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患者女,48岁.因右侧面瘫1月余,渐进性吞咽困难1月伴音哑3周于1996年7月22日入院。患者6月8日发作右侧眼睑闭合不全,口角左偏伴流涎,有右侧耳后压痛,于6月10日就诊。查体:BP:16/10kPa,浅表淋巴结无明显肿大,咽反射(+),并具有周围性面神经麻痹表现。诊断为急性面神经炎,并给以氟美松40mg静脉滴注,1次/日,共3天,后给以强的松50mg,1次/日,口服4天,治疗效果不显著,且于进食时出现吞咽困难,呛咳,进行性加重伴音哑,入院查体:BP18/11kPa,未触及浅表淋巴结肿大,心肺检查无异常,肝、脾肋下来触及,神经系统检查发现:右侧闭目不全,额纹消失,鼻唇沟变浅.伸舌偏左,示齿口角左偏,鼓气右侧口角漏风,咽反射(--),双侧膝腱反射(++),巴氏征(--),诊断为急性面神经炎,经规范化抗炎及抗感染治疗无效。1996年7月24日胸部CT检查显示上纵隔多发肿大淋巴结,于颈部气管后软组织可见融合影,经过进一步检查诊断为淋巴瘤。
The patient female, 48 years old, was hospitalized on July 22, 1996 due to progressive dysphagia in January for 3 weeks due to more than one month of right facial paralysis. On the 8th of June, the patient had a seizure of the right eyelid, an irritated left mouth, and a tenderness on the right side of the ear. He was seen on June 10. Physical examination: BP: 16/10 kPa, superficial lymph nodes without significant swelling, pharyngeal reflexes (+), and peripheral facial paralysis performance. Acute facial neuritis was diagnosed and given intravenous infusion of dexamethasone 40 mg once daily for 3 days. After giving prednisone 50 mg once daily for 4 days, the therapeutic effect was not significant. Dysphagia, cough, progressive aggravation of dumbness during eating, hospital admission examination: BP18/11kPa, no palpation of superficial lymph node enlargement, no abnormalities in cardiopulmonary examination, liver and spleen ribs touch down, neurological examination revealed: right side Insufficiency, the forehead line disappears, and the nasolabial folds become shallow. The left side of the tongue is extended, the left side of the mouth is indicated, the right side of the mouth is airtight, the pharyngeal reflex (--), bilateral knee tendon reflexes (++), and bar The sign (--), diagnosed as acute facial neuritis, was ineffective after standard anti-inflammatory and anti-infective treatments. On July 24, 1996, a chest CT scan showed multiple enlarged lymph nodes in the mediastinum, and a fusion shadow was seen in the soft tissues of the neck after trachea. After further examination, it was diagnosed as lymphoma.