后天性双侧面神经麻痹常见病因及鉴别诊断

<正>面神经是混合性神经,由运动纤维、感觉纤维及副交感神经纤维组成,面神经麻痹可分为中枢性面神经麻痹和周围性面神经麻痹,其中单侧周围性面神经麻痹是临床常见疾病,病因主要有Bell麻痹、听神经瘤、头颈部肿瘤等;而双侧面神经麻痹(bilateral simultaneous facial palsy,BSFP)在临床较少见,依其病因通常分为先天性及后天性,本文就后天性非创伤性双侧面神经麻痹的病因及鉴别诊断作一综述。     

星状神经节阻滞治疗2型糖尿病周围性面神经麻痹的观察

目的观察星状神经节阻滞疗法治疗2型糖尿病合并周围性面神经麻痹的效果。方法采用患侧星状神经节阻滞疗法治疗周围性面神经麻痹患者17例,观察其疗效并与20例常规治疗者比较。结果星状神经节阻滞组痊愈率高于对照组(P<0.05)。结论星状神经节阻滞可有效治疗2型糖尿病合并周围性面神经麻痹。     

综合治疗周围面神经麻痹的疗效观察

目的 探讨周围性面神经麻痹的最佳治疗方法。方法 对48例周围性面神经麻痹的患者的发病早期（1周内）采用药物、物理、康复综合性治疗。结果 完全性周围性面神经麻痹的治疗有效率为86％。不完全性周围性麻痹的有效率为97％，总有效率为94％。两个疗程的有效率为88％，三个疗程的有效率为100％。结论 采用综合治疗周围性面神经麻痹能迅速改善症状。缩短痛程，显效率明显提高，一般以三个疗程为宜，老年人有伴发病者可适当延长治疗时间。     

周围性面瘫的外科治疗

目的探讨周围性面瘫的外科手术治疗方法。方法回顾性分析12例周围性面瘫的手术经验。其中Bell麻痹5例,颞骨损伤致外伤性面瘫3例,桥小脑角肿瘤术后面神经断裂3例,腮腺外伤面神经断裂1例。术前面神经功能House-Brackmann分级Ⅳ级8例,Ⅴ级4例。结果行面神经减压术8例,面神经吻合术3例,面神经移植术1例。术后无感染、手术所致感音神经性耳聋、颈静脉球或乙状窦损伤等并发症。术后随访1.2年;面神经功能House-Brackmann分级Ⅰ级2例,Ⅱ级6例,Ⅲ级4例。结论周围性面瘫选择适宜的外科手术方法治疗,可获得良好的治疗效果。     

Bell麻痹病因及发病机制研究进展

Bell麻痹占所有单侧周围性面神经麻痹病例的60％～75％,其病因至今仍不清楚,目前认为可能与病毒感染和自身免疫性因素有关.Bell麻痹是细胞免疫介导的周围神经系统脱髓鞘疾病,在大多数病例中,可能是吉兰-巴雷综合征(Guillain-Barré syndrome,GBS)的一种特殊类型.治疗方面,应尽早使用抗病毒药物如阿昔洛韦或伐昔洛韦,并短期口服糖皮质激素治疗;单克隆抗体和/或T细胞免疫治疗有望成为针对Bell麻痹的一种特异性疗法.     

应用经皮神经低频电刺激治疗早期特发性面神经麻痹的研究

<正>特发性面神经麻痹(idiopathic facial paralysis,IFP)亦称面神经炎或Bell麻痹,是因茎乳孔内面神经非特异性炎症所致的周围性面神经麻痹~([1])。目前治疗特发性面神经麻痹的常规方法包括:糖皮质激素、营养神经、改善微循环、抗病毒、物理治疗等。目前研究认为约80%的IFP患者常规治疗后可在3 m内恢复,但仍有20%左右的患者遗留不同程度的后遗症,如面部肌肉无力、挛缩、面肌痉挛、"联带运动"等。尤     

天眩清穴位注射治疗神经系统疾病30例临床观察

天麻素是传统中药天麻中的主要有效成分,人们根据天麻素的化学结构人工合成天眩清。我们将天眩清用于穴位注射以观察其安全性和疗效,现报道如下。1一般资料全部患者均为住院患者,根据入院先后顺序按奇、偶数随机分为针刺加穴位注射组(治疗组)和针刺组(对照组),每组30例。1.1分组1.1.1治疗组周围性面神经麻痹12例,偏头痛5例,三叉神经痛4例,神经衰弱综合征4例,中风后遗症3例,神经性耳鸣2例。1.1.2对照组周围性面神经麻痹13例,中风后遗症8例,偏头痛6例,三叉神经痛2例,神经性耳鸣1例。1.2治疗方法二组均按常规取穴及针刺治疗。治疗组中周围性面…     

通心络治疗周围性面神经麻痹的临床研究

目的 探讨通心络胶囊对周围性面神经麻痹的治疗效果.方法 随机将126例周围性面神经麻痹的病例分为治疗组和对照组,分别给予常规治疗加通心络胶囊和单纯给予常规治疗.比较2组的治愈率和达到治愈或好转时的治疗时间.结果 通心络胶囊治疗组治愈率明显高于对照组,而达到治愈或好转的治疗时间明显少于对照组.结论 通心络胶囊用于治疗周围性面神经麻痹可以明显提高疗效和缩短治疗时间,值得临床推广应用.     

