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Alternating facial paralysis in a girl with hypertension: case report

Özlem Bağ, Utku Karaarslan, Sezer Acar

    Archivos Argentinos De Pediatria
    |November 8, 2013
    PubMed

    Insights

    Pediatricians may misdiagnose Bell's palsy in children. This case highlights recurrent facial palsy as a symptom of hypertension, emphasizing the need for blood pressure checks before steroid treatment.

    Area of Science:

    • Pediatric Neurology
    • Cardiology
    • Ophthalmology

    Background:

    • Bell's palsy is the most common cause of unilateral facial nerve palsy in children.
    • Diagnosis often involves excluding less common causes like infections, trauma, malignancy, and hypertension.
    • Pediatricians may default to diagnosing idiopathic Bell's palsy in cases of acquired facial weakness.

    Observation:

    • An eight-year-old girl presented with recurrent and alternating facial palsy.
    • This was the initial symptom of systemic hypertension.
    • She received steroid treatment without prior blood pressure measurement, potentially exacerbating her hypertension.

    Findings:

    • Recurrent and alternating facial palsy can be an early sign of systemic hypertension in children.
    • Steroid treatment for presumed Bell's palsy can worsen underlying, undiagnosed hypertension.
    • Failure to measure blood pressure can lead to inappropriate treatment and adverse outcomes.

    Implications:

    • Clinicians must consider systemic hypertension as a cause of facial palsy in children, especially with recurrent or alternating patterns.
    • Measuring blood pressure is crucial before initiating steroid therapy for suspected Bell's palsy.
    • A broader differential diagnosis for acquired facial palsy in pediatric patients is essential.

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