PMC9795040_01
Clinical examination reveals dysfunction of facial nerve and the motor branch of the trigeminal nerve. (A) Bilateral facial weakness and Bell's sign, (B) Limited mouth opening (tried the most effort to open her mouth); (C-E). Multiple lesions in the lower lobe of the right lung; (F-J). Head magnetic resonance imaging was normal.
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Upon admission to our hospital, physical examinations showed dysfunction of the motor branch of the facial and trigeminal nerves ( Figures 1A, B ). CT scan revealed multiple lesions in the lower lobe of the right lung, suggesting lung infection ( Figures 1C-E ). Combining these results with laboratory tests, the patient was diagnosed with M. pneumoniae infection. An X-ray of the mandibular joint and head MRI were normal ( Figures 1F-J ).
EMG reveals that the facial nerve has obvious demyelination and axonal loss. Motor nerve conduction of the bilateral facial nerve (temporal, zygomatic, and buccal branches) is prolonged, and amplitude potentials are decreased. EMG of the bilateral buccinator and orbicularis muscle and the right musculus dormitator show reduced recruitment of motor units with obvious spontaneous activity. Blink reflex R1 and R2 latency is prolonged with a discrete waveform.
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The examination revealed that the bilateral blink reflex and facial nerve presented with remarkable demyelination and axonal loss ( Figure 2 ).