Lin Jianwen, Chen Yicong, Wen Hongmei, Yang Zhiyun, Zeng Jinsheng
Department of Neurology and Stroke Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China.
J Stroke Cerebrovasc Dis. 2017 Apr;26(4):834-841. doi: 10.1016/j.jstrokecerebrovasdis.2016.10.029. Epub 2016 Dec 13.
Upper facial dysfunction is not generally considered a feature of central facial paralysis after unilateral hemispheric stroke; however, weakness of eye closure (WEC) has been observed in some cases. We aimed to investigate the frequency and characteristics of WEC in unilateral stroke and its association with stroke prognosis.
Patients with unilateral stroke and central facial paralysis were prospectively recruited within 7 days of onset. Facial paralysis was evaluated via the fourth item in the National Institute of Health Stroke Scale (NIHSS-4) and the Japan Facial Score (JFS) on admission, and at days 7, 14, 21, and 30 after stroke. Eye closure strength was measured daily using an ergometer for 30 days after stroke. Primary outcome was assessed using the modified Rankin Scale (mRS) at 90 and 180 days. Univariate and multivariate analyses were performed to investigate risk factors of WEC.
WEC was identified in 16 of 242 patients (6.6%). Baseline characteristics, stroke risk factors, and lesion volume were not significantly different between patients with and patients without WEC. Patients with WEC featured higher NIHSS-4 scores and lower JFS between admission and at 21 days after stroke. Severe central facial paralysis (odds ratio [OR] = 8.1, 95% confidence interval [CI] = 2.3-28.6, P = .001) and right hemispheric stroke (OR = 13.7, 95% CI = 3.7-51.2, P < .001) were potential predictors of WEC. At 180 days after stroke, patients with WEC demonstrated a lower rate of functional independence (mRS = 0-2: 37.5% versus 72.1%, P < .001).
WEC, which predicts a worse functional outcome at 180 days after unilateral stroke, demonstrates an association with severe central facial paralysis and right hemispheric stroke.
单侧半球性卒中后，上半面部功能障碍一般不被视为中枢性面瘫的特征；然而，在某些病例中已观察到闭眼无力（WEC）。我们旨在调查单侧卒中中WEC的发生率和特征及其与卒中预后的关联。
在发病7天内前瞻性招募单侧卒中和中枢性面瘫患者。入院时、卒中后第7天、14天、21天和30天，通过美国国立卫生研究院卒中量表（NIHSS - 4）的第四项和日本面部评分（JFS）评估面瘫情况。卒中后30天内每天使用测力计测量闭眼力量。在90天和180天时使用改良Rankin量表（mRS）评估主要结局。进行单因素和多因素分析以调查WEC的危险因素。
242例患者中有16例（6.6%）出现WEC。有WEC和无WEC的患者之间，基线特征、卒中危险因素和病变体积无显著差异。有WEC的患者在入院时和卒中后21天的NIHSS - 4评分较高，JFS较低。严重中枢性面瘫（比值比[OR] = 8.1，95%置信区间[CI] = 2.3 - 28.6，P = 0.001）和右半球卒中（OR = 13.
