Japan Case report 1 1 Smoker 35/F No Right Yes NA NS Cough, malaise, sore throat, nausea, fever, right‐sided aguesia of tongue and anosmia None CT scan: multiple bilateral ground‐glass opacities Acetaminophen, Maoto, favipiravir, and inhaled Ciclesonide (corticosteroid) CR
Goh et al. Singapore Case report 1 1 NA 27/M No Left No (after 6 days) Left‐sided otalgia NS Myalgia, cough, fever, dysguesia, left‐sided throbbing headache, and conjunctival infection None Chest X‐ray: unremarkable; brain MRI; left CN7 enhancement Oral corticosteroid, valacyclovir and Lopinavir/ritonavir No significant improvement.
Figueiredo et al. Portugal Case report 1 1 Pregnant 35/F No Left Yes Involuntary drooling, left‐side labial commissure deviation and ipsilateral lagophthalmos NA None None NA Corticosteroid therapy and eye hydration therapy No significant improvement.
Caamaño et al. Spain Case report 1 1 None 61/M Yes Bilateral No (after 10 days) Involuntary drooling on his right facial commissure, unresponsive blink reflex on both eyes Protein: mildly elevated; WBC: normal; SARS‐COV: negative Fever, cough, and pneumonia None Brain MRI: unremarkable; Chest X‐ray: bilateral frosted glass pneumonia Oral corticosteroid, antimalarial and lopinavir/Ritonavir No significant improvement.
Muras et al. Spain Case report 1 1 None 20/M No Bilateral No (after a week) NA Protein: elevated; WBC: elevated; SARS‐COV: negative Fever, significant asthenia, headache, myalgia, nausea, headache, odynophagia and vomiting EBV coinfection Brain MRI: confirmed bilateral facial neuritis Levofloxacin and oral corticosteroid CR
Manganotti et al. Italy Case series 3 1 NA 72/M Yes Right No (after 18 days) Mild right sided lower face weakness Protein: elevated; WBC: normal; SARS‐COV: negative Fever, dyspnea, hyposmia, ageusia Flaccid tetraparesis, hypesthesia of extremities, dysuria, dysphasia, sinus arrythmia NA IVIG cycle, antimalarial, oseltamivir, darunavir, IV corticosteroid, and tocilizumab NA
2 NA 49/F Yes Right No (after 14 days) Right‐sided hypoesthesia of the face Protein: elevated; WBC: normal; SARS‐COV: negative Fever, cough, dyspnea, hyposmia, and ageusia Ophthalmoplegia with diplopia in the vertical and lateral gaze, and limb ataxia Brain MRI: normal IVIG cycle, antimalarial, lopinavir–ritonavir, IV corticosteroid Progressive improvement
3 NA 76/M Yes Left No (after 22 days) Mild left‐sided lower facial deficit Protein: elevated; WBC: normal; SARS‐COV: negative Fever, cough, hyposmia, ageusia Mild transient diplopia, tetraparesis and dysuria NA IVIG cycle, oseltamivir, darunavir, IV corticosteroid, Progressive improvement
Tocilizumab,
meropenem, linezolid
clarithromycin,
doxycycline and fluconazole
Khaja et al. USA Case report 1 1 HTN and asthma 44/M Yes Bilateral No (after 3 days) Severe (HB Grade 5) Protein: elevated; WBC: normal; glucose: normal Ageusia None Chest X‐ray: clear; MRI brain: unremarkable IVIG CR
Sancho‐Saldaña et al. Spain Case report 1 1 None 56/F Yes Bilateral No (after 20 days) NA Protein: elevated; WBC: normal; SARS‐COV: negative Fever, dry cough, and dyspnea Tetraparesis, lumbar pain, pararesthesia in both hands and oropharyngeal weakness Chest X‐ray: lobar consolidation Antimalarial, azithromycin and IVIG PR
Theophanous et al. USA Case report 1 1 Prematurely born, multiple congenital abnormalities, asthma, and gastrostomy tube feeding 6/M No Right Yes Moderate severe (HB Grade 4) NA None Tachycardiac NA IV acyclovir, IVIG infusion, lubricating eye drops and IV corticosteroids Significant improvement
Dahl et al. Norway Case report 1 1 Acute MI 37/M No Right No (after 18 days) NA Protein: elevated; IgG: normal; WBC: elevated Fever, headache, dyspnea Oliguria, hypotension, tachycardiac, tachypneic and unilateral painful neck swelling X‐ray thorax: bibasal consolidations IV furosemide and intermittently required low‐dose norepinephrine CR
