神经电生理检测在Bell麻痹中的应用

目的探讨神经电生理检测,如瞬目反射(BR)、面神经电图(ENG)、肌电图(EMG)在Bell麻痹患者中的应用价值。方法46例Bell麻痹患者在病程3d内(A组)和>3～10d(B组)分别进行BR、ENG、EMG测定,并于3个月(C组)后复查。结果BR在3d内即出现明显异常;且R1R2R2′消失者预后较差,仅R1R2R2′延长者预后较好。ENG潜伏期延长,波幅下降<70%为轻度损害,3个月内可完全恢复,好转率100%;波幅下降70%～90%为中度损害,3个月内可大部分恢复正常,好转率86.3%;波幅下降>90%为重度损害,预后较差,好转率50%。EMG极早期(3d内)检测无异常,轻收缩有MU者预后较好,无MU者预后差。结论BR检测宜用于早期诊断及鉴别诊断,联合ENG、EMG检测Bell麻痹患者,可全面客观评价面神经损害程度,对估计预后和临床治疗有重要价值。     

神经电生理检测在Bell麻痹中的应用

目的探讨神经电生理检测，如瞬目反射（BR）、面神经电图（ENG）、肌电图（EMG）在Bell麻痹患者中的应用价值。方法46例Bell麻痹患者在病程3d内（A组）和〉3～10d（B组）分别进行BR、ENG、EMG测定，并于3个月（C组）后复查。结果BR在3d内即出现明显异常；且R1R2R2’消失者预后较差，仅R1R2R2’延长者预后较好。ENG潜伏期延长，波幅下降＜70％为轻度损害，3个月内可完全恢复，好转率100％；波幅下降70％～90％为中度损害，3个月内可大部分恢复正常，好转率86．3％；波幅下降〉90％为重度损害，预后较差，好转率50％。EMG极早期（3d内）检测无异常，轻收缩有MU者预后较好，无MU者预后差。结论BR检测宜用于早期诊断及鉴别诊断，联合ENG、EMG检测Bell麻痹患者，可全面客观评价面神经损害程度，对估计预后和临床治疗有重要价值。     

瞬目反射与面神经电图对面神经麻痹预后评估的价值

目的:探讨瞬目反射(BR)、面神经电图检测在面神经麻痹患者早期诊断和预后评估中的价值.方法:对64例面神经麻痹患者在7d内(A组)和8～15 d(B组)时分别进行BR、面神经电图检测.结果:患侧R1、R2',健侧R2’缺如者37例,其余27例患侧R1、R2',健侧R2'波潜伏期延长,异常率为100％;患侧面神经运动传导潜伏期延长,波幅降低,与健侧比较差异有显著意义(P＜0.01),发病7d内异常率为58％.结论:BR测定是诊断面神经麻痹的敏感指标,同时结合面神经电图可全面客观地评价面神经损害的程度和预后.     

瞬目反射与面神经电图对面神经麻痹预后评估的价值

目的探讨瞬目反射(Blink Reflex,BR)、面神经电图(Facial Nerve Conduction,FNC)检测在面神经麻痹患者早期诊断和预后评估的价值。方法对64例面神经麻痹患者在7d(A组)和8~15d(B组)时分别进行BR、FNC检测。结果患侧R1、R2,健侧R2’,缺如者37例,其余27例患侧R1、R2,健侧R2’波潜伏期延长,异常率为100%;患侧面神经运动传导潜伏期延长,波幅降低,与健侧比较差异有显著性(P<0.01),发病7d内异常率为57.5%。结论 BR测定是诊断面神经麻痹的敏感指标,同时结合FNC可全面客观地评价面神经损害的程度和预后。     

