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。     

首发为动眼神经麻痹糖尿病的临床分析

目的 探讨以动眼神经麻痹为首发症状的糖尿病性动眼神经麻痹的临床特征，以提高对该病的重视，达到及早治疗。方法 对24例糖尿病性动眼神经麻痹的临床资料进行回顾性分析。结果 24例患者均以动眼神经麻痹为首发，缺乏糖尿病的典型症状，均为单眼受累，动眼神经眼外肌麻痹16例，合并跟内肌麻痹8例，其中不完全动跟神经麻痹16例（66．7％），完全性麻痹8例（33．3％），24例患者经过及时治疗均完全恢复。结论 1．本病突然发病，其发病机制与微血管病变及代谢障碍有关，多为单侧不完全性动眼神经麻痹。2．眼科医师要重视病因检查，及时诊治，有利于功能早期恢复。     

4例动眼神经麻痹病因分析

目的 分析引起动眼神经麻痹的不同病因.方法 回顾性研究4例(4只眼)以动眼神经麻痹首诊于眼科的颅脑疾病的临床资料.结果 颈内-后交通动脉瘤2例,颈内动脉床突上段动脉瘤1例,垂体瘤1例.结论 首诊于眼科的动眼神经麻痹病因复杂,应考虑颅脑疾病及全身系统疫病,完善相关影像学检查(头颅CT、MRI、CTA或DSA)及血糖等检查.     

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。     

动眼神经麻痹临床特征及病因分析——单中心研究

目的总结首诊眼科的动眼神经麻痹患者的临床特征及病因。方法单中心病例回顾性分析。收集2013年5月～2021年8月间复旦大学附属眼耳鼻喉科医院神经眼科就诊及转诊诊断为动眼神经麻痹者资料,对其人口学特征、发病特征、临床及影像学表现、病因以及转归进行分析。结果 143例确诊为动眼神经麻痹患者,其中男性74例、女性69例;平均年龄为(45.2±20.6)岁(3～89岁);平均病程为(2.9±7.6)年。单纯性动眼神经麻痹110例(76.9%),合并其他脑神经及神经系统疾病的33例(23.1%)。病因依次为外伤(23例,16%)、炎症(23例,16%)、缺血(21例,14.7%)、肿瘤(20例,14.0%)及动脉瘤/动静脉瘘(18例,12.6%)等。其他病因包括核性、放射损伤及医源性等。少见病因包括周期性发作性动眼神经麻痹伴痉挛发作、神经肌强直等。2例患者病因不明。81例患者预后良好,后无明显上睑下垂及复视。结论动眼神经麻痹是导致上睑下垂及复视的重要疾患,老年人群中缺血性占比高;动脉瘤/动静脉瘘虽然仅占12.6%,但危及生命,为神经眼科急症。     

95例单侧动眼神经麻痹的临床研究

目的分析单侧动眼神经麻痹的病因、治疗方法、效果以及预后情况。方法回顾性分析本院1995年5月-2005年5月诊断为单侧动眼神经麻痹的95例住院患者。结果单侧动眼神经麻痹的主要病因为颅内动脉瘤（49.5%）,进一步分析表明绝大多数（87%）患者动脉瘤位于基底节或是后交通动脉附近;其次为糖尿病性外周神经麻痹（26.3%）;虽然经一系列的检查（如：DSA、MRI、颈内血管超声等）仍有11.5%的患者不能明确致病原因。单侧动眼神经麻痹患者预后不佳,有26.3%的患者虽然经过多种治疗方案（如：营养神经,改善微循环,降低血糖或血脂等）病情仍然没有改变,51.5%患者经过一定周期治疗后病情好转,但是治愈率仅22.2%。收入单侧动眼神经麻痹患者最多的三个科室依次为神经内科,神经外科以及内分泌科;而眼科只占到了9.5%,其中绝大多数是外伤患者（5例）。结论引起单侧动眼神经麻痹的病因多样,而预后除糖尿病性麻痹外一般不佳;仍需临床资料的不断积累才能确定各种病因引起的单侧动眼神经麻痹患者的最佳治疗方案;眼科医生临床遇单侧动眼神经麻痹的患者应该充分考虑颅内动脉瘤的危险性。     

