一54歲男性，有吸菸之習慣，具高血壓之病史，因右側顏面肌肉無力1日而就診。來診時高血壓為193/129 mmHg，再確認後為207/130 mmHg。理學檢查顯示右側周邊型顏面麻痺 （House-Brackmann面神經分級第4級），尚無其他神經學病症或徵候。然而，腦部電腦斷層顯示右側橋腦有一低密度的區域，磁振造影證實僅是血管旁空間，但是，梯度迴訊時序T2*權重影像顯示右側上橋腦有陳舊性的出血。本個案之週邊型顏面麻痺傾向是貝爾氏麻痺所致或與第3級高血壓有關。貝爾氏麻痺是國內顏面麻痺最常見的原因，但在診治時，需注意患者是否同時具有心血管疾病或是腦出血的風險因子，不要忽略相關的風險告知或密切追蹤。

A 54-year-old male smoker with hypertension presented with right-sided facial muscle weakness for one day. At emergency, his blood pressure values were respectively 193/129 mmHg and 207/130 mmHg at initital and re-measurement. Physical examination showed right peripheral-type facial palsy (House-Brackmann Facial Nerve Grading IV) with no presence of other neurologic focal symptoms or signs. However, brain computed tomography identified  in the right pons a hypodense lesion, which was later confirmed to be a perivascular space (Virchow-Robin space) as indicated by the magnetic resonance image. Gradient echo T2* weighted image, on the other hand, showed the trace of remote hemorrhage in the right upper pons. Based on the examination results, the right peripheral-type facial palsy appeared to be either attributable to Bell’s palsy or associated with stage 3 hypertension. Although Bell’s palsy contributes to most facial palsies in Taiwan, a potential brain organic lesion should be considered if a patient has any risk factor of cardiovascular disease or brain hemorrhage; the patient needs to be duly informed of related risks and follow-up shold be initiated withhout hesitation.