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目的探讨双侧周围性面神经麻痹的诊断和治疗方法。方法回顾性分析1996—2003年双侧周围性面神经麻痹患者7例,其中明确诊断6例,分别为急性淋巴细胞白血病L2型1例、Machado-Jesoph病1例、双下颌骨骨折1例、格林-巴利综合征变异型1例、Vogt-小柳-原田病1例、Bell面神经麻痹1例。诊断不明1例,诊断为可疑带状疱疹病毒感染或Lyme病。脑脊液检查5例其中有阳性发现者4例。Lyme抗体检查6例中有阳性发现者1例;影像学检查5例中有阳性发现者2例;肌电图和瞬目反射检查7例,均为周围性损害。7例患者均应用激素和维生素治疗。结果患者随访时间最长2个月,以House-BrackmannⅠ级为面神经麻痹完整治愈标准。治愈4例,好转2例,无效1例。结论双侧周围性面神经麻痹在临床中少见,诊断和鉴别诊断困难,诊断失误可以危及患者的生命,应该在临床中得到足够的重视。临床中面对这样的患者,应详细询问病史,做细致的全身检查;同时应了解可能的原发病及其特点,才能做出正确判断。
Objective To investigate the diagnosis and treatment of bilateral peripheral facial paralysis. Methods Retrospective analysis of 7 cases of bilateral peripheral facial paralysis between 1996 and 2003, of which 6 cases were definitely diagnosed, including 1 case of acute lymphoblastic leukemia type L2, 1 case of Machado-Jesophosis, 1 case of double mandibular fracture, 1 case of Barre syndrome variant, 1 case of Vogt-Koyanagi-Harada disease and 1 case of Bell facial nerve paralysis. One patient was diagnosed as unknown or was diagnosed with herpes zoster virus infection or Lyme disease. Cerebrospinal fluid examination in 5 cases, including positive findings in 4 cases. Lyme antibody examination in 6 cases found positive in 1 case; imaging findings in 5 cases found positive in 2 cases; EMG and blink reflex in 7 cases, are peripheral lesions. Seven patients were treated with hormones and vitamins. Results The patients were followed up for up to 2 months, with House-Brackmann class I as the complete cure standard for facial paralysis. 4 cases were cured, 2 cases improved, 1 case ineffective. Conclusions Bilateral peripheral facial paralysis is uncommon in clinical practice. It is difficult to diagnose and differentiate the patients. Diagnostic errors can endanger the life of patients and should be given enough attention in clinic. Faced with such patients in clinical, history should be asked in detail to do a detailed examination of the body; the same time should understand the underlying disease and its characteristics in order to make the right judgments.