瞬目反射与面神经运动传导检测在特发性面神经麻痹中的临床应用价值

目的探讨瞬目反射与面神经运动传导在特发性面神经麻痹中的临床应用价值。方法选取特发性面神麻痹患者101例,于发病3~7d内进行瞬目反射(BR)和面神经运动传导(FMC)检测,以评估其与临床表现、面瘫预后的关系。结果 101例患者BR检测均异常,表现为患侧R1、R2、R2'波潜伏期延长或未出波;在比较不同未出波情况的痊愈时间分布时发现,4组(全出波、1个未出波、2个未出波、3个未出波)间痊愈时间分布(P0.05)。101例患者患侧额肌、眼轮匝肌、口轮匝肌M波潜伏期均较对侧延长,差异有统计学意义(P0.05);101例患者患侧M波波幅均有下降,Pearson分析显示痊愈时间与患侧M波下降幅度呈正相关,(r=0.592,P0.05)。按照患侧M波波幅较对侧下降幅度大小,分为50%以下、50%~80%、80%以上3组,3组间痊愈时间分布(P0.05),下降幅度为50%以下组的患者80.4%在1个月内痊愈,下降幅度为50%~80%组的患者56.1%在2个月内痊愈,下降幅度80%以上组的患者77.8%在3个月及以上痊愈。结论特发性面神经麻痹患者患侧BR均异常,BR可作为其诊断的客观、敏感的指标;面神经运动传导检测,患侧M波波幅下降幅度与痊愈时间呈正相关,可客观评估其预后。     

瞬目反射与面神经运动传导检测对特发性面神经麻痹早期诊断和预后评估的价值

目的 探讨瞬目反射（BR）与面神经运动传导（FMC）检测对特发性面神经麻痹早期诊断和预后评估的价值。方法 选取2019年9月至2020年9月收治的特发性面神经麻痹100例。发病1~7 d,BR记录R1、R2及R2’波,分为出波组和未出波组;FMC检测复合肌肉动作电位（CMAP）,分为正常组和异常组。结果 BR检测显示,患侧R1、R2及R2’波未出波率分别为42.00%、30.00%、30.00%,均明显高于健侧（均为0.00%;P<0.05）。出波者患侧R1、R2及R2’波潜伏期较健侧均明显延长（P<0.05）。FMC检测显示,患侧CMAP潜伏期较健侧均明显延长（P<0.05）。治疗1、2、3个月的痊愈率分别为47.0%、74.0%、90.0%;BR出波组治疗1、2、3个月痊愈率明显高于未出波组（P<0.05）;CMAP正常组治疗1、2、3个月痊愈率明显高于异常组（P<0.05）。结论 BR与FMC检测可作为早期诊断特发性面神经麻痹的客观指标,BR出波情况与CMAP下降幅度可客观评估病人预后情况。     

脑梗死对瞬目反射的影响

目的探讨不同部位脑梗死对瞬目反射(blink reflex,BR)的影响。方法77例脑梗死患者分为基底节组、脑干组、大脑皮质组进行BR检测,比较不同病变部位的R1、R2和R2′之间有无差异。结果各病变组病侧与健侧R1、R2和R2′潜伏期较对照组均延长,有显著性差异。大脑皮质组之病侧与健侧R2、R2′均较基底节组明显延长,存在显著性差异。结论无论是大脑皮质、基底节或脑干的病变均会导致BR的异常,BR可作为了解脑梗死病变后神经传导通路是否受损的客观指标。     

电刺激诱发瞬目反射对脑桥梗死患者的预后价值

目的 探讨电刺激诱发瞬目反射(blink reflex,BR)对脑桥梗死患者的预后价值.方法 对43例脑桥梗死患者和37例健康对照组进行电刺激诱发BR的检测,采用欧洲脑卒中评分(The European stroke scale,ESS)和日常生活活动(activity of daily life,ADL)量表对每位患者在BR检查当日和4周末分别进行神经功能缺损程度评分.结果 脑桥梗死组病灶侧R1的潜伏期较对照组明显延长,病灶侧R1的潜伏期较健侧也显著延长(P＜0.001).脑桥梗死组BR各波的异常率以R1最高,占81.4%,而R2和R2′的异常率分别为23.3%和25.6%.R1的异常率显著高于R2和R2′(P＜0.001).双侧脑桥梗死(双侧均有病灶,每侧病灶直径均＞3mm),导致BR各波均未引出.一侧脑桥单个梗死灶,梗死灶直径＞3mm,主要引起R1潜伏期延长;一侧脑桥单个梗死灶,梗死灶直径0.5～3mm,BR各波潜伏期均正常.R1波未引出组神经功能缺损程度最重,ESS评分和ADL评分显著低于R1潜伏期延长组和R1潜伏期正常组(P＜0.001);R1潜伏期正常组预后最好,4周末其ESS评分和ADL评分均较1周内显著提高(P＜0.01和0.001);R1潜伏期延长组次之.结论 脑桥梗死患者的BR异常以R1潜伏期延长为特征.脑桥的病灶主要引起R1异常,进一步提示R1的反射中枢位于脑桥.BR的异常类型可大致反映脑桥梗死病灶的范围,BR的R1异常可作为脑桥梗死患者神经功能缺损程度和预后评价的电生理指标之一.     

