50例眼肌麻痹病因与临床诊治分析

目的探讨眼肌麻痹的病因、临床特点及治疗效果。方法回顾性分析了50例（50只眼）眼肌麻痹患者的临床资料,根据病史、红玻片复视像检查、眼科检查、实验室检查、影像学诊断,分析发病原因,并对其进行相关治疗。结果 50例中神经血管源性眼肌麻痹42例（84%）,肌源性麻痹3例（6%）,全身免疫性麻痹3例（6%）,机械性麻痹2例（4%）。结论眼肌麻痹病因复杂,仔细分析临床特征,进行全面细致的眼科检查、影像学检查有助于病因诊断及有效的治疗。     

眼肌麻痹的眼外相关病因分析

目的:探讨眼肌麻痹的眼外相关病因。方法:对157例眼肌麻痹患者采用三棱镜、同视机及红玻片等方法进行常规眼科和眼肌检查,辅以血液生化检查和影像学(CT,MRI,DSA)诊断。结果:眼肌麻痹的眼外相关病因主要有糖尿病(23.6%)、颅脑血管疾病(18.5%)、颅脑外伤(15.9%)、炎症性疾病(10.8%)、甲状腺性相关眼病(7.0%)、颅脑肿瘤(4.5%)、重症肌无力(1.9%)、鼻咽癌(1.9%)等。结论:眼肌麻痹病因复杂,对无法用眼部原因解释的双眼复像患者,应进行详细的全身和眼部检查,以明确病因。     

痛性眼肌麻痹综合征5例临床分析

目的 :探讨痛性眼肌麻痹综合征 (TolosaHuntSyn drome)的临床特点。方法 :对 5例痛性眼肌麻痹综合征患者的临床资料进行分析。结果 :5例痛性眼肌麻痹综合征患者均符合诊断标准 ,对激素治疗效果佳 ,4例痊愈 ,1例并发化脓性脑膜炎。结论 :痛性眼肌麻痹病因多样 ,临床表现复杂 ,诊断时应慎重。头颅CT、MRI及动脉造影对其诊断有一定的价值。大部分患者对激素疗效好 ,但需警惕炎症播散     

80例以复视为首发症状的眼外肌麻痹病因分析

目的：探讨以复视为首发症状的眼肌麻痹患者的临床特征、鉴别诊断,探讨其病因及发病机制。方法回顾分析2008至2013年我院神经内科收治以复视症状为主症的眼肌麻痹患者80例,根据病史、详细的查体和眼部检查,分析其发病原因。结果80例病例中,糖尿病性眼肌麻痹24例（动眼神经麻痹16例,外展神经麻痹6例,合并动眼神经、外展神经麻痹2例）,脑血管病20例,动脉粥样硬化性动眼神经、外展神经麻痹18例,颅内动脉瘤者10例,重症肌无力眼肌型2例,躯体形式障碍1例,颅内肿瘤2例,多发性硬化1例,神经梅毒1例,脑干脑炎1例。结论很多神经系统疾病可引起复视的神经眼科体征,其中糖尿病性眼肌麻痹为最主要病因,脑血管病、动脉瘤眼肌麻痹、动脉粥样硬化也是重要原因,其他还有重症肌无力（眼肌型）、躯体形式障碍、颅内占位等。以复视为首发症状的急性眼外肌麻痹病因复杂,容易误诊,临床医生应高度重视,明确诊断,以达到正确治疗。     

儿童眼肌型重症肌无力发生眼肌麻痹的相关因素研究

目的:探讨儿童眼肌型重症肌无力(OMG)患儿发生眼肌麻痹的相关因素。方法:回顾性分析2011-11/2020-05期间就诊于我院的203例儿童OMG患儿,将其分为眼肌麻痹组97例和非眼肌麻痹组106例,对两组患儿的临床资料进行单因素统计分析,对有统计学差异的指标进一步行多因素回归分析。结果:纳入的203例儿童OMG患儿发生眼肌麻痹者97例(47.8%),69例(71.1%)表现为斜视,其次为歪头视物(18例,18.6%)。97例患儿中单眼79例(81.4%),单条眼外肌受累53例(54.6%),其中内直肌19例(35.8%)。眼肌麻痹组和非眼肌麻痹组患儿年龄,血清免疫球蛋白M(IgM),血清游离三碘甲状腺原氨酸(FT3),血清甲状腺球蛋白(TG),采用激素联合治疗(72.2%vs 38.7%)均有统计学意义(P<0.05)。血清FT3水平(OR=2.006,95%CI:1.233~3.263)和采用激素联合治疗(OR=4.328,95%CI:1.936~9.677)是影响儿童OMG患儿发生眼肌麻痹的相关因素。结论:儿童OMG患儿发生眼肌麻痹较常见,单眼多发,内直肌最易受累,较少出现复视。血清FT3可作为评估儿童OMG患儿发生眼肌麻痹的重要免疫指标。     

