Bell’s Palsy as a Late Neurologic Manifestation of COVID-19 Infection

Authors: Ibiyemi O. OkeOlubunmi O. OladunjoyeAdeolu O. OladunjoyeAnish PaudelRyan Zimmerman


Bell’s palsy is acute peripheral facial nerve palsy; its cause is often unknown but it can be triggered by acute viral infection. Coronavirus disease 2019 (COVID-19) infection commonly presents with respiratory symptoms, but neurologic complications have been reported. A few studies have reported the occurrence of facial nerve palsy during the COVID-19 pandemic. We present a case of Bell’s palsy in a 36-year-old man with COVID-19 infection and a past medical history of nephrolithiasis. He presented to the emergency room with a day history of sudden right facial weakness and difficulty closing his right eye four weeks following a diagnosis of COVID-19 infection. Physical examination revealed right lower motor neuron facial nerve palsy (House-Brackmann grade IV). Serologic screen for Lyme disease, human immunodeficiency virus (HIV), and herpes simplex virus (HSV) 1 and 2 were negative for acute infection; however, neuroimaging with MRI confirmed Bell’s palsy. He made remarkable improvement following treatment with a course of valacyclovir and methylprednisolone. This case adds to the growing body of literature on neurological complications that should be considered when managing patients with COVID-19 infection.


Bell’s palsy is an acute peripheral lower motor neuron (LMN) facial nerve palsy leading to weakness on one side of the face without any other neurologic abnormalities on examination. The cause is often unknown; however, herpes simplex virus isoform 1 (HSV 1) and/or herpes zoster virus (HZV) reactivation is thought to be the most likely cause [1]. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the novel virus that causes coronavirus disease 2019 (COVID-19). It was first identified in Wuhan, a city in Hubei province of China, in December 2019.

There are a few theories on the neuropathogenesis of COVID-19, which include the binding of coronavirus to angiotensin-converting enzyme 2 (ACE2) receptors, which are widely distributed on glial cells and neurons [2,3]. Dubé et al. postulated in their study with animal models that there is axonal transport of human coronavirus (HCoV) OC43 protein into the nervous system [4]. These two mechanisms may lead to nerve damage through direct injury, autoimmunity, and ischemia of the vasa nervorum or inflammatory demyelination [5,6].

Facial nerve palsy may be the first presentation of COVID-19 and it may occur within a few days of its diagnosis [7-13]. We present a patient with a unilateral LMN facial nerve palsy four weeks after a diagnosis of COVID-19 infection.

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Bell’s Palsy after second dose of Pfizer COVID-19 vaccination in a patient with history of recurrent Bell’s palsy

Authors: Michael Repajic,a Xue Lei Lai,a Prissilla Xu,b and Antonio Liua,∗



To report a patient with history of recurrent Bell’s Palsy who developed Bell’s Palsy 36 ​h after the administration of the second dose of the Pfizer-BioNTech COVID-19 vaccine.


The patient is a 57-year-old female with past medical history of 3 episodes of Bell’s Palsy. She responded to prednisone treatment and returned to her baseline after each occurrence. Less than 36 ​h following the second dose of the vaccine, the patient developed a left Bell’s Palsy. The facial droop progressed in severity over the next 72 ​h.


Given the expedited production of the vaccine and the novelty associated with its production, there may be information pertaining to side effects and individual response that remain to be discovered. Since both the Moderna and Pfizer Vaccine trials reported Bell’s Palsy as medically attended adverse events, the association between vaccine administration and onset of symptomatic Bell’s Palsy may warrant further investigation.

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Bell’s palsy and SARS-CoV-2 vaccines

Authors: 24 FEB 2021  The Lancet Ozonoff et al.

There is a possible increased risk of developing Bell’s palsy in COVID-19 mRNA vaccine recipients, but the rate was extremely low (7 cases in 40,000 participants vaccinated), and was not statistically significantly different than the rate seen in the placebo recipients. This condition usually self-resolves. Preventing the risk of COVID-19 infection with vaccination greatly outweighs the incredibly small and less severe risk of Bell’s palsy, but this finding signals a potential issue that should be monitored in vaccine recipients moving forward.

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Bell’s palsy following COVID-19 vaccination

Authors: Giuseppe Colella,1Massimiliano Orlandi,2 and Nicola Cirillo1,3

Currently two Coronavirus Disease 2019 (COVID-19) vaccines have been granted emergency use and marketing authorization by the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) [12]. Initial efficacy and safety data for both BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) vaccines have been published [34]. To the best of our knowledge, there is no mention of facial paralysis in the article describing safety and efficacy of the BNT162b2 vaccine [3], however, four such adverse events were eventually highlighted in product monographs published by the relevant regulatory bodies [15]. Although FDA vaccine review memoranda do mention the occurrence of facial paralysis in the test group for both vaccines [12], consumer/patient information sheets of neither of the vaccines distributed in North America warn about Bell’s palsy as a possible adverse effect [6].