电刺激诱发瞬目反射和脑干听觉诱发电位在多发性硬化诊断中的作用

目的　探讨瞬目反射 (BR)在多发性硬化 (MS)诊断中的价值。方法　对 32例确诊MS患者分别进行BR和脑干听觉诱发电位 (BAEP)检测。结果　MS组BR检测在有脑干症状组和无脑干症状组的脑干损害检出率分别为 85 7%和 5 0 0 % ;BR检测对MS组患者Ⅴ、Ⅶ脑神经损害的异常检出率均为 2 1 9% ;BAEP检测在有脑干症状组和无脑干症状组的脑干损害检出率分别为 71 4 %和4 4 4 % ;BR、BAEP及二者联合检测检出MS患者脑干损害的阳性率分别为 6 5 6 %、5 6 3%和75 0 %。结论　BR能检出MS患者脑干、三叉神经及面神经的亚临床病灶 ;BR与BAEP联合检测更易于发现脑干亚临床病灶 ,有助于MS的早期诊断     

糖皮质激素不同给药方式治疗贝尔面瘫临床观察

目的观察糖皮质激素不同给药方式治疗贝尔面瘫的临床疗效。方法将贝尔面瘫120例患者随机分为3组各40例,A组(常规治疗组)给予常规药物、红外线理疗治疗,B组(静滴组)及C组(耳后注射组)在常规治疗的基础上分别加用糖皮质激素静滴及耳后乳突区注射糖皮质激素,3组疗程均为15 d,观察3组临床疗效。结果 A组总有效率为70.0%,B组为92.5%,C组为90.0%,A组分别与B组、C组比较差异均有统计学意义(P0.05),B组、C组比较差异无统计学意义(P0.05)。结论糖皮质激素早期应用于贝尔面瘫治疗,可迅速减轻面神经水肿,有利于疾病恢复。耳后局部注射糖皮质激素与全身用药效果相当,不良反应较低,值得临床推荐。     

瞬目反射、面神经电图和面肌肌电图对面神经炎的诊断、治疗和预后的评估

目的 探讨瞬目反射(BR)和面神经电图(ENG)、面肌肌电图(EMG)对面神经炎的诊断、治疗和预后的价值.方法 53例面神经炎患者在发病后1周内首次进行BR检查以及ENG、EMG测定,发病后1,3,6个月重复上述检查.结果 首次检查患侧R1、R2及R2'缺如者23例,其余有30例患侧R1、R2及R2'与健侧相比潜伏期延长,差异有统计学意义(P＜0.01).异常率达91%.37例患侧面神经运动传导与健侧相比潜伏期延长、波幅降低,差异有统计学意义(P＜0.05),异常率为75%.23例患侧出现正锐波、纤颤电位,运动单位电位波幅降低,时限延长,多相渡增多,病理性干扰相.1个月后复查,上述检查完全恢复者26例.3个月后复查完全恢复者42例,6个月后复查完全恢复者51例,2例未恢复者1年后仍遗留有后遗症.结论 BR测定是诊断面神经炎的敏感指标.BR结合ENG、EMG检测能评估面神经炎的病情、疗效及预后.     

激素在不同发病时间对Bell麻痹治疗的临床疗效观察

目的比较激素治疗Bell麻痹介入的时间对Bell麻痹的治疗效果,论证激素治疗的介入时机、延期治疗的疗效。方法根据Bell麻痹发病阶段分为急性期组(发病7d内接受激素治疗)、持续期组(发病8²0d内接受激素治疗)以及恢复期组(发病20d后接受激素治疗)。采用Sunnybrook评分系统和House-Brackmann评分系统评价面部功能。评价患者初诊时和完成治疗后3个月的恢复情况。结果急性期组和持续期组在治愈率方面比较,P<0.05,差异无统计学意义;而急性期组与恢复期组、持续期组与恢复期组比较,P<0.05,急性期组和持续期组的治愈率均高于恢复期组。结论不论Bell麻痹严重程度如何,均应在急性期尽早进行激素治疗,以在早期减轻面神经的炎性反应,达到较好的治疗效果。另外,即使错过急性期,也不应放弃激素治疗。     

