Hypertension Presenting As Bell's Palsy In Children
Description
Abstract
Background Bell’s palsy is a rare symptom of hypertension. We describe a case of childhood hypertension of underlying renovascular etiology presenting as recurrent Bell’s palsy.
Case Presentation A 2-year-old male was admitted to hospital for severe hypertension. His solepresenting symptom was recurrent episodes of 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.
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References
- 1. Lorch M, Teach SJ. Bell's palsy: etiology and approach to diagnosis and treatment. Pediatric Emergency Care. 2010; 26(10):763-769; quiz 70-73.
- 2. Pavlou E, Gkampeta A, Arampatzi M. Bell's palsy in childhood. Brain & Development. 2011; 33(8):644-650.
- 3. Riordan M. Investigation and treatment of facial paralysis. Arch Dis Child. 2001; 84(4): 286-288.
- 4. Paine RS. Facial paralysis in children; review of the differential diagnosis and report of ten cases treated with cortisone. Pediatrics. 1957; 19(2): 303-316.
- 5. Lloyd AV, Jewitt DE, Still JD. Facial paralysis in children with hypertension. Arch Dis Child. 1966; 41(217): 292-294.
- 6. Siegler RL, Brewer ED, Corneli HM, Thompson JA. Hypertension first seen as facial paralysis: case reports and review of the literature. Pediatrics. 1991; 87(3): 387-389.
- 7. Riley M, Bluhm B. High blood pressure in children and adolescents. American Family Physician. 2012; 85(7):693-700.
- 8. Brady TM, Feld LG. Pediatric approach to hypertension. Seminars in Nephrology. 2009; 29(4): 379-388.
- 9. Meyers K, Falkner B. Hypertension in children and adolescents: an approach to management of complex hyper-tension in pediatric patients. Current Hypertension Reports. 2009; 11(5): 315-322.
- 10. Fommei E, Ghione S, Hilson AJ, et al. Captopril radionuclide test in renovascular hypertension: a European multicentre study. European Multicentre Study Group. European Journal of Nuclear Medicine. 1993; 20(7): 617-623.
- 11. Chaves AA, Buchpiguel CA, Praxedes JN, Bortolotto LA, Sapienza MT. Glomerular filtration rate measured by (51)Cr-EDTA clearance: Evaluation of captopril-induced changes in hypertensive patients with and without renal artery stenosis. Clinics. 2010; 65(6): 607-612.
- 12. Thomas CA, Moffett BS, Wagner JL, Mott AR, Feig DI. Safety and efficacy of intravenous labetalol for hypertensive crisis in infants and small children. Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2011; 12(1): 28-32.
- 13. Chandar J, Zilleruelo G. Hypertensive crisis in children. Pediatr Nephrol. 2012; 27(5): 741-751.
- 14. Wong H, Hadi M, Khoury T, Geary D, Rubin B, Filler G. Management of severe hypertension in a child with tuberous sclerosis- related major vascular abnormalities. J Hypertens. 2006; 24(3): 597-599.