Acute Isolated Central Facial Palsy as Manifestation of Middle Cerebral Artery Ischemia
Sands KA, Shahripour RB, Kumar G, Barlinn K, Lyerly MJ, Haršány M, Cure J, Yakov YL, Alexandrov AW, Alexandrov AV. J Neuroimaging. 2016 Apr 8. doi: 10.1111/jon.12338
This retrospective study coming from Sands et al. highlights the incidence of acute isolated central facial palsy as manifestation of Middle Cerebral Artery Ischemia. The authors evaluated retrospectively a record of overall 2.202 patients, that presented with an acute middle cerebral artery ischemia from 2008-2012 in their Stroke Centre.
According to this study, 879 patients (35%) had NIHSS score 3 points (mean age 63±15 years, 46 % women), while only 9 patients (0.4%) presented with I-CFP ± dysarthria. It is interesting that among these 9 patients, only 1 had a lesion in the corona radiata and patent MCA, 1 had a pontine lesion without proximal vessel occlusion (2/9, or 22%), while the remaining 7 patients (78%) had flow-limiting thromboembolic mid-to-distal M1/proximal M2 MCA disease. A closer look into the results reveals that among the remaining 7 patients, 6 (86%) patients had a prominent early anterior temporal artery on MRA and non-lacunar ischemic lesions on MRI.
The main take-home message of this study is that contrary to current teaching of lesion localization for an I-CFP, the majority of acute patients presenting with this symptom may have an evidence of flow-limiting thromboembolic MCA disease rather than a lacunar lesion. The above results underscore the essential role of comprehensive vascular imaging in patients presenting with I-CFP.