七叶皂苷钠、强的松治疗Bell麻痹的随机对照研究

目的　探讨七叶皂苷钠治疗Bell麻痹的有效性。方法　采用随机对照研究 ,收集首次诊断Bell麻痹的急性期患者 85例 ,随机分为七叶皂苷钠组 (七叶皂苷钠加基础治疗 ) 30例、强的松组 (强的松加基础治疗 ) 2 8例、基础治疗组 2 7例 ,基础治疗包括多种维生素、针灸、理疗等 ,均在发病 3天内给予相应的治疗。采用House Brach mann(H B)面神经麻痹评定标准 ,分别于治疗前与治疗后 1个月时评定面神经麻痹等级。结果　治疗前 3组患者性别、年龄、面瘫部位、发病至开始治疗时间、首次治疗时H B面瘫等级分布均无统计学差异 ,具有可比性。治疗后 1个月时三组患者H B面瘫等级经Kruskal Wallis秩和检验 ,有统计学差异 (P =0 0 4 8)。 3组间两两比较显示七叶皂苷钠组、强的松组面瘫恢复均优于基础治疗组 ,有统计学意义 (P值分别为 0 0 4 5、0 0 14 ) ;而七叶皂苷钠组与强的松组面瘫恢复比较无统计学差异 (P =0 6 16 )。结论　七叶皂苷钠可替代皮质类固醇治疗Bell麻痹 ,同时避免皮质类固醇的副作用。     

瞬目反射对微血管减压术后迟发性面神经麻痹的预测价值

目的 研究面肌痉挛微血管减压术(MVD)前后瞬目反射的变化,探讨术后迟发性面神经麻痹(DFP)的发生机制.方法 对印例面肌痉挛患者术前1d、术后第1、3、5天行瞬目反射检查,并观察DFP的发生.结果 56例术后未出现DFP,但瞬目反射检查仍表现为短暂的R1、R2潜伏期延长,且R1潜伏期于术后第5天,R2潜伏期于术后第3天恢复至术前水平.4例分别于术后第6-15天出现DFP症状,术后瞬目反射记录表现为R1潜伏期逐渐延长,甚至波形消失.结论 MVD对面神经功能存在影响,对于大部分患者(93%),面神经功能术后5 d内可自行恢复,而R1潜伏期逐渐延长甚至波形消失则表现为DFP.瞬目反射检查中R1波的监测对MVD术后DFP的发生有一定的预示作用.     

Orbicularis oculi-Reflexe und Summenpotentiale des Orbicularis oris bei idiopathischer Facialislähmung

In 84 patients with idiopathic, clinically complete Bell's palsy the electrically induced blink reflexes with their two components (OOR I and II) were electromyographically recorded on both sides using skin electrodes. In 67 of these patients the evoked responses of the orbicularis oris muscle were also studied. The latencies and amplitudes were measured and related to the clinical outcome of the facial paralysis. The patients were divided into two groups, one with good recovery of the palsy (46 patients), the other with significant residual paresis and/or strong associated movements of the facial musculature (38 patients). In the group with good recovery the following results were obtained: 1. the OOR I remained elicitable or reappeated during the first 12 days after the onset of palsy; 2. the OOR II began to rise during the first 10 days of palsy; 3. the amplitude of the orbicularis oris response did not decrease to below 10%. In the group with poor recovery: 1. both components of the OOR were absent or diminished to below 4% for more than 12 days after the onset of palsy; 2. the latency difference of the OOR I exceeded 8 msec; 3. the amplitude of the orbicularis oris responses decreased to below 10%. Using these criteria it appears to be possible in about 85% of patients to make a prognosis between the 3rd to 5th and the 10th to 12th day after the onset of Bell's palsy.     

