Denouement and Discussion
Peripheral Facial Paralysis and Hypertension
The association of peripheral seventh nerve palsy and hypertension was first described in 1869. The paralysis, which is frequently the presenting complaint and is unilateral, occurs simultaneously with the elevation of blood pressure. As the hypertension decreases, the facial paralysis improves. The pathophysiology has not been adequately defined. In the two reported autopsies, hemorrhage into the facial nerve was found and Lloyd et al suggest that this is the etiology in the majority of the cases. Other possible explanations include direct pressure from a thickened vessel or edema secondary to increased intracranial pressure. In one series of 35 children with severe hypertension (defined as a diastolic blood pressure above 120 mm Hg), 20% of the patients had a lower motor neuron facial paralysis.
Treatment consists of determining the underlying cause of the hypertension and its proper medical management.
Gellis SS, Feingold M, Van Pelt JC, Copple PJ. Picture of the Month. Am J Dis Child. 1970;119(1):59-60. doi:10.1001/archpedi.1970.02100050061013