Internal Medicine, Saitama Citizens Medical Center, Saitama-shi, Saitama, Outside of the US, Japan
Internal Medicine, Saitama Citizens Medical Center, Saitama-shi, Saitama, Outside of the US, Japan.
BMJ Case Rep. 2024 Apr 25;17(4):e259534. doi: 10.1136/bcr-2023-259534.
Facial paralysis presents as unilateral mouth drooping and lagophthalmos. The main causes of peripheral facial paralysis are Bell's palsy and Ramsay-Hunt syndrome. However, rarely occurring pontine infarctions of the facial nucleus also manifest a lower motor neuron pattern of facial paralysis. We report a case of a man in his 50s who presented to the emergency department with unilateral peripheral facial paralysis. The initial diffusion-weighted images were unremarkable, and the patient was managed as per guidelines for hypertensive encephalopathy or Bell's palsy. On the 3rd day after admission, he was diagnosed with left pontine infarction and suspected infarction of the left anterior inferior cerebellar artery. We propose that in similar cases, re-examination of imaging results should be considered, as diffusion-weighted imaging is characteristically prone to generate false-negative results in patients with early onset or posterior circulation infarction.
面瘫表现为单侧口角下垂和眼睑闭合不全。周围性面瘫的主要病因是贝尔麻痹和 Ramsay-Hunt 综合征。然而，面神经核的罕见的脑桥梗死也表现为下运动神经元模式的面瘫。我们报告了 1 例 50 多岁男性，因单侧周围性面瘫到急诊科就诊。最初的弥散加权成像未见异常，患者按照高血压脑病或贝尔麻痹的指南进行治疗。入院后第 3 天，他被诊断为左侧脑桥梗死和左侧小脑前下动脉可疑梗死。我们建议，在类似的情况下，应考虑重新检查影像学结果，因为弥散加权成像在早期发病或后循环梗死的患者中容易产生假阴性结果。