Electrophysiologic findings and prognosis in Bell's palsy

Electrophysiologic investigations were carried out on 45 patients with Bell's palsy at periodic intervals after the onset of paralysis. It was found that there was a good correlation between prognosis in Bell's palsy and the amplitude of evoked motor response obtained after six or more days of clinical paresis. When the average amplitude of evoked motor response was within normal limits (i.e., 504μV or greater), complete recovery with no residual deficits took place two to six weeks after the onset of facial palsy. When the evoked motor response was absent in all three major branches of the facial nerve, indicating complete nerve degeneration, electromyographic signs of recovery were apparent by the third or fourth month after the onset of paralysis. In these cases, recovery was relatively slow and incomplete, with some degree of residual deficit and synkinesis. Maximal return of voluntary facial movement was established 8 to 12 months after the initial symptom. When the mean amplitude of evoked motor response was below the lower limit of normal (i.e., less than 504μV), electromyographic signs of recovery were noted within 1 to 3 months, depending on the amplitude values. The final outcome of this intermediate group was similar, but not identical, to that of the previous group. The prognosis of facial paralysis in Bell's palsy was thus found to be directly related to the mean amplitude of evoked motor response, regardless of the extent of clinical paralysis.     

Blink reflex in patients with Wallenberg’s syndrome

Knowledge of the neural circuits involved in Wallenberg’s syndrome (WS) is incomplete. Study of the blink reflex (BR) in patients with WS can help in reaching a better understanding of the physiopathology underlying clinical symptoms and may help in the prediction of clinical outcome. We evaluated the BR in response to supraorbital nerve electrical stimuli in 20 patients with WS. All patients were studied within the 1st week after onset of symptoms, and 10 of them were also studied repeatedly during a follow-up period of 3–12 months. At the first examination the long latency bilateral responses (R2 and R2c) to stimulation of the supraorbital nerve of the affected side were absent in 11, delayed in 4, and normal in 5 patients. At follow-up, there was a normalization of the BR in all patients who had absent or delayed responses at the first examination except for one patient whose responses remained absent at the 9th month. Late responses elicited on the side of the lesion by stimulation of the non-affected supraorbital nerve were normal in all but one patient. This patient died from cardiorespiratory arrest within the 1st month of the illness. One patient with normal BR responses also died in the acute phase. The BR is abnormal in most patients with acute WS and tends to normalize in a mean period of 7 months. BR pattern is not a predictor of early fatal complications in patients with this syndrome. Received: 18 March 1996 Received in revised form: 18 June 1996 Accepted: 26 June 1996     

岩斜区脑膜瘤的显微手术治疗

目的 探讨岩斜区脑膜瘤显微手术的治疗效果. 方法 对21例行显微手术治疗的岩斜脑膜瘤患者(采用枕下乙状窦后入路3例,幕上下经岩骨乙状窦前入路18例)的临床资料及手术效果进行分析. 结果 肿瘤获全切(Simpson I、Ⅱ)11例,次全切(Simpson Ⅲ)5例,大部分切除4例,部分切除1例.术后死亡1例.术后早期出现动眼神经瘫5例,面神经功能障碍4例,后组神经瘫2例,对侧肢体轻瘫2例.术后随访3个月～4年,3例不完全动眼神经瘫1个月后恢复,2例完全损伤未恢复:4例面神经功能障碍中3例3个月后恢复,1例未恢复;2例后组神经瘫术后1周全恢复;2例对侧肢体功能障碍,术后1个月恢复.5例患者术后行γ刀治疗.没有病例出现术后复发. 结论 岩斜区脑膜瘤手术入路的选择是关键,乙状寞前人路是目前最有效的手术入路.     

High‐resolution ultrasound in the evaluation and prognosis of Bell’s palsy

Introduction: Bell’s palsy is a commonly encountered paralysis of the facial nerve occurring worldwide. Prognosis for Bell’s palsy is good, but the proportion of patients with poor outcomes may reach 30%. Ultrasound (US) may provide a novel approach for evaluating and prognosticating Bell’s palsy, in comparison with known electrophysiological techniques. Methods: In this study, we measured the diameter of the distal facial (VII) nerve using US in patients with Bell’s palsy treated with prednisolone, in comparison with healthy controls. Blink reflex and VII nerve conduction studies were also performed. Studies were prospective and performed within 1 week of disease onset. Results: Our results have shown that diameter of the distal VII nerve is a good predictor of favorable (positive predictive value: 100%) and bad outcomes (negative predictive value: 77%) in Bell’s palsy at 3 months after clinical presentation. Furthermore, we also noted the lack of correlation of VII diameter with conventional VII nerve conduction studies (NCS) and blink reflex studies. US was superior to VII nerve conduction and blink reflex studies in outcome prediction. Conclusions: This first study utilizing US in Bell’s palsy highlights its role in outcome prediction and contributes to our understanding of recovery processes in this common neurological disorder.