Facial paralysis in children with hypertension.

A child was recently seen in whom a lower motor neurone facial palsy was one of the presenting signs of malignant hypertension. The association between facial paralysis and hypertension was first noted by Moxon in 1869. Although nearly 100 years have elapsed since then, this clinical picture has received little attention. Under the title: 'Apoplexy into Canal of Fallopius' Moxon described a patient with Bright's disease who had a lower motor neurone facial palsy. Dissection of the temporal bone at necropsy disclosed a blood clot in the facial canal. Since that time isolated cases have been reported, and in 1933 Griffith reviewed the published reports, and described 9 patients, ofwhom 3 were children. Clarke and Murphy (1956) reviewed 190 patients with malignant hypertension, and found 8 with isolated cranial nerve palsies; 7 of these had a facial paralysis. In an attempt to assess the incidence of hypertension as a cause of facial palsy we have reviewed all cases of severe hypertension seen at this hospital in the past 10 years, and have also analysed the causes of facial palsy seen during the same period. The possible anatomical sites and pathological causes of this complication are presented below.