Egilmez et al. Turkey Retrospective cohort 8 1 HTN, CHF 90/M No Left Yes Moderate severe (HB Grade 4) NA Pneumonia None Thorax CT: Intense pneumonia with ground glass opacities IV moxifloxacin and corticosteroids (dexamethasone and prednisolone) PR
2 None 4/F No Left No (after 7 days) Moderate severe (HB Grade 4) NA Cough and fever None Thorax CT: normal Oral corticosteroid CR
3 None 17/F No Right Yes Moderate (HB Grade 3) NA Cough, ageusia and anosmia None Thorax CT: normal Favipravir and oral corticosteroid CR
4 HTN, DM 71/F No Right Yes Moderate severe (HB Grade 4) NA Fever, ageusia and anosmia None Thorax CT: normal Favipravir and IV corticosteroid CR
5 None 63/F No Left Yes Moderate severe (HB Grade 4) NA Fever, myalgia, ageusia and anosmia None Thorax CT: Mild pneumonia with ground glass appearance Favipravir and oral corticosteroid PR
6 None 60/F No Left No (after 12 days) Moderate severe (HB Grade 4) NA Fever, ageusia and anosmia None Thorax CT: normal Favipravir and oral corticosteroid PR
7 HTN 65/F No Left Yes Moderate (HB Grade 3) NA Ageusia and anosmia None Thorax CT: Mild pneumonia with ground glass opacities IV corticosteroids PR
8 HTN, OSA 30/M No Left No (after 9 days) Moderate (HB Grade 3) NA ageusia and anosmia None Thorax CT: Mild pneumonia with ground glass appearance; brain MRI: normal Favipravir and oral corticosteroid (methylprednisolone and dexamethasone) No improvement
Engström et al. Sweden Case report 1 1 None 46/F No Left No (after 26 days) Tongue deviation to left, inability to wrinkle forehead and left lagophthalmos, drooping left corner of mouth, vocal cord paresis, left‐sided paresis NA High fever, cough, dyspnea, dysphagia, and severe headaches None CT thorax: bilateral ground glass appearance. MRI brain: some edema in the parotid gland High‐flow oxygen therapy, dalteparin, IV cefotaxime, oral and IV corticosteroids, and tear substitutes with watch bandages Significant improvement
Corrêa et al. Brazil Case series 4 1 None 25/F No Right No (after 2 weeks) Right‐sided facial muscle weakness and right lagophthalmos NA Vertigo, mild dyspnea, and fever Strabismus in the right eye after right CN6 palsy Brain MRI: restricted diffusion (right CN6 nucleus) and an asymmetrical enhancement (right CN7) Oral corticosteroids CR
2 None 30/F No Right No (after 10 days) NA NA Mild fever and sore throat None Brain MRI: enhancement in right CN7 Oral corticosteroids CR
3 OA, AF 65/M Yes Bilateral No (after 2 weeks) NA Protein: elevated; WBC: normal; SARS‐COV: negative Headache, fever, and generalized myalgia Lower limbs weakness Brain MRI: bilateral enhancement in CN7 IVIg PR
4 None 33/M No Bilateral No (after 2 weeks) NA NA Fever NA Brain MRI: enhancement in CN7 Oral corticosteroids CR
Chan et al. Canada Case report 1 1 None 58/M Yes Bilateral Yes Dysarthria, bilateral lagophthalmos, inability to raise eyebrow, wrinkle forehead, smile, and close lips Protein: elevated; WBC: normal; SARS‐COV: negative None Hypertension, tachypnea, paresthesia in his feet, and tachycardia Chest X‐ray: bilateral infiltrates; CT: bilateral ground‐glass opacities in lung apices; Brain MRI: Bilateral CN7 enhancement Empiric ceftriaxone, azithromycin and IVIG PR
Decio et al. Italy Correspondence 1 1 NA 1.25/F No Right NA NA NA Mild respiratory symptoms, fever, anosmia, and ageusia None Brain MRI: right CN7 enhancement Oral corticosteroids CR
Ozer et al. Turkey Case report 1 1 NA 62/F No Left No (after 2 days) Total paralysis (HB Grade 6) NA Fatigue, chills, and myalgia Sensorineural hearing loss Brain MRI: CN7 and CN 8 enhancement Oral corticosteroids, famotidine, oral favipiravir and SQ enoxaparin sodium PR
Neo et al. Singapore Case series 2 1 NA 25/M No Left Yes Severe (HB Grade 5) NA None None All imaging were unremarkable Oral corticocorticosteroids, valaciclovir and given eye care advice CR
2 NA 34/M No Right Yes Moderate severe (HB Grade 4) NA None None All imaging were unremarkable Oral corticocorticosteroids, valaciclovir and given eye care advice PR
