Bushara K, Wilson A, Rust R S
Department of Neurology, University of Wisconsin, Madison, USA.
Pediatr Neurol. 1997 Nov;17(4):362-4. doi: 10.1016/s0887-8994(97)00103-3.
Facial nerve palsy, a very rare complication of Kawasaki syndrome, has been reported in only 25 patients. We treated a 12-week-old boy with bilateral coronary artery aneurysms due to Kawasaki syndrome who developed marked unilateral peripheral facial nerve palsy on day 36 of illness. None of the 25 previously reported patients with this complication were treated with immunoglobulin; they required 7 to 90 days to recover. In our patient, treatment with this agent was associated with complete resolution of facial nerve palsy within 36 hours. Review of prior cases demonstrates that children with Kawasaki-associated facial nerve palsy have more than twice the risk for coronary artery aneurysm (52% vs <25%) as that of children who do not develop this neurological complication. Unexplained facial nerve paralysis in young children with a prolonged febrile illness should provoke consideration of Kawasaki syndrome and of echocardiography to exclude coronary artery aneurysms. Although facial palsy appears likely to resolve in all patients that survive the acute phase of Kawasaki syndrome, treatment with intravenous immunoglobulin appears to considerably shorten the time to full recovery and provides an important clue to the mechanisms of neurological injury in this illness.
面神经麻痹是川崎病一种非常罕见的并发症，仅有25例相关报道。我们治疗了一名12周大的男孩，他因川崎病患有双侧冠状动脉瘤，在发病第36天出现明显的单侧周围性面神经麻痹。之前报道的25例有此并发症的患者均未接受免疫球蛋白治疗；他们需要7至90天才能恢复。在我们的患者中，使用该药物治疗后，面神经麻痹在36小时内完全消退。回顾之前的病例表明，患有川崎病相关面神经麻痹的儿童发生冠状动脉瘤的风险是未发生这种神经并发症儿童的两倍多（52%对<25%）。患有持续性发热疾病的幼儿出现不明原因的面神经麻痹时，应考虑川崎病并进行超声心动图检查以排除冠状动脉瘤。尽管面神经麻痹似乎在所有度过川崎病急性期的患者中都可能恢复，但静脉注射免疫球蛋白治疗似乎能显著缩短完全恢复的时间，并为该疾病神经损伤的机制提供了重要线索。