首诊动眼神经麻痹35例病因分析

目的: 分析首诊动眼神经麻痹的原因及临床特点。方法: 回顾分析2009-01/2012-12在我院首诊为动眼神经麻痹的患者,通过血糖、头颅计算机断层扫描(computed tomography,CT)、磁共振成像(magnetic resonance imaging,MRI)、磁共振血管造影(magnetic resonance angiography,MRA)、数字减影血管造影(digital subtraction angiography,DSA)等检查,分析动眼神经麻痹的原因及特点。结果: 动眼神经麻痹35例中,头部外伤10例(29%),颅内炎性8例(23%),糖尿病6例(17%),颅内动脉瘤4例(11%),颅内肿瘤4例(11%),脑血管梗塞、脑血管出血、原因不明均为1例(3%)。结论: 引起动眼神经麻痹的病因复杂,以头部外伤最常见,其他原因还见于颅内炎性、糖尿病等。各病因在各年龄段分布具有一定特点,有针对性及时准确查明病因极为重要,是正确治疗的基础和关键。     

脑干梗死早期眼球运动异常的特点

目的分析脑干梗死早期眼球运动异常的特点,评价其在早期诊断中的意义。方法收集287例脑干梗死患者的临床资料,选取其中以复视为首发症状的24例患者。回顾性分析所纳入患者的眼部表现、伴随症状及相关检查。结果24例患者中男19例,女5例;发病年龄42～81岁,中位数为64岁。发病危险因素:83.3%(20/24)患者有高血压病史,37.5%(9/24)患冠心病,29.2%(7/24)患糖尿病,12.5%(3/24)患房颤。在伴随症状中,87.5%的患者伴有头晕,16.7%伴有恶心,16.7%伴有肢体共济失调,8.3%伴有眩晕,4.2%伴有对侧肢体无力。发病部位:脑桥梗死14例(58.3%),中脑9例(37.5%),延髓1例(4.2%)。中脑梗死患者的眼肌麻痹均为核性动眼神经麻痹,其中眼球内转异常出现最多(8例)。脑桥梗死引起的眼球运动异常表现多样,有3例表现为核间性眼肌麻痹,3例外展神经麻痹,2例核性动眼神经麻痹,1例为不全性Horner综合征,10例伴有眼球震颤。结论脑干梗死患者眼球运动异常的主要特点包括核性眼肌麻痹、核间性眼肌麻痹、眼球震颤等,神经眼科体征对脑干梗死早期诊断具有提示作用。     

眼肌麻痹的临床表现分析

目的观察眼肌麻痹患者的临床表现,探讨其发病机制。方法回顾性病例研究。收集本科2009年3月~2012年5月37例(41眼)眼肌麻痹患者的相关资料,包括病史、视力、瞳孔、眼底、眼睑、眼球运动、代偿头位、视野、同视机、眼肌超声、颈动脉和球后多普勒超声、眼眶断层扫描(CT)、头部断层扫描血管成像(CTA)、头部磁共振成像(MRI)及纵隔CT检查以及血液生物化学和免疫学检查。结果本组眼肌麻痹患者中,既往有糖尿病史者12例、高血压病史者15例、高血脂病史者11例、心脏病病史者9例、缺血性脑血管病史者4例、甲亢病史者1例。眼球运动受限检查:水平方向受限17例(20眼),垂直方向受限16例(16眼),水平和垂直方向都受限4例(5眼)。微血管缺血性病变引起的眼肌麻痹患者具有较高比例的糖尿病、心脑血管疾病史,同时伴有球后血流速度减低、颈动脉狭窄和斑块形成;特发性颅内压增高患者具备双眼视盘水肿、眼球水平运动受限和视野生理盲点扩大;颅内垂体肿瘤压迫导致眼肌麻痹伴双眼视神经萎缩;甲状腺相关眼病引起的眼肌麻痹者可发现双侧多条眼肌肥厚。结论眼肌麻痹患者的临床表现复杂多样,应进行详细的眼科检查和影像学检查,寻找原发病因,才能进行有针对性的治疗。     