Mackenzie et al. USA Case report 1 1 HTN, T2DM 39/F Yes Bilateral No (after 20 days) NA NA Ageusia, anosmia, headache, myalgias, malaise, and cough Left arm paresthesia, generalized flaccid areflexia, and inability to walk NA Enoxaparin SC, losartan, meperidine IV, antimalarial drug, oral corticosteroids and plasmapheresis PR
Bastola et al. Nepal Case report 1 1 DM 48/M No Left No (after 4 days) Left‐sided facial droop with inability to wrinkle left forehead, raise left eyebrow and left laogphthalmus NA Mild dry cough and hyposmia None HRCT chest: ground‐glass opacity in the right lower lobe Regular insulin and other antidiabetic medications, tear plus drops for dry eyes, and IV corticosteroid Significant improvement with some residual weakness
Hookham et al. UK Case report 1 1 Childhood asthma and HTN 17/M No Right No (after 1.5 months) Right‐sided facial droop with right‐sided facial hypoesthesia NA Fever, diarrhea, vomiting, mild headache, intermittent right‐sided chest pain, myalgia and lethargy, diaphoretic and conjunctival injection (anterior uveitis) Pediatric inflammatory multisystem syndrome, tachycardiac, tachypnea, raised blood pressure, palpitations Brain MRI: minimal increased enhancement of a segment of right CN 7 IV fluids, broad spectrum antibiotics, oral corticosteroids, tocilizumab, amlodipine (for HTN), aspirin and eye drops NA
Khedr et al. Egypt Case report 2 1 None 49/F Yes Left No Right‐sided deviation of mouth and left lagophthalmos NA Fever, dysphagia, and vomiting Flaccid areflexic quadriplegia, hoarseness of voice, and an impaired cough reflex and stock and glove hypoesthesia CT chest: bilateral ground‐glass opacities Plasmapheresis and IVIg Progressive improvement
2 None 55/F Yes Bilateral No Bilateral inability to close eyes, with reduced blinking, inability to whistle, protrude the lips or expose the teeth. NA Fever, cough, and expectoration flaccid areflexic quadriplegia, stock and glove hypoesthesia CT chest: bilateral ground‐glass opacities IVIg CR
Kumar et al. India Case report 1 1 pregnant and PCOS 28/F No Right No Inability to wrinkle right forehead and close right eye, left‐sided deviation of mouth, numbness of the right side of the face and right‐sided drooling NA Fever, dysgeusia, and anosmia Persistently high blood pressure (160/110), generalized weakness NA Oral valacyclovir and oral corticosteroid, insulin (for steroid‐induced DM) with physiotherapy and eye protective measures CR
Aasfara et al. Morocco Case report 1 1 Pregnant 36/F Yes Bilateral Yes Moderate severe (HB Grade 4) protein: elevated; WBC: normal cell count; glucose: normal Vertigo, nausea, and vomiting asymmetric numbness in the lower limbs and left fingers, right sensorineural hearing loss, right vestibular areflexia and nystagmus NA IVIg and IV corticosteroids CR of facial palsy.
Paybast et al. Iran Case report 1 1 HTN 38/M Yes Bilateral Yes Bilateral facial droop, drooling, and slurred speech Glucose: normal; WBC: normal; protein: elevated Band‐like headache, dysphagia, and mild dizziness quadriparesthesia, decrease in all sensation modalities in four limbs affecting the distal parts up to ankle and elbow joints, tachycardia, blood pressure instability NA Plasmapharesis and labetalol (for HTN) No significant improvement
Bigaut et al. France Case report 2 1 None 43/M Yes Right No NA WBC: normal; protein: elevated Cough, anosmia, ageusia, and diarrhea Flaccid paraparesis, generalized areflexia, hypoesthesia, fore limb paresthesia, ataxia, myalgias in legs Chest CT: bilateral ground‐glass opacities; MRI: CN 3, 5, 6, 7, and 8 neuritis IVIg Progressive improvement
2 Obesity 70/M Yes Left No NA WBC: normal; protein: elevated anosmia, ageusia, diarrhea, dyspnea Flaccid tetraparesis, generalized areflexia, forelimb paresthesia Chest CT: bilateral moderate ground‐glass opacities IVIg and physiotherapy No significant improvement.