糖尿病性眼肌麻痹临床分析

目的　探讨老年人糖尿病性眼肌麻痹的临床特点和发病机制。方法　常规眼科检查和眼肌专科检查及实验室生化检查确诊为糖尿病性眼肌麻痹 2 4例 (2 4只眼 ) ,部分病例辅以影像学检查。结果　 2 4例均匀单眼发病 ,受累颅神经以动眼神经最多见 13例 (13只眼 ) ,其次为外展神经 9只眼 ,滑车神经 1只眼。结论　老年人糖尿病患者易合并眼肌麻痹 ,其发病可能与微血管病变有关     

变化多端——2例周期性动眼神经麻痹伴痉挛发作病例分析

周期性动眼神经麻痹伴痉挛发作(cyclic oculomotor nerve paresis with spasms,COPS)为罕见性、发作性动眼神经功能障碍。病因可分为先天性及获得性。患者表现为动眼神经麻痹期与痉挛期交替发作。由于患者临床表现复杂、多变,如果缺乏对该病的认识将导致不当的治疗,甚至手术。我们通过对2例成人患者临床特征的分析,总结该病的诊断要点及处理。1病例病例1男性,20岁,自幼家长发现其右眼睑裂较左侧小。     

123例单纯性动眼神经麻痹的MRI病因学分析

目的 探讨单纯性动眼神经麻痹的MRI表现及病因。设计 回顾性病例系列。研究对象123例单纯性动眼神经麻痹患者。方法 回顾性分析患者的MRI表现,结合动眼神经的解剖特点,分析动眼神经麻痹的病因。主要指标  MRI表现。结果 123例动眼神经麻痹病例中,MRI表现异常者87例（70.7%）。其中海绵窦区病变62例（71.2%）（炎症45例,颈内动脉动脉瘤8例,鼻咽部/蝶窦/鞍区/鞍旁占位性病变累及海绵窦者6例,颈内动脉海绵窦瘘2例,颈内动脉海绵窦段增粗迂曲1例）;脑干病变16例（18.4%）（中脑梗塞15例,中脑炎症1例）;颅眶沟通性病变5例（5.7%）（炎症3例,肿瘤2例）;动眼神经脑池段及其周围病变4例（4.6%）（动眼神经炎性病变2例,动眼神经神经鞘瘤1例,脚间池胆脂瘤压迫动眼神经1例）。结论 单纯性动眼神经麻痹的病因多样,海绵窦区病变占大多数。MRI检查有助于明确动眼神经麻痹的病因。（眼科, 2015, 24： 304-308）     

老年人糖尿病性眼肌麻痹的临床分析

目的：探讨老年人糖尿病性眼肌麻痹的临床特点和发病机制。方法：常规的眼科检查和眼肌专科检查，内科行全身检查及实验室血生化检查以确诊糖尿病；部分病例辅以影像学检查。结果：３９例老年人糖尿病患者多数为单眼患病；受累颅神经以动眼神经最多２１例２３只眼，以后依次为外展神经１２例，滑车神经和复合神经麻痹各３例。动眼神经麻痹中５例为伴随上睑下垂和瞳孔变化的完全性动眼神经麻痹。大多数患者合并有高血压，近半数患者有     

Cause and prognosis of neurologically isolated third, fourth, or sixth cranial nerve dysfunction in cases of oculomotor palsy

Purpose To determine the cause and prognosis of neurologically isolated third, fourth, or sixth cranial nerve dysfunction in cases of oculomotor palsy, and to determine the best imaging methods to make a correct diagnosis. Methods The medical records of 221 consecutive patients with oculomotor palsy caused by neurologically isolated cranial nerve dysfunction were reviewed. There were 63 cases of third, 41 of fourth, and 117 of sixth cranial nerve dysfunction. The patients were examined at the Neuro-ophthalmology Clinic of Kyoto University Hospital between 1993 and 2001. Results Vascular disorders accounted for 34.9% of the third nerve dysfunction, and 90% of these recovered completely in 6 months. Ninety percent of the patients with an isolated third nerve dysfunction that was caused by an aneurysm also had anisocoria, and 68% of the patients with a third nerve dysfunction caused by a vascular disorder had anisocoria. In all of the vascular cases with anisocoria, the difference in the pupillary diameter was <1.0 mm. The presence of ptosis did not play an important role in making a diagnosis of third nerve dysfunction. Ninety percent of the patients with fourth nerve dysfunction and 60% of the patients with sixth nerve dysfunction recovered within 9 months. Conclusions The age of the patient, signs of an improvement, and associated alterations are important diagnostic markers to determine the best type of imaging methods for evaluating neurologically isolated third, fourth, and sixth cranial nerve dysfunction.     