糖尿病性眼肌麻痹

许多原因可发生眼外肌麻痹。糖尿病性眼肌麻痹则比较少见,我们从1979年～1990年11年间共收集本病9例,现报告如下。临床资料本文9例中男5例,女4例;年龄25～63岁,平均45岁,40岁以上者8人(88.89%),眼肌麻痹发生在患糖尿病后6年、8年、12及15年各1例,10年4例。双侧眼肌麻痹1例,单侧8例,动眼神经受累7例,其中1例25岁患者系妊娠期糖尿病患者,分娩后糖     

复视45例的病因分析

目的:探讨复视的病因及临床特点。方法:对复视患者45例进行视力、眼位、眼球运动及复视检查,并进行血液生化和影像学检查,分析复视的发病原因。结果:复视患者45例中单眼复视3例(7%),双眼复视42例(93%)。其中伴眼肌运动障碍的双眼复视40例,病因包括:神经源性29例(64%)(其中脑血栓12例,脑出血7例,颅内肿瘤4例,流感3例,颅内血管瘤1例,颅脑外伤1例,鼻咽癌1例),肌源性3例(7%),神经肌肉接头处病变1例(2%),机械性5例(11%),原因不明2例(4%)。结论:本组患者复视的主要病因为脑血管病,脑肿瘤和眶壁骨折。     

Traumatic Unilateral Internuclear Ophthalmoplegia

A 23-year-old man was admitted for a closed head injury following a fall from a height of 5 meters from a ladder. Because of a C-7 burst fracture, a halo and halo vest were applied approximately 9 hours following the fall. Approximately 21 hours after the accident, the patient complained of diplopia. On neuro-ophthalmology evaluation, a unilateral internuclear ophthalmoplegia was noted. MRI of the brain, performed 3 days after application of the halo and vest, showed a small infarct at the posterior aspect of the inferior midbrain, slightly left of midline. At 9.5 weeks there was 90% improvement of the internuclear ophthalmoplegia noted. Of the reported cases in the medical literature of traumatic internuclear ophthalmoplegia, 30 (83.33%) cases were male and 6 (16.67%) were female. The mean age was 31.7. 54% of the cases were bilateral; 46% unilateral. Mechanisms include: motor vehicle accident: 28 (41.79%), fall: 7 (10.45%), blunt trauma: 11 (16.42%), penetrating trauma 1: (1.49%), bike accident 3: (4.48%), other: 1 (1.49%), Unknown: 16 (23.88%).     

Traumatic unilateral internuclear ophthalmoplegia

A 23-year-old man was admitted for a closed head injury following a fall from a height of 5 meters from a ladder. Because of a C-7 burst fracture, a halo and halo vest were applied approximately 9 hours following the fall. Approximately 21 hours after the accident, the patient complained of diplopia. On neuro-ophthalmology evaluation, a unilateral internuclear ophthalmoplegia was noted. MRI of the brain, performed 3 days after application of the halo and vest, showed a small infarct at the posterior aspect of the inferior midbrain, slightly left of midline. At 9.5 weeks there was 90% improvement of the internuclear ophthalmoplegia noted. Of the reported cases in the medical literature of traumatic internuclear ophthalmoplegia, 30 (83.33%) cases were male and 6 (16.67%) were female. The mean age was 31.7. 54% of the cases were bilateral; 46% unilateral. Mechanisms include: motor vehicle accident: 28 (41.79%), fall: 7 (10.45%), blunt trauma: 11 (16.42%), penetrating trauma 1: (1.49%), bike accident 3: (4.48%), other: 1 (1.49%), Unknown: 16 (23.88%).     

颅内动脉瘤眼部表现的临床分析

目的：探讨颅内动脉瘤引起的眼部病变。方法：回顾近5年来在我院神经科住院并确诊为颅内动脉瘤的39例患者的临床资料，对其引起的眼部病变进行着重分析。结果：39例中有眼部改变者22例（56.41％）。22你（22只眼，56.41％）均有眼肌麻痹；伴有视力下降者8例（8只眼，20.51％）；眼球及眼眶疼痛者8例（8只眼，20.51％））；眼底改变者3例（4只眼，7.69％）；视野缺损者2例（4只眼，5.13％）；角膜反射减弱者2例（2只眼，5.13％）；流泪者1例（1只眼，2.56％）；眼睑皮肤感觉下降者1例（1只眼，2.56％）。以上睑下垂、复视为主诉到眼科首诊的患者有9例（23.08％）。结论：颅内动脉瘤可引起眼部多种病变，其中最常见的病变为眼肌麻痹。     

Anti‐GM1 antibodies: the cause of otherwise unexplained ophthalmoplegias?

