Two pediatric cases of facial palsy caused by intracranial disease

We report two pediatric cases of facial palsy caused by intracranial disease, and review 54 facial palsy patients under 12 years old who were admitted to Kurashiki Central Hospital between January 1991 and January 2002. Previously reported cases, congenital palsy patients and traumatic palsy patients were excluded from review. Case 1 was a 2-year-old girl, who was hospitalized due to left facial palsy. MRI revealed a well-enhanced mass both in the cerebellopontine (CP) angle and the spinal cord. The tumor in the spinal cord was pathologically diagnosed as an atypical teratoid-rhabdoid tumor, which probably caused metastasis from the CP angle to the spinal cord. Case 2 was a 5-year-old girl, who was admitted to the hospital with right facial palsy. At 3 years old, she developed right facial palsy but recovered one month later. At 4 years old, right arm and right leg palsy occurred, but recovered. MRI revealed arteriovenous malformation in the parietal lobe. Of 54 cases reviewed, 35 patients were diagnosed as having idiopathic palsy (Bell's palsy), 11 as having viral infection, 7 as having otogenic disorder, 1 as having neoplasm. We were able to follow 42 cases over a prolonged period. Of these 42 cases, 39 cases recovered, and 3 cases did not recover. Facial palsy in children is considered to have a good prognosis, but it may be the initial manifestation of a life-threatening disorder such as intracranial vascular malformation or neoplasm. When neurologic findings in addition to facial palsy are manifested or suspected, it is important to search for an intracranial lesion. MRI is a very useful method of evaluating intracranial disease.