肌兴奋治疗仪对小儿面神经麻痹的疗效观察

目的观察肌兴奋治疗仪对小儿面神经麻痹的临床疗效。方法 46例小儿面神经麻痹患者随机分为实验组(23例)和对照组(23例),对照组行常规治疗,实验组在常规治疗的同时使用肌兴奋治疗仪治疗,治疗30d后,对2组结果进行比较分析。结果实验组治愈率高于对照组,2组比较差异有统计学意义(P<0.05)。结论早期应用肌兴奋治疗有助于提高小儿面神经麻痹治愈率。     

耳源性面瘫综合治疗26例分析

面瘫分中枢性和周围性，引起面瘫的病因很复杂，耳源性面瘫排除中枢性、核上性面神经麻痹、颅内核性面瘫及颈面部疾病引起的面瘫，亦即限于颞骨内病变引起的面神经麻痹。本科自1998～2003年共收住耳源性面瘫26例，分析如下。     

针灸治疗老年周围性面瘫的疗效分析

目的 探讨针灸治疗老年急性期周围性面瘫的临床效果。方法 2017年4月至2019年2月收治老年急性期周围性面瘫96例,其中48例采用针灸治疗（观察组）,48例采用常规治疗（对照组）。对照组病人给予常规药物口服联合康复训练,观察组病人在对照组治疗基础上联合使用针灸治疗。结果 治疗后,两组House-Brackmann评分、Sunnybrook评分、躯体功能评分、社会功能评分、面神经潜伏期、面神经波幅均明显改善（P<0.05）,而且,观察组明显优于对照组（P<0.05）。观察组有效率（97.97%,47/48）明显高于对照组（83.33%,41/48;P<0.05）。结论 针灸治疗老年周围性面瘫,疗效显著,能够促进病人面神经功能恢复,改善临床症状     

Bell's palsy in children: analysis of clinical findings and course

To evaluate treatment of Bell's palsy (acute idiopathic peripheral facial nerve paralysis) of children, the authors analyzed 38 cases (18 females, 20 males) of Bell's palsy in children aged below 16 years old. The mean age of all cases was 6.8 +/- 6.2 years old. All cases resulted in complete recovery within 6 months. Clinical score of facial motor functions were adapted to 17 patients who were more than 5 years old. They were divided into two groups: early recovery group (clinical symptoms recovered within 3 months; 10 cases) and later recover group (over 3 months; 7 cases). Clinical scores evaluated in the first week from the onset were not significantly different. Steroid therapy was used for 9 patients of early group and 6 patient of later group. All patients of this study were recovered, thus we could not evaluate effect of steroid therapy for Bell's palsy in children. Use of steroid therapy for Bell's palsy needs more concretely administration. We consider how the region locates near to the center is an important prognostic factor.     

Facial paralysis as a presenting symptom of leukemia

Facial paralysis may occur as a complication of central nervous system leukemias in children, but it is rarely a presenting symptom. This report describes an 8-month-old child who presented with peripheral facial palsy, failure to thrive, anemia, and otitis media. Antibiotic and steroid treatment led to an improvement in the clinical condition, but not the paralysis. At readmission 3 weeks later, physical examination revealed bluish, firm, palpable masses on the scalp and facial areas, and laboratory and imaging studies confirmed the diagnosis of acute myeloid leukemia. This case should alert physicians to consider hematologic malignancies in children with facial paralysis.     

肌内效贴贴扎疗法治疗周围性面瘫的临床效果

目的研究肌内效贴贴扎疗法治疗周围性面瘫的临床效果。方法选取2013-09—2016-09于我院接受治疗的60例周围性面瘫患者为研究对象,按照入院顺序分为对照组与观察组各30例。对照组给予常规物理康复联合西药治疗,观察组在此基础上给予肌内效贴贴扎疗法,观察2组临床效果。结果治疗后,观察组评分提升至(16.83±3.14)分,明显高于对照组的(12.11±2.18)分,差异有统计学意义(P0.05);观察组总有效率为93.33%,明显高于对照组的70.00%。结论在周围性面瘫患者的临床治疗中,应用肌内效贴贴扎疗法,可缓解患者脸部疼痛感,促进肌肉力量的恢复,改善患者的临床症状,疗效显著,值得推广。     

Peripheral facial paralysis and HIV infection: report of four African cases and review of the literature