PURPOSE: To report four patients with otherwise unexplained ophthalmoplegia who were found to have elevated levels of anti-GM1 antibodies. METHODS: Retrospective chart evaluation of 50 consecutive patients with otherwise unexplained ophthalmoparesis. All patients were tested for anti-GM1 antibodies. RESULTS: Six out of 50 cases (12%) were found to have elevated anti-GM1 antibodies, far greater than the 2.7% found in the general population. Four of the subjects with elevated anti-GM1 antibodies are reported. CONCLUSION: Although the mechanism and relationship between the neural antibodies and ophthalmoparesis is not understood, it is proposed that the presence of anti-GM1 antibodies should be considered in cases of otherwise unexplained ophthalmoplegia.     

老年人眼外肌麻痹的原因分析

目的探讨老年人眼外肌麻痹的临床病因及特点。方法对113例以复视为首发症状的眼外肌麻痹患者的临床资料进行回顾性研究,依据病史、临床检查分析发病原因,并对其进行相关治疗。结果眼外肌麻痹的发病部位以核性及核下性眼球运动障碍为主,占83．19％。发病原因以血管性疾病为主,占49．56％。受累部位以动眼神经麻痹占首位为36．28％外展神经麻痹次之,占30．09％。单条眼外肌麻痹较多条肌肉麻痹多见,其中以内直肌受累居多。结论以复视为首发症状的老年人眼外肌麻痹多见,其中以内直肌受累居多。结论以复视为首发症状的老年人眼外肌麻痹病因复杂,以血管性疾病多见,以核及核下性损害为主,动眼神经麻痹占首位。必须及早检查,明确诊断,并给予相关治疗,以免误诊,应引起重视。     

Trochlear nerve palsy in herpes zoster opthalmicus

Herpes zoster ophthalmicus (HZO) causes a wide range of ocular manifestations, and ophthalmoplegia is among the infrequent complications. The most commonly affected nerve is the third nerve, the least affected is the trochlear nerve. Herein, we describe two cases of isolated fourth nerve palsy associated with HZO. In both cases, the onset of ophthalmoplegia was shortly after the appearance of skin lesions, and both of the patients received oral acyclovir. Complete recovery was observed in a period of a few months.     

Saccadic eye movements in myasthenia gravis

The peak velocities of horizontal saccades were measured in patients with myasthenia gravis (MG) to determine whether they can differentiate MG from other causes of ophthalmoplegia. Eye movements were recorded with electrooculography (EOG) or infrared scleral reflection (IR) in 42 patients with MG, 26 patients with sixth cranial nerve palsy (CNP), 19 patients with chronic progressive external ophthalmoplegia (PEO) and 28 normal subjects. Despite limitation of ductions in MG, the group means of velocities of 10 deg saccades recorded with IR were similar in MG and normal subjects. With EOG, small but statistically significant decreases in mean velocities of 10, 20 and 30 deg saccades were found in MG, compared to those in normal subjects. Twenty-one to 28% of MG patients had velocities outside of the normal range (outliers). In contrast, the group means in CNP and PEO were markedly lower than those in MG and normal subjects. The frequencies of outliers were 89 to 100% in CNP and 88 to 100% in PEO. Measurement of saccadic velocities can be helpful in differentiating MG from other causes of ophthalmoplegia.     

Internuclear ophthalmoplegia. An electro-oculographic study of peak angular saccadic velocities.

Peak angular saccadic velocities were measured during 30 degrees saccades in 18 patients with internuclear ophthalmoplegia who had full or nearly full adduction range, and 25 normal subjects. The following observations were made: 1. In the normal group adduction velocities were significantly faster than abduction velocities and centring movements were faster than decentring movements. 2. In patients with internuclear ophthalmoplegia adduction movements were significantly slower than in normal subjects and were significantly slower than abduction velocities. 3. Abduction velocities in patients with internuclear ophthalmoplegia were significantly slower than abduction velocities in normal subjects. It was concluded that measurements of peak angular velocities during saccades may be useful in detecting internuclear ophthalmoplegia or confirming the presence of suspected internuclear ophthalmoplegia. Slow abduction suggests that many patients with internuclear ophthalmoplegia (60 per cent in this series) have lesions affecting the supranuclear pathways subserving horizontal conjugate gaze.