"LIKE A MASK PRESSING ON MY
FACE." ON A PARTICULAR SYMPTOM AMONG THE STABILIZED OUTCOMES OF THE FACIAL
NERVE PARALYSIS.
Renato COCCHI, a neurologist and a medical
psychologist.
(Other two texts on the facial nerve paralysis)
Summary.
This text describes the bilateral feeling
"like of a mask pressing on my face" as a stabilized outcome of the
facial nerve paralysis. The suggestions for a possible understanding of it are
put forwards.
Key words: Facial nerve, paralysis,
stabilized outcome, paresthesia, face, "like a pressing mask."
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At the beginning of a drug therapy for an
atypical depression, in a woman of 54 years, a particular symptom reappeared,
as the feeling of a mask that presses on the face. This is the definition of
this symptom as the same patient said. The same symptom was already reported by
an other girl with so-called "stabilized" outcomes of a posterpetic
paralysis of the facial nerve.
Therefore, I asked the new patient if she
had in past a paralysis of the facial nerve, and I had the confirmation of it.
I wanted to report it in this short note,
because I did not find any mention of it in the consulted literature (Medline
and the search motor Google).
The case history.
Female, of 54 years, married, and clerk.
Beginning of the February 2005. From over
two years she is depressed and anxious, and she is taking a regimen of
triazolam 0.50mg and chlomipramine 75mg (daily doses, by the oral via). For
nearly two years she was well off, but now relapsed in spite of the current
drug therapy.
She tells that she reduced to half the dose
of triazolam, because this drug gets her daze, but anxiety and fear came back.
A particular symptom "as the feeling of a mask pressing on her face,"
inclusive the ears, reappeared. In her opinion, this is a depressive symptom,
but, to my exact question, she answers of having had a right half-face
paralysis of the facial nerve, 12 years before.
At the neurological examination, there were
no other stabilized signs of such a paralysis, but she has a light paresthesia
when she is touching her face, in both sides of it.
Discussion.
The idea of a link between this symptom and
a preceding peripheral paralysis of the facial nerve, came to me because the
preceding patient had used nearly the same words, written by herself. "The
only problem on the facial I have still is that feeling of constraint on my
face, like I had a mask pressing on my face." (Cocchi, 2004).
Between the two cases there are several
differences. In the preceding case it seems the symptom, as a bilateral one,
could derive from a bilateral paralysis of the facial nerve, even if each side
had a different intensity. In this second case the paralysis of the facial
nerve was only in the right side. In the first patient the symptom reappeared
about three years from the initial paralysis, while in this second case it
reappeared even 12 years later.
About certainly in both cases, even if not
very clear in the first of them, the symptom is fluctuating, and reappears in
depressive situations, or perhaps it would be better to speak of stress.
The fact that the symptom is bilateral even
when the paralysis was one-sided, allows different interpretative hypotheses.
We may think that really, at the onset,
there is not an exclusive and clear one-sided paralysis, but in fact also the
other half-face is always involved but in a subclinical way. Against this
hypothesis there is that this symptom unknown, and that during the objective
examination in the acute state comparisons between the two sides of the face
are always done.
The feeling of "a mask that presses on
the face" is only a residual symptom, a stabilized outcome. It is strange
that it not had a report, or, at least, I could not be able to find any
description of it. Having found it 12 years later in a person who not
apparently show other stabilized residual symptoms does however think to an
instability of the nuclei of the facial nerve, to level of the pons Varolii and
the medulla oblongata.
Being a sensitive symptom and not a motor
one, the related nucleus could be the solitary fascicle nucleus that has
already a place in the medulla oblongata. According to Adams and Victor, 1989,
I do not know that this nucleus picks up sensibility of the face skin,
sensibility, among others, elicited by feeling of pressure.
Another curious element is the bilaterality
of the symptom. Is there in some part, a kind of double innervation, as for the
motor component of the nucleus of the facial nerve that controls the superior
part of the face, by receiving bilateral cortical inputs? Or are we dealing
with a phenomenon of mirroring due to a cellular instability of the sensitive
nucleus (What?) related to the supranuclear paralysis, inclining to the
repetition of this instability in the nucleus of the opposite side of the
brain?
This are some problems that this unusual
symptom drives into an account, and on which, by now we can do only hypotheses.
(Other two texts on the facial nerve paralysis)
References.
Adams RD, Victor M.
Principles of Neurology. McGraw-Ill, New york 1989 (Italian translation:
McGraw-Ill Libri Italia, Milano 1992).
Cocchi R. A woman with peripheral bilateral paresis's
followings of the facial nerve from herpetic neuritis, treated by antistress
therapy. 2004, <www.stress-cocchi.net/Other12.htm>
Posted on Internet 21 February 2005.
Copyright by Renato Cocchi, 2005.
Author's address: dr Renato COCCHI, via Rabbeno, 3
42100 Reggio Emilia
renatococchi@libero.it
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