Summary Four cases of infranuclear facial palsy associated with infection by the human immunodeficiency virus in young heterosexual African patients are reported. Two cases were healthy HIV carriers, one patient manifested AIDS-related complex, and one case fulfilled the CDC criteria for AIDS. Two patients had a typical Bell's palsy, one presented with manifest cephalic Herpes zoster infection and one, who suffered from facial diplegia, could be considered to have a cephalic form of Guillain-Barré syndrome. A review of the literature confirmed that peripheral facial palsy can occur at any stage of HIV infection and in various clinical contexts. In stages I and II of the HIV infection, patients may develop either Bell's palsy or Guillain-Barré syndrome. In stages III and IV, when the cellular immunity has begun to decline, Herpes zoster-related facial paralysis, seventh cranial nerve involvement secondary to meningeal lymphomatosis, and peripheral facial paralysis as one aspect of widespread chronic peripheral neuropathy may also occur.     

Abstracts

Bell’s palsy causes about two thirds of cases of acute peripheral facial weakness. Although the majority of cases completely recover spontaneously, about 30% of cases do not and are at risk from persisting severe facial paralysis and pain. It has been suggested that herpes simplex virus type 1 (HSV-1) may be the etiological agent that causes Bell’s palsy. Although corticosteroid therapy is now universally recognized as improving the outcome of Bell’s palsy, the question as to whether or not a combination of antiviral agents and corticosteroids result in a better rate of complete facial recovery compared with corticosteroids alone is now a highly contentious issue. The evidence obtained from laboratory studies of animals and humans that HSV-1 may be linked to facial nerve paralysis is first outlined. The discussion then focuses on the results of different clinical trials of the efficacy of antiviral agents combined with corticosteroids in increasing the rate of complete recovery in Bell’s palsy. These have often given different results leading to opposite conclusions as to the efficacy of antivirals. Of three recent meta-analyses of previous trials, two concluded that antivirals produce no added benefit to corticosteroids alone in producing complete facial recovery, and one concluded that such combined therapy may be associated with additional benefit. Although it is probably not justified at the present time to treat patients with Bell’s palsy with antiviral agents in addition to corticosteroids, it remains to be shown whether antivirals may be beneficial in treating patients who present with severe or complete facial paralysis.     

延髓梗死11例患者MRI与临床特点对照研究

目的 探讨延髓梗死患者MRI病灶部位与临床表现特点的关系.方法 总结11例患者的临床症状和体征,对照MRI结果对梗死病灶进行定位,讨论病灶部位与临床表现的关系.结果 延髓外侧梗死5例,延髓内侧梗死6例(其中双侧梗死2例);延髓外侧梗死常见症状是言语不清、眩晕、饮水呛咳、吞咽困难及面部麻木,延髓内侧梗死常见症状是肢体瘫痪、言语不清;延髓外侧梗死常见体征是构音障碍、感觉障碍、Horner征及面瘫,延髓内侧梗死常见体征是肢体瘫痪、周围性舌瘫.结论 不同病灶部位的延髓梗死患者症状、体征各异,借助MRI可帮助诊断.     

Peripheral facial paralysis, polyneuritis and chronic Chagas' disease

The author reports the case of a 42-year-old woman who developed right peripheral facial paralysis and mixed polyneuritis in the course of an undiagnosed Chagas' disease. The clinical diagnosis could be confirmed by serological reactions for Chagas' disease. A likely relationship between chronic Chagas' disease, peripheral facial paralysis and mixed polyneuritis is discussed.     

吉兰-巴雷综合征脑脊液蛋白与面神经瘫痪的相关性

目的探讨吉兰-巴雷综合征(Guillain-Barre Snydrome,GBS)患者脑脊液蛋白与面神经瘫痪的关系及其临床意义。方法回顾性分析2005年1月至2015年9月我院神经内科确诊的111例GBS患者临床与生化资料,根据面神经瘫痪将患者分为面神经正常组与瘫痪组,比较两组患者间的临床、生化特征;根据脑脊液蛋白值将患者分为脑脊液蛋白正常组、轻度偏高组与异常偏高组,比较3组间面神经瘫痪数量的变化;分析脑脊液蛋白与面神经瘫痪的相关性。结果面神经正常组与瘫痪组之间患者性别、年龄、残疾量表评分(≥3)、上呼吸道感染、胃肠感染、肺部感染及近期疫苗接种史比较无统计学差异(P0.05),脑脊液蛋白、免疫球蛋白G(Ig G)、脑脊液白蛋白/血清白蛋白(QALB)比较有统计学差异(P0.05);3组不同脑脊液蛋白水平患者面神经瘫痪数量比较有统计学差异(F=3.48,P=0.03);脑脊液蛋白水平与面神经瘫痪数量呈正相关(r=0.288,P0.01)。结论 GBS患者脑脊液蛋白值越高面神经瘫痪发生的可能性越大,脑脊液蛋白有助于GBS患者面神经瘫痪的病情监测。