Facial Nerve Palsy

Division of Emergency Medicine, Children's National Medical Center, Washington, DC, USA.
Pediatric emergency care (Impact Factor: 1.05). 10/2010; 26(10):763-9; quiz 770-3. DOI: 10.1097/PEC.0b013e3181f3bd4a
Source: PubMed


Facial nerve palsy has a broad differential diagnosis and possible psychological and anatomical consequences. A thorough investigation must be performed to determine the cause of the palsy and to direct treatment. If no cause can be found, therapy with prednisone with or without an antiviral medication can be considered and begun as early as possible after onset of symptoms. Resolution and time to recovery vary with etiology, but overall prognosis is good.

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    ABSTRACT: Background Facial nerve palsy is a rare symptom of hypertension. We describe a case of childhood hyper-tension of underlying renovascular etiology presenting as recurrent facial nerve palsy. Case Presentation A 2-year-old male was admitted to hospital for severe hypertension. His solepresenting symptom was recurrent episodes of facial nerve palsy (7 times over a period of 15 months), previously diagnosed as Bell’s palsy.) The elevated blood pressure was noted incidentally during anaesthesia assessment for magnetic resonance imaging of the brain. He was otherwise healthy, and had not had blood pressure measuremented during assessments prior to hospitalilization. On admission, blood pressure was 220/120 mm Hg, with evidence for moderate concentric left ventricular hypertrophy indicating both a chronic process and end organ damage from his hypertension. The patient’s blood pressure was initially managed with labetalol and nitroprusside, and later he was converted to enalapril (0.5 mg/kg/day), amlodipine (0.5 mg/kg/day), minoxidil (0.625 mg/kg/day) and metoprolol (2.5 mg/kg/day). A duplex right kidney with stenosis of the cranial of the two renal arteries was diagnosed using 99mTc MAG3 scintigraphy with ACE inhibitor, Doppler renal ultrasound and MR angiography.) The patient is awaiting angiography for further management while being normotensive on the medications named above. Conclusions Any child presenting with facial nerve palsy should have an accurate blood pressure measured. Facial nerve palsy can be the sole presenting symptom of an underlying hypertensive condition. Properly identifying this rare etiology ultimately changes and optimizes patient management.
    The Open Inflammation Journal 2(1):61.

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    ABSTRACT: The clinical significance of facial palsy hinges on its psychosocial consequences. While its causes are very numerous, several infections account for a majority of cases: Lyme disease, geniculate zoster (Ramsay Hunt syndrome), while the role of HSV-1 in essential (Bell's) palsy remains controversial. Essentials of facial palsy management are discussed, including the importance of the functional grading of palsy, the complexity of Lyme disease serological diagnosis, and its treatment using doxycycline, antiviral and steroids treatment of geniculate zoster, while regarding essential facial palsy, only steroids, but not antiviral have been shown to improve functional recovery.
    Revue médicale suisse 10/2011; 7(311):1901-7.
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