以急性單側聲帶麻痺為初始表徵之外側延髓梗塞

Acute Unilateral Vocal Palsy as an Initial Presentation of Lateral Medullary Infarction

陳建志(Jiann-Jy Chen) ； 陳亮宇(Liang-Yu Chen) ； 張馨丰(Hsin-Feng Chang) ； 鄒永恩(Yung-An Tsou) ； 陳登郎(Dem-Lion Chen)

《台灣耳鼻喉頭頸外科雜誌》 50卷3期 (2015/09) Pp. 181-185

https://doi.org/10.6286/2015.50.3.181

摘要

腦梗塞所致之聲帶麻痺最常與外側延髓梗塞（lateral medullary infarction）（Wallenberg氏症候群）有關（45.5%），其次是小孔狀梗塞（lacunar infarction）（36.4%）。外側延髓梗塞一開始就以單側聲帶麻痺為表徵者，目前在英文文獻中僅有兩例個案報告，而國內文獻尚無人報告過。一64歲女性，罹患糖尿病已經5年，在右半邊中度搏動性頭痛半日後，突發聲音沙啞合併氣息聲急診於本院，理檢發現右側聲帶麻痺，腦部電腦斷層無異常發現。半日後，開始出現吞嚥困難、飲水嗆食及眩暈，腦部磁振造影證實是右方外側延髓的急性梗塞，隨即收治住院接受點滴輸液及口服抗血小板劑治療，並建議鼻胃管灌餵食以避免吸入性肺炎。因此，在診療急性單側聲帶麻痺時，需先設法排除Ortner氏症候群（胸主動脈剝離或心包膜填塞所致）、顱內動脈瘤…等會致命的疾病，亦須留意是否有其他神經學病症出現，畢竟仍有可能是外側延髓梗塞的早期症狀。

關鍵字

單側聲帶麻痺 ； 外側延髓梗塞 ； Wallenberg氏症候群 ； 眩暈 ； 運動失調

並列摘要

Stroke with vocal palsy has been most often attributable to lateral medullary infarction (45.5%), and the next, lacunar infarction (36.4%). There were only two case reports of acute unilateral vocal palsy as one initial presentation of lateral medullary infarction in the English literature; however, such a case is not reported in the Taiwanese literature. A 64-year-old woman has suffered diabetic mellitus for 5 years. She presented with half-day right moderate pulsatile headache followed by sudden breathy hoarseness. Physical examination demonstrated right vocal palsy and brain computed tomography showed unremarkable. However, dysphagia, water choke and vertigo occurred half day later. Brain magnetic resonance imaging demonstrated acute lateral medullary infarction. She was afterward hospitalized for intravenous fluid supportive treatment and oral antiplatelet therapy; besides, she also received nasogastric tube feeding diet to prevent aspiration pneumonia. As a sequence, it is recommendatory to exclude the possibility of Ortner syndrome (thoracic aortic dissection or cardiac tamponade), intracranial aneurysm or other morbid disease when we treat acute unilateral vocal palsy. Furthermore, it is also recommendatory to look out any neurologic focal sign because acute lateral medullary infarction is possible.

並列關鍵字

unilateral vocal palsy ； lateral medullary infarction ； Wallenberg syndrome ； vertigo ； ataxia