Sixty-two patients with acute idiopathic peripheral facial nerve
palsy (AIPFP) and 31 patients with lymphocytic meningoradiculitis (Garin-Bujadoux or Bannwarth's syndrome) are described. Results of cerebrospinal fluid (CSF) analysis, including the measurement of
immunoglobulins (Ig) G, A, and M, indicate that
pleocytosis and/or disturbance of the blood-CSF barrier (BCB) and/or local
immunoglobulin synthesis within the central nervous system (CNS) do occur in about 25% of patients with AIPFP. The commonest finding is a slight to moderate breakdown of BCB function without evidence of intrathecal
immunoglobulin synthesis. In only about 10% of patients, further support for an inflammatory process within the CNS is found by intrathecal synthesis of
oligoclonal IgG and/or localized synthesis of
IgG and/or
IgA. The majority of cases (75%) do not show any signs of an inflammatory process within the CNS. In contrast, lymphocytic meningopolyradiculitis (LMR) has a characteristic CSF profile with early impairment of BCB permeability as well as with rapid and predominant intrathecal
IgM synthesis, which helps to distinguish monosymptomatic LMR from AIPFP. By applying a sensitive
enzyme-linked
immunosorbent assay to identical concentrations of
IgG in serum and CSF, evidence of intrathecal synthesis of virus-specific
antibodies was found only in 2 of 13 patients with AIPFP. In contrast, all 4 patients with
herpes zoster oticus and peripheral
facial palsy (
Ramsay Hunt syndrome) showed an intrathecal
IgG synthesis to varicella zoster virus lasting for up to 4 months after onset of disease.