貝爾氏麻痺合併年輕型腦中風－病例報告

Bell's Palsy Combined with Young Stroke: A Case Report

陳建志(Jiann-Jy Chen) ； 王韋竣(Wei-Chung Wang) ； 張馨丰(Hsin-Feng Chang) ； 郭育呈(Yuh-Cherng Guo) ； 陳登郎(Dem-Lion Chen)

《北市醫學雜誌》 12卷1期 (2015/03) Pp. 98-106

https://doi.org/10.6200/TCMJ.2015.12.1.09

摘要

貝爾氏麻痺是國內顏面麻痺最常見的原因，在治療的過程中須留意是否出現其他神經學病症，並要排除同時罹患急性腦中風的可能性。一位40歲男性，有吸菸之習慣，具高血壓和糖尿病之病史，因右側顏面肌肉無力1日而就診。就診時理學檢查顯示右側週邊型顏面麻痺（House-Brackmann面神經分級第3級），尚無其他神經學病症。半日後，患者開始感到右側上肢有點拙力，呈現陽性旋前肌徵候。腦部電腦斷層顯示左側大腦有低密度的病灶，臆斷為左側大腦急性梗塞，美國國家衛生研究院中風評量表評為3分，住院接受口服抗血小板劑及類固醇等保守治療。眨眼反射檢查顯示為右側週邊性顏面麻痺，腦部磁振造影證實是左側大腦急性梗塞。本個案診斷為貝爾氏麻痺合併年輕型腦中風。已知吸菸、高血壓和血中高密度膽固醇值偏低均是年輕型腦中風的危險因子，加上貝爾氏麻痹患者有較高的機會原本就有高血壓或糖尿病，而貝爾氏麻痹可以單獨是引起腦中風的風險因子，故於診治貝爾氏麻痺時，需注意患者是否具有上述危險因子，在往後的半年內，還必須嚴格控制血壓、血糖和血脂，以免同時合併或續發腦中風。

關鍵字

週邊型顏面麻痺 ； 貝爾氏麻痺 ； 眨眼反射測試 ； 大腦梗塞 ； 年輕型腦中風

並列摘要

Bell's palsy contributes to most facial palsies in Taiwan. A delicate examination of neurologic focal signs should be conducted to exclude coincident possibility of brain infarction. A 40-year-old man with cigarette smoking habit and history of hypertension and diabetic mellitus came to seek medical helps because of right facial muscle weakness which had persisted for the whole day. Physical examination showed right peripheral-type facial palsy (House- Brackmann Facial Nerve Grading III) rather than other neurologic focal signs. But half day later, his right upper limb became a little clumsy, having a positive pronator sign. Brain computed tomography demonstrated a hypodense lesion at left cerebrum and acute left cerebral infarction was impressed. The patient scored 3 on the National Institutes of Health Stroke Scale. He was hospitalized and conservatively treated with oral antiplatelet and steroid. The blink reflex test indicated a right peripheral-type facial palsy. Further brain magnetic resonance imaging demonstrated an evidence of acute left cerebral infarction. He was diagnosed with Bell's palsy combined with young stroke. Cigarette smoking, hypertension and low high-density-lipoprotein cholesterol are known risk factors of young stroke. Patients with Bell's palsy have higher risk of preexisting hypertension or diabetic mellitus, but Bell's palsy is also an independent risk of stroke. The risk factors mentioned above should be concerned when treating patients with Bell's palsy, and blood pressure, blood sugar and blood lipid should be stringently controlled over the following half year to prevent coincident or following brain infarction.

並列關鍵字

peripheral-type facial palsy ； Bell's palsy ； blink reflex test ； cerebral infarction ； young stroke