一病例報告：周邊型顏面麻痺和第3期高血壓

Peripheral-type Facial Palsy and Stage 3 Hypertension: A Case Report

陳建志(Jiann-Jy Chen) ； 張馨丰(Hsin-Feng Chang) ； 陳登郎(Dem-Lion Chen)

《台灣家庭醫學雜誌》 24卷2期 (2014/06) Pp. 99-106

https://doi.org/10.3966/168232812014062402005

摘要

一54歲男性，有吸菸之習慣，具高血壓之病史，因右側顏面肌肉無力1日而就診。來診時高血壓為193/129 mmHg，再確認後為207/130 mmHg。理學檢查顯示右側周邊型顏面麻痺（House-Brackmann面神經分級第4級），尚無其他神經學病症或徵候。然而，腦部電腦斷層顯示右側橋腦有一低密度的區域，磁振造影證實僅是血管旁空間，但是，梯度迴訊時序T2*權重影像顯示右側上橋腦有陳舊性的出血。本個案之週邊型顏面麻痺傾向是貝爾氏麻痺所致或與第3級高血壓有關。貝爾氏麻痺是國內顏面麻痺最常見的原因，但在診治時，需注意患者是否同時具有心血管疾病或是腦出血的風險因子，不要忽略相關的風險告知或密切追蹤。

關鍵字

周邊型顏面麻痺 ； 貝爾氏麻痺 ； 橋腦出血 ； 高血壓

並列摘要

A 54-year-old male smoker with hypertension presented with right-sided facial muscle weakness for one day. At emergency, his blood pressure values were respectively 193/129 mmHg and 207/130 mmHg at initital and re-measurement. Physical examination showed right peripheral-type facial palsy (House-Brackmann Facial Nerve Grading IV) with no presence of other neurologic focal symptoms or signs. However, brain computed tomography identified in the right pons a hypodense lesion, which was later confirmed to be a perivascular space (Virchow-Robin space) as indicated by the magnetic resonance image. Gradient echo T2* weighted image, on the other hand, showed the trace of remote hemorrhage in the right upper pons. Based on the examination results, the right peripheral-type facial palsy appeared to be either attributable to Bell's palsy or associated with stage 3 hypertension. Although Bell's palsy contributes to most facial palsies in Taiwan, a potential brain organic lesion should be considered if a patient has any risk factor of cardiovascular disease or brain hemorrhage; the patient needs to be duly informed of related risks and follow-up shold be initiated withhout hesitation.

並列關鍵字

Bell's palsy ； hypertension ； peripheral-type facial palsy ； pontine hemorrhage

參考文獻

Moxon M: Apoplexy into canal of Fallopius in a case of Bright's disease causing facial paralysis. Trans Path Soc London 1869; 20: 420-2

Agarwal, R,Manandhar, L,Saluja, P,Grandhi, B(2011).Pontine stroke presenting as isolated facial nerve palsy mimicking Bell's palsy: a case report.J Med Case Rep.5,287.

Baugh, RF,Basura, GJ,Ishii, LE(2013).Clinical practice guideline: Bell's palsy.Otolaryngol Head Neck Surg.149,S1-27.

Chiang, CE,Wang, TD,Ueng, KC(2015).2015 Guidelines of the Taiwan Society of Cardiology and the Taiwan Hypertension Society for the Management of Hypertension.J Chin Med Assoc.75,1-47.

Clarke, E,Murphy, EA(1956).Neurological manifestations of malignant hypertension.Br Med J.2,1319-26.