Chimeric antigen receptor (CAR-T) cell therapy is highly effective against hematological
cancers but is associated with immune mediated side effects, including neurotoxicity. The most commonly described presentations of immune cell mediated
neurotoxicity syndrome (ICANS) include cortical symptoms and generally localize to the central nervous system. In this report, we present a patient with acute onset of bilateral facial nerve
palsy following CAR-T cell therapy, followed by a complete clinical recovery. Aside from a temporary
anisocoria, he had no other
neurologic symptoms and no
encephalopathy or
seizures. MRI Brain was non-contributory and cerebrospinal fluid revealed a modest increase in lymphocytes without systemic
leukocytosis and viral studies were all negative. He was diagnosed with bilateral facial nerve
palsy secondary to CAR-T cell therapy and subsequently treated with a course of
steroids. Several weeks after presentation he returned to his neurological baseline. The presentation of CAR-T cell mediated facial nerve
palsy is both clinically and scientifically relevant for physicians, patients, and researchers.