Differential Diagnosis for Acute Onset Symmetrical LMN Bifacial Weakness
Single Most Likely Diagnosis
- Guillain-Barré Syndrome (GBS): This is the most likely diagnosis due to its classic presentation of acute onset, symmetrical, and ascending weakness, often including bifacial weakness. GBS is an autoimmune disorder that typically follows a minor infection.
Other Likely Diagnoses
- Myasthenia Gravis: Although more commonly associated with ocular and proximal muscle weakness, myasthenia gravis can present with bifacial weakness, especially in the context of a myasthenic crisis. The weakness is typically fluctuating and worsens with use.
- Lyme Disease (Neuroborreliosis): In endemic areas, Lyme disease can cause a range of neurological symptoms, including facial nerve palsy, which can be bilateral, presenting as bifacial weakness.
- Tick Paralysis: Caused by the neurotoxin from certain tick bites, this condition can lead to ascending paralysis, including facial weakness, which can be bilateral.
Do Not Miss Diagnoses
- Botulism: A potentially life-threatening condition caused by the toxin from Clostridium botulinum. It presents with descending paralysis, starting with cranial nerves, which can include bilateral facial weakness. Prompt recognition is crucial for treatment.
- Diphtheria: Although rare in areas with good vaccination coverage, diphtheria can cause neurological manifestations, including cranial nerve palsies, due to the toxin produced by Corynebacterium diphtheriae.
Rare Diagnoses
- Fisher Syndrome: A variant of Guillain-Barré Syndrome, characterized by the triad of ophthalmoplegia, ataxia, and areflexia. Bifacial weakness can be a part of the presentation.
- Mitochondrial Myopathies: Certain mitochondrial disorders can present with progressive external ophthalmoplegia and other muscle weaknesses, which might include facial muscles, though acute onset would be unusual.
- Congenital Myasthenic Syndromes: These are a group of rare genetic disorders affecting the neuromuscular junction, which can present with fluctuating muscle weakness, including facial weakness, though typically from birth or early childhood.