Ottaviani et al. Italy Case report 1 1 Mild HTN 66/F NA left Yes NA Protein: elevated; rest; normal Acute fatigue, mild fever, and cough Paraplegia, transient pruriginous dorsal rash, initial distal weakness in the upper limbs and diffuse areflexia Lung CT: bilateral ground‐glass opacities IVIg, lopinavir/ritonavir and antimalarial NA
Casas et al. Spain Case report 1 1 vWB 32/M No Left No Moderate severe (HB Grade 4) NA Malaise, fever, dry cough, and headache None Brain MRI: asymmetric contrast uptake in a segment of Left CN7 acetaminophen, metamizole, physiotherapy and ocular hydration CR.
Hutchins et al. USA Case report 1 1 HTN, prediabetes, Class I obesity 21/M Yes Bilateral No Dysarthria, hypogeusia, and facial numbness Protein: mildly elevated; WBC: normal; SARS‐COV: negative Fever, cough, dyspnea, diarrhea, nausea, headache, and sinonasal congestion, dizziness, hypogeusia Tachycardic, bilateral lower extremity weakness, bilateral upper extremity paranesthesia, Grade 4/5 weakness in the deltoids and hip flexors bilaterally, diffuse areflexia Chest X‐ray: increased bilateral air space opacities; brain MRI: abnormal bilateral enhancement of CN 6 and 7, alongside right CN 3 Plasmapheresis Nonsignificant improvement
Abolmaali et al. Iran Case series 3 1 HTN 88/F Yes Left Yes Left lagophthalmos and neck flexion weakness Protein: elevated; rest: normal Fatigue Quadriparesis, low back and thigh pain, impaired proprioception CT: pneumonia with a ground‐glass pattern Plasmapharesis, intubation, corticosteroids, antimalarial and lopinavir/ritonavir No significant improvement.
2 NA 47/M Yes Bilateral No Weakness of neck flexors and dysarthria Protein: elevated; rest: normal Fatigue, dyspnea, and cough Generalized hyporeflexia, urinary retention, quadriparesis, low back pain CT: ground‐glass opacities Plasmapharesis, intubation, corticosteroids, antimalarial and lopinavir/ritonavir Death
3 NA 58/M Yes NA No NA Protein: elevated; rest: normal Progressive dyspnea, dry cough, and dizziness Muscle weakness, gait disturbance and areflexia. CT: ground‐glass opacities Plasmapharesis, IVIg, remdesivir, antimalarial, favipiravir and lopinavir/ritonavir Death
Oke et al. USA Case report 1 1 history of nephrolithiasis 36/M No Right No Moderate severe (HB Grade 4) NA Fever and body aches NA Brain MRI: asymmetric enhancement of the right CN7 Oral valacyclovir, corticosteroid, eye patch and artificial tears Significant improvement
Derollez et al. France Case report 1 1 Overweight 57/F NA Left No NA NA Fatigue, myalgia, chills, and moderate cough NA Chest X‐ray: infiltrates Ocular protection CR
Hasibi et al. Iran Case report 1 1 Class 1 obesity 52/M No Right No Severe (HB Grade 5) NA Fever, malaise, dry cough, and anorexia NA CT: multiple bilateral peripheral ground glass opacities Oral and corticosteroid, favipiravir, remdesivir, arbidol and NSAID CR
Taouihar et al Morocco Case report 2 1 DM, CML 39/M No Right Yes Facial asymmetry, dysarthria, and difficulty chewing NA Dyspnea NA NA Azithromycin, zinc, vitamin C, oral corticosteroid, preventive anticoagulation CR of facial palsy
2 DM, HTN 57/M No Right Yes Dysarthria, facial asymmetry, swallowing disorder, and left‐sided deviation of mouth NA Dyspnea NA NA Azithromycin, zinc, vitamin C, oral corticosteroid, and preventive anticoagulation Significant improvement
Kaplan et al. USA Case report 1 1 DM 48/F No Left No Asymmetric forehead folds, dry eye, inability to raise the left eyebrow and left facial droop NA Fever, chills, headaches, fatigue, myalgia, and weakness NA CT: bilateral ground‐glass opacities Oral corticosteroids, valacyclovir, and doxycycline Significant improvement
Kerstens et al. Belgium Case report 1 1 NA 27/M No Bilateral Yes Severe (HB Grade 5) IgG: elevated; rest: normal Ageusia None MRI: bilateral CN7 contrast enhancement Valaciclovir, artificial tears and oral corticosteroids CR
Kakumoto et al. Japan Case report 1 1 NA 22/M Yes Bilateral No Dysarthria Protein: elevated; rest: normal Fever and dysphagia Tetraparesis, hypesthesia of extremities, dysuria, inability to defecate, dyschezia, sinus arrythmia. Head MRI: bilateral CN7 contrast enhancement IVIG, intubated and managed on a ventilator CR
