Malignant hypertension may present a clinical picture strongly suggesting a mass lesion of the brain, with headache and choked disk as the outstanding symptoms in each condition. This was emphasized by Pepper1 in 1931, who also pointed out that occasionally paralysis of a cranial nerve, usually the facial nerve, added to the confusion. Pepper quoted three such cases from the literature, but offered no suggestion as to the method by which the arteriolar changes of malignant hypertension produce the facial paralysis.
Soon after Pepper's publication there appeared in the wards of the University Hospital a patient with typical malignant hypertension recovering from a right peripheral facial palsy and giving a history of a similar palsy one year previously. Uncertainty as to the mode of production of the facial palsy suggested the advisability of reviewing available cases, and of considering various hypotheses. With that thought in mind, the present case
GRIFFITH JQ. INVOLVEMENT OF THE FACIAL NERVE IN MALIGNANT HYPERTENSION. Arch NeurPsych. 1933;29(6):1195-1202. doi:10.1001/archneurpsyc.1933.02240120018002