Paralysis of the oculomotor nerve caused by aneurysm--general facts and a case report

One of the most frequent etiology of oculomotor nerve palsy are intracerebral aneurysms. Due to anatomical facts (its course and main relations with vascular structures of the brain) lesions of the oculomotor nerve often occur. In this paper there are presented essential issues concerning neuroanatomy of the III-rd cranial nerve pair main locations of the cerebral aneurysms in order to investigate the effect of nerve compression, clinical data regarding the palsy of the oculomotor nerve due to a cerebral aneurysm, the treatment and post surgery recovery followed by a clinical report.     

颅底动脉瘤的眼部改变

目的：探讨颅底动脉瘤的早期眼部改变，避免误诊。方法：回顾性对30例颅底动脉瘤的眼部改变进行分析。结果：临床表现有4组：①单纯颅神经受压症状6例。②自发性颈动脉海绵窦瘘5例。③轻度蛛网膜下腔出血伴有颅神经受压症状6例。④蛛网膜下腔出血为主者4例。总计颅神经受压症状中，动眼神经麻痹16只眼(53％)，外展神经麻痹11只眼(37％)，三叉神经麻痹11只眼(37％)，视神经受损导致的视力减退9只眼(30％)。视神经萎缩5只眼(17％)，视乳头水肿2只眼(7％)。结论：中年以上原因不明的明显头痛伴有动眼神经等颅神经障碍者，自发性颈动脉海绵窦瘘者应警惕到颅底动脉瘤的可能。     

Acute Transient Oculomotor Nerve Palsy from Presumed Cavernous Angioma in an Infant

Cavernous angiomas of the cranial nerves are extremely rare, and those of the oculomotor (third) cranial nerve are rarer still, with no previous cases having been reported in the literature. We report herein the first case of a presumed cavernous angioma involving the subarachnoid portion of the left third nerve presenting as an acute left third nerve palsy in an infant. The child was followed without intervention and the palsy completely resolved. Given the poor functional results with attempted surgical excision and the potential for spontaneous improvement in oculomotor nerve function, it is reasonable to follow patients with these lesions without intervention.     

头颅外伤患者的眼运动神经麻痹(英文)

目的:了解头颅外伤患者眼运动神经麻痹的情况。方法:收集2006-03/2006-09 Shahid Rahnemon医院神经外科收治的300名头颅外伤患者的资料,包括眼科检查和调查问答,采用SPSS软件卡方和F检验进行数据分析。结果:300例患者中242例为男性(81. 1% ), 58例为女性(18.9% ),年龄为1~87(平均46)岁。意外跌伤是头部外伤最常见的原因,共247例患者(82. 3% )因此致伤;大多数患者的GCS得分为13~15(82.3% )。最多见的颅脑外伤为硬膜下腔、蛛网膜下腔出血。滑车神经或外展神经麻痹(28.6% )、其他眼运动神经麻痹或同时两处眼运动神经麻痹(常见第3颅神经和第4颅神经麻痹,14.3% )是最常出现的情况。结论:虽然头颅外伤同时出现颅神经麻痹的几率较小,但是在急诊时应根据情况进行神经眼科检查。     

High-resolution magnetic resonance imaging of the extraocular muscles and nerves demonstrates various etiologies of third nerve palsy