Al‐Mashdali et al. Qatar Case report 1 1 Atrial septal defect 21/M No Right No NA NA Fever, cough, watery diarrhea, vomiting, conjunctivitis, and abdominal pain Acute myocarditis CT: Bilateral ground‐glass opacities and pleural effusion IV corticosteroids and ocular lubricant Significant improvement
Judge et al. USA Case report 1 1 NA 64/M No Bilateral No Dysarthria and subjective facial paresthesia WBC: elevated; protein: elevated; Glucose: normal Cough, fever, and chills None NA NA Progressive improvement
Tran et al. USA Case report 1 1 DM 42/M Yes Right Yes Right‐sided hypesthesia, dysarthria, diplopia, ptosis, and inability to raise eyebrows or smile protein: elevated; WBC: normal; glucose: elevated None Right lower extremity weakness Chest X‐ray: bibasilar infiltrates; CT: ground‐glass opacities IV corticosteroids, electrolyte replacement for hypokalemia, IVIg, physical, occupational, and speech therapy CR
Silveira et al. Brazil Case report 1 1 DM, HTN 65/M No Left Yes Facial asymmetry, otalgia, and ophthalmoplegia NA Fever, dry cough, and dyspnea Clear left eye proptosis and blindness, otorrhea and complete hearing loss on the left and partial hearing on the right Initial CT: erosion of the anterior wall of the left external ear conduct and left mandible condyle; brain MRI: compression of left CN 2, 3, 4 and 6 IV Meropenem, IV vancomycin, IV Ciprofloxacin, and mastoidectomy Death
Liberatore et al. Italy Case report 1 1 HTN and history of testicular seminoma 49/M Yes Left No NA Glucose: normal; protein: slight elevation; WBC: normal Fever, cough Symmetric weakness in the upper limbs with flaccid tone, reduced tendon reflexes, and respiratory insufficiency; gastroparesis, alternating episodes of tachy‐/bradyarrhythmia, and frequent hypertensive crises) Chest CT: multifocal ground‐glass opacities; Brain MRI: normal Antimalarial, lopinavir/ritonavir, and ceftriaxone NA
Shinde et al. India Case report 1 1 HTN 64/M No Right Yes Severe (HB Grade 5) NA None Macular erythematous rash along zygomatic arch, maxillary and mandibular division of trigeminal nerve Chest X‐ray: normal Eye care, acyclovir, corticosteroid, and methyl cobalamin PR
Ochoa‐Fernández et al. Spain Case report 1 1 None 6/F No Left Yes Moderate (HB Grade 3) NA None None NA Eye protection and oral corticosteroids CR
Zain et al. USA Case report 1 1 None 2/F No Right Yes Right lagophthalmos, ptosis, and drooping of corner of mouth, flattening of the nasiolabial fold, dryness of the eye and tearing Glucose: normal; protein: normal; WBC: normal None EBV coinfection and contact dermatitis Brain MRI: abnormal enhancement of the canalicular segment of right CN7 IV corticosteroids CR
Ribeiro et al. Brazil Case report 1 1 None 26/M No Right No (on 8th day from first onset of symptoms) Right facial weakness NA Cough and fever None Chest CT: multiple bilateral ground‐glass opacities and some superimposed intralobular septal thickening; Brain MRI: enhancement of the right CN7 NA NA
González‐Castro et al. Spain Case series 2 1 Obesity 40/F No Left No (after 2nd day of ward admission) Moderate (HB Grade 3) NA NA None MRI: poorly defined contrast uptake in the left hemifacial/malar subcutaneous region High‐flow oxygen therapy NA
2 DM, smoker and Parkinson's disease patient 65/M No Left No Moderate (HB Grade 3) NA NA None NA High‐flow oxygen therapy NA
Pelea et al. Germany Case report 1 1 HTN, hypothereosis 56/F yes Bilateral No Severe (HB Grade 5) Protein: elevated; glucose: normal; WBC: elevated; SARS‐COV: negative Dry cough, mild fever, and a general weakness Tingling sensation in all fingertips and toes, flaccid tetraparesis, arreflexia and tachycardia Chest CT: leaky infiltrates in the right lower lobe IVIG and Plasmapharesis PR
Karimi‐Galougahi Iran Letter to the editor 1 1 None 60/M No Right No Right‐sided facial nerve palsy, involving mouth, eye, and forehead NA Fever, cough, and dyspnea None Chest CT: ground‐glass opacitiesAbbr Remdesivir, corticosteroid, and oxygen therapy NA

Abbreviations: CR, complete recovery; CT, computed tomography; IVIg, intravenous immunoglobulin; MRI, magnetic resonance imaging; NA, not applicable; PR, partial recovery.