Introduction
Facial Nerve palsy is a neurological condition in which the function of the facial nerve is partially or completely impaired. The most common presentation is unilateral with an incidence of around 25 per 100,000 population, of which about 70% can be attributed to Bell’s palsy [1]. Lower motor neuron (LMN) facial diplegia represents a very small portion (about 2%) of all facial nerve palsy cases. Facial diplegia has an incidence of 1 per 5,000,000 population. The etiologies of this diplegia include Bell’s palsy, Guillain-Barré syndrome (GBS), idiopathic cranial neuropathies, Lyme disease, sarcoidosis, brainstem encephalitis, Miller Fisher syndrome, idiopathic intracranial hypertension, intracranial tumors, Syphilis, Hansen’s disease, cryptococcal meningitis with acquired immunodeficiency syndrome and tuberculous meningitis [2]. One study of 43 patients with bilateral facial nerve palsy showed that ten cases were attributed to Bell’s palsy and five were due to GBS [3]. There are several variants of GBS and among these, facial diplegia with paresthesia is a rare variant. It is characterized by simultaneous facial diplegia, distal paresthesia and minimal or no motor weakness. In defining facial diplegia, it is simultaneous if both sides are involved within 30 days of the initial onset of unilateral facial paralysis [4]. We present a unique case of a young man with sudden-onset isolated bilateral facial diplegia as an atypical presentation of Guillain-Barré Syndrome.