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LETTER TO EDITOR
Year : 2011  |  Volume : 1  |  Issue : 1  |  Page : 83-84

Severe systemic hypertension presenting with infranuclear facial palsy


Department of Medicine and Otolaryngology, Jawahar Lal Nehru Medical College, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India

Date of Web Publication11-Mar-2011

Correspondence Address:
Sunil Kumar
Department of Medicine, Jawahar Lal Nehru Medical College, DMIMS (DU), Sawangi, Meghe, Wardha, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0738.77540

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How to cite this article:
Kumar S, Jain S, Diwan S K, Mahajan S N. Severe systemic hypertension presenting with infranuclear facial palsy. Int J Nutr Pharmacol Neurol Dis 2011;1:83-4

How to cite this URL:
Kumar S, Jain S, Diwan S K, Mahajan S N. Severe systemic hypertension presenting with infranuclear facial palsy. Int J Nutr Pharmacol Neurol Dis [serial online] 2011 [cited 2019 Oct 13];1:83-4. Available from: http://www.ijnpnd.com/text.asp?2011/1/1/83/77540

Sir,

Infranuclear facial palsy is a very common problem that involves the paralysis of any structure innervated by the facial nerve. The most common cause is Bell's palsy (>80%), an idiopathic disease that may only be diagnosed by exclusion, with the highest incidence in the 15-45-year-old age group. [1] Focusing on specific diseases underlying infranuclear facial palsy, diabetes is the best known one. Regarding hypertension's independent role, acceptable studies are hardly available, with only few case reports that are available mainly in children. Here, we report a case of a 60-year-old lady who presented with right side lower motor neuron palsy as the initial manifestation of severe hypertension. Her blood pressure was 190/110 mmHg right arm supine and 186/116 mmHg on standing at the time of presentation. She was not a known case of hypertension and diabetes mellitus, which were neither present in her family. She had post-auricular pain resembling that of acute mastoiditis. There was no history of ear discharge, fever, or trauma to the head. On examination, she had right infranuclear facial palsy. Other systemic examinations were normal. There were no vesicles around the ear. She had superficial tenderness over the mastoid region. On otoscopic examination of the right ear, the tympanic membrane and external auditory canal were normal. There was no neurological deficit. Fundus examination revealed a soft exudate without the evidence of hemorrhage and papilledema. Her investigation revealed Hb 11 gm/dl, serum creatinine 1 mg/dl, blood urea 38 mg/dl, and serum potassium 4.2 mEq/l. Her fasting blood sugar was 96 mg/dl and post-prandial glucose was 138 mg/dl. Lipid profile and urine examination were normal. There was no proteinuria. Chest X-ray and electrocardiogram did not reveal any evidence of left ventricular hypertrophy . An ultrasound examination of the abdomen showed normal right and left kidney, with no suprarenal masses, and Doppler studies suggested good bilateral flow in the renal arteries. Computed tomography of the brain was within normal limits, without any evidence of mastoiditis. The association of facial palsy and hypertension was first described as early as 1869. [2] Incidence of facial paresis in severe hypertension has been reported to be 3-17%, mainly in young children. [3] The non-awareness of this association at presentation may cause serious medical errors and result in delays in the diagnosis of hypertension, which may worsen with corticosteroid therapy. Physiological theories to explain the relationship between facial paralysis and hypertension have been published in few literatures.[4],[5] Although the true etiology remains unknown, there seems to be an adequate explanation to support a probable association between hypertension and facial palsy. Small hemorrhages into the facial canal (just like retinal hemorrhage) and neural partial necrosis may be a possible explanation. [5] Increased vascular pathology at higher ages explains the association present at higher ages. Any of the above explanations or some other unknown mechanisms may explain the association of hypertension and facial palsy, although based on these case findings we may not accept or reject any, and further research is needed. Researchers should be very cautious when declaring an independent role of hypertension in the etiology of facial palsy.

 
   References Top

1.Peitersen E. Bell's palsy: The spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002;549:4-30.  Back to cited text no. 1
    
2.Lloyd AV, Jewitt DE, Lloyd Still JD. Facial paralysis in children with hypertension. Arch Dis Child 1966;41:292-4.  Back to cited text no. 2
    
3.Aynaci FM, Sen Y. Peripheral facial paralysis as initial manifestation of hypertension in a child. Turk J Pediatr 2002;44:73-5.  Back to cited text no. 3
    
4.Daryoush SO, Ali A, Homayoun SB. Independent Role of Hypertension in Bell's palsy: A case-control study. Eur Neurol 2008;60:253-7.  Back to cited text no. 4
    
5.Bademosi O, Ogunlesi TO, Osuntokun BO. Clinical study of unilateral peripheral facial nerve paralysis in Nigerians. Afr J Med Med Sci 1987;16:197-201.  Back to cited text no. 5
    



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