Neurosyphilis is a rare but reversible cause of ischemic stroke. We report a 41-year-old male with no cardiovascular risk factors initially diagnosed with Bell's palsy for left facial weakness. Four days later, he developed left-sided hemiparesis and dysarthria. Neuroimaging confirmed a right nucleocapsular ischemic stroke. Cerebrospinal fluid analysis revealed pleocytosis (39 cells/µL), elevated protein (191.9 mg/dL), and a reactive VDRL, confirming meningovascular neurosyphilis. Treatment with 14 days of intravenous Penicillin G led to complete clinical recovery after six months. This case highlights "the great imitator" during a global resurgence of syphilis. This clinical evolution highlights how isolated cranial nerve deficits can act as a deceptive precursor to a endarteritis obliterans, masking a systemic infection behind a seemingly benign presentation. In young patients with stroke and no vascular risk factors, neurosyphilis should be considered, particularly when preceded by cranial nerve deficits.

Facial palsy is one of many manifestations of Lyme borreliosis. Data from our 3- year retrospective descriptive cohort quality improvement study suggests an opportunity for improvement between testing practices for Lyme borreliosis-associated facial palsy and Ohio's rising Lyme borreliosis incidence. Provider education regarding Ohio's Lyme borreliosis endemicity is crucial, particularly during peak summer months.

This systematic review and meta-analysis was conducted in accordance with PRISMA guidelines to explore diagnostic errors in peripheral facial palsy in adults and their impact on medical and paramedical care. Four databases were used to collect 303 articles, 23 of which, published between 2015 and 2024, were analyzed using the CARE grid for case studies and the JBI grid for case series. Fifty cases of diagnostic error were identified. A tumor was found to be the cause in 56% of cases that were initially identified as Bell's palsy. The results of this meta-analysis show that symptoms that come on gradually are linked to longer time to diagnosis (P=0.04). Furthermore, time to diagnosis was significantly longer (P=0.04) when the final diagnosis was a tumor. The results also highlight the importance of detailed clinical and medical assessment, particularly for women, who are consistently diagnosed later than men despite presenting the same symptoms. The challenge of diagnosis by exclusion is highlighted by the diversity of etiologies, but is essential before a diagnosis of Bell's palsy can be established. Healthcare professionals must be vigilant in case of atypical developments in peripheral facial palsy, as such cases can be complex and require careful monitoring. Paramedical professionals also play a key role in alerting the medical profession when the progression of the disorder does not correspond to the typical clinical picture.

Patients with post-paralytic facial synkinesis (PPFS) experience a diverse array of neuronal changes from aberrant peripheral neurogenesis to cortical changes. The aim of this review is to utilize a comprehensive search strategy to (1) identify studies using functional magnetic resonance imaging (fMRI) to evaluate PPFS, and (2) synthesize the available evidence for any unifying structural and functional cortical changes which hold promise for future investigation. A search of Pubmed and Embase databases was conducted with a research librarian. Articles were then screened and reviewed independently by two authors. Inclusion criteria specified studies reporting quantitative imaging evaluation of post-paralytic facial synkinesis. Cerebral cortical changes were evaluated using diffuse tensor imaging, task-based, and resting-state fMRI. Specific assessments of sameness (Dice coefficients), transmission patterns (functional anisotropy), synchronization (Voxel-Mirrored Homotopic Connectivity: VMHC), intrinsic activity (Amplitude of Low Frequency Fluctuations: ALFF), and network efficiency (rich-club nodes) were all examined. Of the 359 studies identified, 13 studies met inclusion criteria. The cortical changes observed included diffuse/overlapping activation patterns, impaired interhemispheric communication, structural brain changes, and structural/functional connectivity mismatch. Evidence of cortical reorganization is apparent in post-paralytic facial synkinesis. Maladaptive neuroplasticity is a hallmark of multiple neuropathologic disorders and should be investigated as a future therapeutic target.