Residency Training: Bilateral facial nerve palsies after a suicide attempt by hanging

摘要

A 56-year-old woman presented with bilateral facial paralysis. Two days before, she had attempted to hang herself. Immediately after the event, her husband noted that her facial expressions had changed but it was not until 2 days later that she was brought to the hospital after she failed to improve. Examination revealed a ligature mark from the anterior neck to bilateral postauricular areas (figure 1, A) and bilateral peripheral facial palsies (figure 1, B). Brain MRI showed no hypoxic damage. Testing of the blink reflex showed bilateral efferent pathway defects (figure 2). The extratemporal segment of the facial nerve originates at the stylomastoid foramen and passes through the parotid gland.(1) In our patient, compression provoked by the ligature over the extratemporal segment of the facial nerves just outside the stylomastoid foramen may have led to regional ischemia.