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

10.3966/168232812014062402005

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

周邊型顏面麻痺 ； 貝爾氏麻痺 ； 橋腦出血 ； 高血壓 ； Bell's palsy ； hypertension ； peripheral-type facial palsy ； pontine hemorrhage

台灣家庭醫學雜誌

24卷2期（2014 / 06 / 01）

99 - 106

繁體中文

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。

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.

1. 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
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.
3. Baugh, RF,Basura, GJ,Ishii, LE(2013).Clinical practice guideline: Bell's palsy.Otolaryngol Head Neck Surg,149,S1-27.
4. 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.
5. Clarke, E,Murphy, EA(1956).Neurological manifestations of malignant hypertension.Br Med J,2,1319-26.
6. Fahimi, J,Navi, BB,Kamel, H(2014).Potential misdiagnoses of Bell's palsy in the emergency department.Ann Emerg Med,63,428-34.
7. Finsterer, J(2008).Management of peripheral facial nerve palsy.Eur Arch Otorhinolaryngol,265,743-52.
8. Kanazawa, A,Haginomori, S,Takamaki, A,Nonaka, R,Araki, M,Takenaka, H(2007).Prognosis for Bell's palsy: a comparison of diabetic and nondiabetic patients.Acta Otolaryngol,127,888-91.
9. Lloyd, AVC,Jewitt, DE,Still, JDL(1966).Facial paralysis in children with hypertension.Arch Dis Child,41,292-4.
10. Matsukawa, H,Shinoda, M,Fujii, M,Takahashi, O,Murakata, A(2015).Risk factors for mortality in patients with non-traumatic pontine hemorrhage.Acta Neurol Scand,131,240-5.
11. Oosterveer, DM,Bénit, CP,de Schryver, EL(2012).Differential diagnosis of recurrent or bilateral peripheral facial palsy.J Laryngol Otol,126,833-6.
12. Riga, M,Kefalidis, G,Danielides, V(2012).The role of diabetes mellitus in the clinical presentation and prognosis of Bell palsy.J Am Board Fam Med,25,819-26.
13. Rowland, LP(ed.),Pedley, TA(ed.)(2010).Merritt›s Neurology.Philadelphia:Lippincott Williams & Wilkins.
14. Savadi-Oskouei, D,Abedi, A,Sadeghi- Bazargani, H(2008).Independent role of hypertension in Bell's palsy: a case-control study.Eur Neurol,60,253-7.
15. Semplicini, A,Maresca, A,Boscolo, G(2003).Hypertension in acute ischemic stroke: a compensatory mechanism or an additional damaging factor?.Arch Intern Med,163,211-6.
16. Sherman, SC,Thompson, TM(2005).Pontine hemorrhage presenting as an isolated facial nerve palsy.Ann Emerg Med,46,64-6.
17. Terao, S,Miura, N,Takeda, A,Takahashi, A,Mitsuma, T,Sobue, G(2000).Course and distribution of facial corticobulbar tract fibres in the lower brain stem.J Neurol Neurosurg Psychiatry,69,262-5.
18. Tiemstra, JD,Khatkhate, N(2007).Bell's palsy: diagnosis and management.Am Fam Physician,76,997-1002.
19. Tirodker, UH,Dabbagh, S(2001).Facial paralysis in childhood hypertension.J Paediatr Child Health,37,193-4.
20. Tomek, M,Nandoskar, A,Chapman, N,Gabriel, C(2012).Facial nerve palsy in the setting of malignant hypertension: a link not to be missed.QJM,Jun
21. Toyoda, K,Imamura, T,Saku, Y(1996).Medial medullary infarction: analyses of eleven patients.Neurology,47,1141-7.
22. Trompeter, RS,Smith, RL,Hoare, RD,Neville, BG,Chantler, C(1982).Neurological complications of arterial hypertension..Arch Dis Child,57,913-7.
23. van der Merwe, W,van der Merwe, V(2013).Malignant hypertension: a preventable emergency.NZ Med J,126,39-45.
24. 徐莉萍、張燕良、柯政郁、徐茂銘(1995)。顏面神經麻痺之臨床表現─10年案例之分析。中耳醫誌，30，325-31。
25. 陳建志、陳登郎、劉崇祥、蔡崇豪(2013)。以單側周邊型顏面神經麻痺為表徵之橋腦梗塞─個案報告。台灣老誌，8，47-53。
26. 陳建志、鄒永恩、蔡銘修、陳登郎(2013)。以急性周邊型面神經麻痺為初始表徵之急性下橋腦梗塞。台耳醫誌，48，180-3。
27. 曾淵如(2007)。白袍高血壓─高血壓的重要課題。秀傳醫誌，7，175-82。