Isolated Recurrent Palatal Palsy in a Child

Sir,

To our knowledge, as we said in 1998 [[4]], isolated and benign recurrent palatal palsy has not been reported in children or in adults so far. We report a child with recurrent glossopharyngeal nerve palsy. Benign and isolated glossopharyngeal nerve palsy is a rare condition in children. A few cases were reported on [[2], [4], [7]].

A 5-year-old boy presented during a febrile illness with nasal speech, regurgitations of fluids to the nostrils, and dysphagia for solids. There was no specific clinical history. The onset of his disorder was sudden. On examination, there was an isolated right pharyngeal and palatal paralysis. No treatment was given. After one week, the symptoms progressively disappeared and there was total recovery three weeks later.

At the age of 6, our patient had the same clinical presentation with sudden onset, 11 months after the first episode. There was no recent febrile or infectious history. The examination was normal except for the right glossopharyngeal nerve paralysis. Etiologic research made in recurrent facial nerve palsy suggested a number of the investigations [[5]]. White blood count, erythrocyte sedimentation rate, C-reactive protein, complement, antinuclear antibodies, thyroid hormones, and angiotensin converting enzyme were normal. Our patient received 1 mg/kg/day of prednisolone during 7 days.

At the age of 7, our patient did not have any neurological symptoms. Clinical examination was normal. MRI of the brain did not show any abnormality. Accessory salivary gland biopsy was normal.

Isolated palatal palsy, sudden onset without specific medical history suggest an isolated and benign glossopharyngeal palsy in our patient. The course of each event had those features.

Transient and isolated palsy of a cranial nerve in childhood is well recognized. Facial nerve or Bell's palsy, sixth-nerve palsy [[3]], and palatal palsy [[4]] were already published. A transient unilateral twelfth-nerve palsy has been reported in 2 children with infectious mononucleosis [[3], [8]]. Uncommonly, idiopathic recurrent cranial nerve palsies may occur. It was even reported for the sixth cranial nerve [[1]] and the seventh cranial nerve [[5]]. Five patients with benign recurrent abducens palsy were reported by Afifi et al [[1]]. In these cases, they suggested idiopathic common features: spontaneous recovery, ipsilateral recurrence, and painless palsy. Immunization or viral infections were suggested to be a possible etiology. Recurrent facial nerve palsy was usually benign and the etiology was unknown. The estimated incidence was 6 % of facial nerve palsy and was comparable to that in adults [[5]]. In these cases, Melkersson-Rosenthal syndrome should be considered. Benign recurrent cranial nerve palsy seems to be an exclusion etiology.

In our case, complete recovery, the absence of neurological abnormality, and recognizable etiology since the second episode suggest that recurrent palatal nerve palsy could exist like other benign recurrent cranial nerve palsies. In case of palatal recurrent palsy, we recommend attentive neurological examination, biological exams, and MRI of the brain to rule out organic etiology of the glossopharyngeal nerve involvement. In the absence of abnormalities, our case suggests the possible benign recurrence of palatal palsy.

References

• 1 Afifi A, Bell W, Bale J, Thompson H. Recurrent lateral rectus palsy in childhood.  Pediatr Neurol. 1990;  6 315-318
• 2 Aubergé C, Ponsot G, Gayraud P, Bouygues D, Arthuis M. Les hémiparalysies vélopalatines isolées et acquises chez l'enfant.  Arch Fr Pediatr. 1979;  36 283-286
• 3 Cohen H, Nussinovitch M, Ashkenazi A, Staussberg R, Kaushansky A. Benign abducens nerve palsy of childhood.  Pediatr Neurol. 1993;  9 394-395
• 4 Cuvellier J C, Cuisset J M, Nuyts J P, Vallée L. Acquired and isolated asymmetrical palatal palsy.  Neuropediatrics. 1998;  29 324-325
• 5 Eidlitz-Markus T, Gialai A, Mimouni M, Shuper A. Recurrent facial nerve palsy in paediatric patients.  Eur J Pediatr. 2001;  160 659-663
• 6 Parano A, Giuffrida S, Restivo D, Saponara R, Greco F, Trifiletti R R. Reversible palsy of the hypoglossal nerve complicating infectious mononucleosis in a young child.  Neuropediatrics. 1998;  29 46-47
• 7 Roberton D M, Mellor D H. Asymmetrical palatal paresis in childhood: a transient cranial mononeuropathy?.  Dev Med Child Neurol. 1982;  24 842-849
• 8 Wright G, Lee K. An isolated right hypoglossal nerve palsy in association with infectious mononucleosis.  Postgrad Med J. 1980;  56 185-186