Park Hanna, Kim Youn-Jung, Kim Won Young
Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
Diagnostics (Basel). 2025 Aug 24;15(17):2135. doi: 10.3390/diagnostics15172135.
The need for routine brain magnetic resonance imaging (MRI) for patients presenting with unilateral facial palsy in the emergency department (ED) is a subject of ongoing debate. This study aimed to evaluate the diagnostic yield of MRI in this population and to identify clinical risk factors associated with non-idiopathic causes, to inform selective imaging strategies. This single-center, retrospective study was conducted in the ED of a tertiary-care center in Korea. We analyzed adult patients (aged ≥ 18 years) who presented with facial palsy as the primary symptom between 1 January 2020 and 31 December 2022. Patients with other neurological abnormalities detected during the initial examination or those who did not undergo brain MRI were excluded. The primary outcome was the identification of positive MRI findings, defined as brain lesions (e.g., ischemic stroke, tumor, and hemorrhage) considered causally related to the facial palsy based on anatomical correlation and radiological interpretation. Patients were categorized into positive or negative MRI groups accordingly, and baseline characteristics were compared between the groups. Among the 436 patients who underwent brain MRI, 13 (3.0%) showed positive findings such as brain tumors or stroke that led to diagnoses other than Bell's palsy, while the remaining 423 (97.0%) were ultimately diagnosed with Bell's palsy. The proportion of patients with a history of transient ischemic attack/stroke and malignancy was significantly higher in the group with non-idiopathic facial palsy ( = 0.02 and < 0.001, respectively). In adults presenting to the ED with clinically isolated unilateral facial palsy and no other neurological signs, routine brain MRI had a low diagnostic yield (3%). A history of malignancy or prior TIA/stroke was associated with alternative diagnoses. A selective imaging strategy based on risk factors may improve diagnostic efficiency without compromising safety.
对于急诊科（ED）中出现单侧面瘫的患者，是否需要进行常规脑磁共振成像（MRI）仍是一个持续争论的话题。本研究旨在评估MRI在该人群中的诊断价值，并确定与非特发性病因相关的临床风险因素，以指导选择性成像策略。这项单中心回顾性研究在韩国一家三级医疗中心的急诊科进行。我们分析了2020年1月1日至2022年12月31日期间以面瘫为主要症状就诊的成年患者（年龄≥18岁）。排除初次检查时发现其他神经异常的患者或未接受脑MRI检查的患者。主要结局是确定MRI阳性结果，即根据解剖相关性和影像学解释，被认为与面瘫有因果关系的脑病变（如缺血性中风、肿瘤和出血）。患者据此分为MRI阳性或阴性组，并比较两组的基线特征。在436例接受脑MRI检查的患者中，13例（3.0%）显示出阳性结果，如脑肿瘤或中风，导致诊断为贝尔面瘫以外的疾病，而其余423例（97.0%）最终被诊断为贝尔面瘫。非特发性面瘫组中既往有短暂性脑缺血发作/中风和恶性肿瘤病史的患者比例显著更高（分别为=0.02和<0.001）。对于临床上孤立出现单侧面瘫且无其他神经体征的成年急诊患者，常规脑MRI的诊断价值较低（3%）。恶性肿瘤病史或既往TIA/中风与其他诊断相关。基于风险因素的选择性成像策略可能在不影响安全性的情况下提高诊断效率。