Here, we report a case of an otherwise healthy 37-year-old white Caucasian male who developed facial palsy within days after COVID-19 vaccination. We were given written, explicit informed consent to disclose the information reported in this letter. The patient received the first injection of the mRNA Vaccine BNT162b2 on 8th January, 2021, and the following day he developed symptoms including malaise, fatigue, and headache, but not hyperpyrexia. From the 11th, he complained of ingravescent left-sided latero-cervical pain irradiating ipsilaterally to the mastoid, ear, and retro-maxillary region. On 13th January upon awakening, he noticed a marked monolateral muscle weakness and attended the Maxillofacial Unit at our University Hospital. He presented with a left-sided facial droop accompanied by reduced mobility (paresis), with flattening of forehead’s skin and marionette line (labial-buccal sulcus) ipsilaterally as well as mild flattening of the nasolabial fold (Fig. 1). Lagophthalmos and mild labial hypomobility was also recorded. This clinical presentation was accompanied by a moderate Bell’s sign (failure to close the eye on the affected side with exposure of the sclera). No history of trauma, cold or other identifiable triggers was reported and no other signs or symptoms were present. Specifically, no history of a preceding infection, including recent SARS-CoV-2 infection, was reported and there was no evidence of a cutaneous rash suggestive of Herpes Zoster infection. The patient was referred to the Neurology Department with a provisional diagnosis of hemifacial paresis and discharged the same day with a clinical diagnosis of Bell’s palsy—an acute unilateral facial nerve paresis or paralysis with onset in less than 72 h and without identifiable cause [7]. No data are available concerning neurophysiological and cerebrospinal fluid investigations, as these were not deemed essential given that Bell’s palsy is fundamentally a clinical diagnosis and that there is no specific laboratory test to confirm the disorder. Laboratory or other diagnostic tests can surely be useful in excluding other conditions such as Lyme disease (not common in our geographical area) or neuropathies such as Gillian–Barre’ syndrome, or also brain tumors. These are especially useful when clinical presentation is not typical, and hence were not undertaken in our patient.

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Canada adds Bells Palsy warning to Pfizer Vaccine…

Health Canada has updated the label on the Pfizer-BioNTech COVID-19 vaccine to reflect very rare reports of Bell’s Palsy. In very rare scenarios, cases of Bell’s Palsy have been reported in a number of people in Canada and internationally. So far in Canada, “there has been a total of 206 reports of Bell’s Palsy following a Pfizer vaccination,” the health agency told Global News in an email Friday.

Symptoms after vaccination may include temporary weakness or paralysis on one side of the face, according to an advisory issued by the department.

Other symptoms include, “uncoordinated movement of the muscles that control facial expression; loss of feeling in the face; headache; tearing from the eye; drooling; lost sense of taste on the front two-thirds of the tongue; hypersensitivity to sound in one ear; or inability to close an eye on one side of the face,” according to the advisory.

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Biden team’s misguided and deadly COVID-19 vaccine strategy

Vaccination ‘arms race’ could prove dangerous to the American public

Authors: Dr. Robert Malone and Peter Navarro

The Biden administration’s strategy to universally vaccinate in the middle of the pandemic is bad science and badly needs a reboot.

This strategy will likely prolong the most dangerous phase of the worst pandemic since 1918 and almost assuredly cause more harm than good – even as it undermines faith in the entire public health system.

Four flawed assumptions drive the Biden strategy. The first is that universal vaccination can eradicate the virus and secure economic recovery by achieving herd immunity throughout the country (and the world).  However, the virus is now so deeply embedded in the world population that, unlike polio and smallpox, eradication is unachievable. SARS-CoV-2 and its myriad mutations will likely continually circulate, much like the common cold and influenza.

The second assumption is that the vaccines are (near) perfectly effective. However, our currently available vaccines are quite “leaky.” While good at preventing severe disease and death, they only reduce, not eliminate, the risk of infection, replication, and transmission. As a slide deck from the Centers for Disease Control has revealed, even 100% acceptance of the current leaky vaccines combined with strict mask compliance will not stop the highly contagious Delta variant from spreading.

The third assumption is that the vaccines are safe.  Yet scientists, physicians, and public health officials now recognize risks that are rare but by no means trivial.  Known side effects include serious cardiac and thrombotic conditions, menstrual cycle disruptions, Bell’s Palsy, Guillain Barre syndrome, and anaphylaxis.

Unknown side effects which virologists fear may emerge include existential reproductive risks, additional autoimmune conditions, and various forms of disease enhancement, i.e., the vaccines can make people more vulnerable to reinfection by SARS-CoV-2 or reactivation of latent viral infections and associated diseases such as shingles.  With good reason, the FDA has yet to approve the vaccines now administered under Emergency Use Authorization.

The failure of the fourth “durability” assumption is the most alarming and perplexing.  It now appears our current vaccines are likely to offer a mere 180-day window of protection – a decided lack of durability underscored by scientific evidence from Israel and confirmed by  Pfizer, the Department of Health and Human Services, and other countries. 

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