PURPOSE: The etiology of third nerve palsy is usually diagnosed by history, motility examination, and presence of lid and pupil involvement, as well as cranial and vascular imaging. We used high-resolution magnetic resonance imaging (hrMRI) of the oculomotor nerve and affected extraocular muscles (EOMs) to investigate oculomotor palsy. DESIGN: Prospective, noncomparative, observational case series in an academic referral setting. METHODS: Twelve patients with nonaneurysmal oculomotor palsy of 0.75 to 252 months' duration were studied. In the orbit and along the intracranial oculomotor nerve, hrMRI at 1- to 2-mm thickness was performed. Coronal plane images of each orbit were obtained in multiple, controlled gaze positions. Structural abnormalities of the oculomotor nerve and associated changes in EOM volume and contractility were evaluated. RESULTS: Cases were categorized as tumor related, congenital, diabetic, traumatic, and idiopathic according to clinical characteristics and hrMRI findings. Reduction of volume and contractility of affected EOMs were noted in six patients; however, there was no marked EOMs atrophy in two cases of diabetic oculomotor palsy, and there were four cases of aberrant regeneration. hrMRI demonstrated the oculomotor nerve at the midbrain and at EOMs in all cases, and in two cases with previous normal neuroimaging elsewhere that demonstrated contrast-enhancing tumors on the oculomotor nerve. One patient with apparently unilateral congenital inferior division oculomotor palsy had no detectable ipsilateral and a hypoplastic contralateral oculomotor nerve exiting the midbrain. CONCLUSIONS: hrMRI provides valuable information in patients with oculomotor palsy, such as structural abnormalities of the orbit and oculomotor nerve, and atrophy and diminished contractility of innervated EOMs. This information could be helpful in diagnosis and management of oculomotor palsy.     

神经梅毒患者22例神经眼科表现分析

目的:分析神经梅毒患者神经眼科表现的临床特征.方法:采用回顾性、非随机对照病例分析方法.共分析神经梅毒患者22例39眼,其中男17例30眼,女5例9眼,年龄34~65(平均49.6)岁.描述并分析患者临床表现,包括视力、瞳孔、视神经、视网膜脉络膜改变以及与眼球运动相关的颅神经病变.并分析血清及脑脊液检验结果.结果:临床表现为视神经萎缩11例22眼,其中1例1眼伴左眼动眼神经麻痹;视神经炎急性期3例5眼,视神经视网膜炎4例6眼;伴有视盘水肿的脉络膜视网膜炎1例2眼;视网膜中央动脉阻塞1例1眼;仅表现为阿罗瞳孔2例3眼.在所有病例中,有阿罗瞳孔体征的共10例19眼.所有患者血清梅毒螺旋体抗原凝集试验(TPPA)检查均为阳性,21例行梅毒快速血浆反应素实验(RPR),19例阳性,2例阴性.所有患者均行腰椎穿刺,检测脑脊液RPR、脑脊液蛋白、白细胞计数,13例脑脊液RPR阳性,18例脑脊液蛋白大于450mg/L,13例脑脊液白细胞计数大于5个/mm3.结论:累及神经眼科的神经梅毒患者多发于中老年男性,亚急性起病,临床表现多样,多为双眼同时或相继发生的视神经疾患,少数可表现为视神经以外的其他颅神经麻痹,容易误诊而导致不能及时进行病因学治疗,造成视功能严重损害.综合病史、临床表现、眼科检查及血清、脑脊液等实验室检查可提高诊断率.     

Herpes zoster ophthalmicus with subsequent oculomotor paralysis and homolateral media infarct

Oculomotor palsy is a well-known complication of herpes zoster ophthalmicus (HZO). Combination with homolateral cerebral media infarction and contralateral hemiplegia is very rare. Since the first paper on HZO and cerebral ischemia was published, in 1919, about 70 cases have been described. Zoster infection is thought to encroach from the fifth cranial nerve on to a cerebral artery at the base of the brain. The authors describe a case of HZO seen by them, with oculomotor palsy and ipsilateral media infarction with contralateral hemiplegia and aphasia. A review of the literature is given and etiologic and therapeutic aspects are discussed.     

Oculomotor palsy and papilledema with pial-dural arteriovenous malformation

A 62-year-old man presented with papilledema, a cranial bruit, and a partial left oculomotor nerve palsy. Arteriography revealed a large mixed pial-dural arteriovenous malformation involving the superior sagittal and both transverse sinuses. After the superior part of the malformation was embolized, the patient's papilledema and ocular motility disturbance resolved. The oculomotor disturbance may have been a nonspecific sign of increased intracranial pressure. Cranial auscultation should be performed in all cases of papilledema and cranial nerve palsy.