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Teaching NeuroImages: Melkersson-Rosenthal syndrome with permanent bilateral facial weakness


A 56-year-old woman had multiple, alternating attacks of Bell palsy, associated with lower labial edema and dysgeusia. The facial paresis and edema resolved only partially, and over the years she lost the ability to smile and kiss, and developed lacrimation while eating (figure). Otherwise, neurologic examination, dermal examination, and brain MRI and magnetic resonance angiography were unremarkable. Family history was negative. Notable were negative serology for Lyme, sarcoidosis, HIV, and HbA1C elevation. Melkersson-Rosenthal is a rare syndrome presenting with a triad of alternating or bilateral facial weakness, macroglossia, and, less commonly, fissured tongue, with features sometimes permanent.1,2

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