脑卒中后中枢性面瘫闭目乏力的临床观察

A clinical study on weakness of eye closure in supranuclear facial paralysis after stroke

目的确切了解脑卒中后中枢性面瘫闭目乏力的发生率,探讨其发生机制。方法观察1年内所有起病7 d 内入院的脑卒中患者。使用美国国立卫生院脑卒中量表(National Institute ofHealth stroke scale,NIHSS)中第4项面瘫评分及日本面瘫评分(Japan facial score,JFS)进行面瘫评估,使用拉力测量器测量双侧眼轮匝肌的闭目力量差值。比较中枢性面瘫者伴与不伴闭目乏力两组的临床资料。结果共收集病例914例,中枢性面瘫者伴闭目乏力且头颅 MRI 显示脑干无病灶者共40例,发生率为4.4%。脑卒中后中枢性面瘫伴闭目乏力者的双眼闭目力量差值随时间延长而递减(F=36.049,P<0.01),而不伴闭目乏力者双眼闭目力量无差异。伴闭目乏力者的责任病灶在右侧大脑半球的比例较不伴闭目乏力者高(72.50% vs 32.01%,X^2=32.95,P<0.01)。两组的责任病灶的性质、分布部位、体积、Alberta 卒中计划早期 CT 评分、有双侧病灶的比例均无差异。责任病灶分布在右侧大脑半球、年龄、性别以及是否有脑干病变这四项因素作为 Cox 回归的协变量,对中枢性面瘫闭目乏力的持续时间均无影响。结论脑卒中后中枢性面瘫伴闭目乏力的发生率达4.4%,其发生机制可能与右侧大脑半球受损有关。

Objectives To investigate the incidence of weakness of eye closure in supranuclear facial paralysis （WECSFP） after stroke, and try to explore its mechanism. Methods All in-patients were recruited into the study during 1-year period. The site and subtype of stroke were identified using computerized topography （CT） and （or） magnetic resonance imaging （MRI）. Neurological disability was assessed using National Institutes of Health stroke scale （ NIHSS）. Facial nerve paralysis was evaluated using Japan facial score （JFS）, and the strength to close eyelid was measured using an ergometer. The differences of strength to close eyelid on the both side 〉 0. 02 kgf was considered as significant. All patients were studied within the first week of presentation with stroke, and underwent every day follow-up within the first month. Results Nine hundred and fourteen patients were recruited into the study during 1-year period. WECSFP without lesion in brain stem was present in 4.4% of patients within the first week of stroke presentation. The patients with WECSFP had less JFS than the patients without WECSFP （P 〈 0. 01 ）. However, JFS changed a little along with the time in both groups. The differences of strength to close eyelid on the paralyzed and the normal side in the patients without WECSFP kept unchanged, whereas they deceased in the patients with WECSFP along with the time after the onset of stroke （ F = 36.049, P 〈 0. 01 ）. The culprit lesion was located in the right hemispheres of 72. 50% WECSFP patients and of 32. 01% non-WECSFP patients （X^2 = 32. 95, P 〈 0. 01 ）. There were no differences of Alberta stroke program early CT score（ASPECTS）, the volume of lesion, subtype of stroke, the culprit lesion of stroke and the ratio of bilateral lesions between the two groups. Moreover, the age, sex, culprit lesion located in right hemisphere, and in the involvement of brain stem were not predictors for the duration of WECSFP. Conclusions WECSFP was present in 4.4% of patients within the first week of presentation of stroke. WECSFP is probably related to the lesion in right hemisphere.