后交通动脉瘤致急性动眼神经麻痹1例

1临床资料 患者，女，51岁，2d前无明显诱因出现头痛、视物成双、视物旋转，伴恶心，同时右眼睁开费力，无四肢无力、耳呜、吞咽困难及饮水呛咳，既往体健。在当地医院测血压170／90mmHg（1kPa=7，5mmHg），血糖正常，颅脑CT检查未见明显异常，给予降压药口服，症状未见改善。于2004年12月25日来我院就诊，视力右眼0．8、左眼1．0，右眼完全性上睑下垂，     

基底动脉瘤致动眼神经麻痹1例

患者 ,女 ,4 5岁 ,因“复视 3d ,左眼上睑下垂 2d”入院。患者于 2 0 0 3年 3月 2 2日晨起发现视物重影 ,未诊治 ,第二天晨起则发现左眼完全睁不开 ,伴左太阳穴皮肤麻木感 ,同侧眉骨胀痛 ,即来我科诊治 ,CT和MRI检查未发现明显异常 ,门诊以“左侧动眼神经麻痹”收入院。身体检查 :T :37.2℃P :76次 /minR :2 0次 /minBP :135 /80mmHg ;VOD:0 .6 ,矫正为1.0 ;VOS:0 .3,矫正为 1.0。右眼 (- )。左眼上睑完全不能上抬 ,掰开左眼 :眼球呈外斜状态 ,完全不能内转和上转 ,下转受限 ,瞳孔 8mm大小 ,直接对光反射消失 ,间接对光反射弱 ,眼底…     

首发为动眼神经麻痹的后交通脑动脉瘤患者不同手术时间的疗效观察

动眼神经麻痹在临床上表现为麻痹性斜视、复视,上睑下垂、眼球运动障碍等,常见于头颅外伤、先天畸形、糖尿病高血压引起的微血管梗塞后遗症等.     

后交通动脉瘤误诊为动眼神经麻痹2例分析

动眼神经麻痹在临床上比较多见，但其原因较复杂，往往只注意表面症状，而造成误诊。1病例介绍例1，患者，女，44岁，因“右眼眶部疼痛，伴有视物不清3天”来我院门诊。查体：患者神清语明，血压正常，右眼视力0．1，左眼视力1．0，右眼上睑明显下垂，眼球明显外斜，向内、向上、向下活动受限，结膜无充血，角膜透明，前房清，深浅正常，瞳孔散大约7mm，对光反射消失。晶体及眼底正常。眼压正常，辅助检查：右眼眶及副鼻窦拍X线片均正常。     

单纯动眼神经麻痹病因分析

目的 探讨动眼神经麻痹的病因。方法 回顾近5年来在我院神经科住院并确诊为动眼神经麻痹的144例患者的临床资料，对其病因进行分析。结果 缺血性病变是其主要病因，其次是动脉瘤。结论 动眼神经麻痹应早期明确诊断，早期给予改善供血或行动脉瘤手术治疗预后较好。     

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。     

首诊眼科的后交通动脉瘤致动眼神经麻痹2例

0引言后交通动脉瘤通常指颈内动脉-后交通动脉分叉处的动脉瘤,在我国的颅内动脉瘤中所占的比率居第一位[1,2]。颅内动脉瘤是一种潜在的致命性疾病,发病前无明显先兆、起病急、症状重、致死率及致残率高,动脉瘤破裂引起的颅内出血是其致死、致残的主要原因[3,4]。重视颅内动脉瘤的早期症状,早发现、早治疗是预防其破裂出血的根本途径。动眼神经自脑干发出后,在进入海绵窦前与后交通动脉并行,位于后交通动脉的外下方,因此后交通动脉常引起同侧动眼神经麻痹,出现相应的眼部表现[5]。临床上,以动眼神经麻痹为首发症状的颅内动脉瘤约占18%,许多患者因复视、上睑下垂首诊于眼科。现将我们收集的2例因动眼神经麻痹首诊眼科的     

以动眼神经麻痹为首发的颅内动脉瘤一例

颅内动脉瘤是神经系统常见疾病,发病率为0.9%[1]。部分颅内动脉瘤的首发症状表现在眼部,因此能够识别颅内动脉瘤对眼科医生至关重要。李××女53岁2005年4月27日以左眼动眼神经麻痹入院。查血糖5mmol/L,血压120/80mmHg。双眼视力均为1.0,双眼眼压均正常。左眼上睑完全不能睁开,眼球向上、下、内不能转动,结膜充血,余未见明显异常。头部CT及MRI均未见明显异常,建议其行DSA检查,因向有危险性,患者拒绝。行抗炎、抗病毒治疗,地塞米松结膜下注射。治疗5天后症状无明显好转,患者同意行数字减影脑血管造影检查(DSA)。回报:大脑后交通动脉上…     

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.     

后交通动脉瘤误诊为动眼神经麻痹1例

王××　女　 6 8岁　以右侧眼眶疼痛伴眼球运动受限2 0天为主诉来我院门诊。曾在外院诊断为“右眼动眼神经麻痹” ,给予营养神经及扩张血管等药物治疗 ,效果不佳。头颅计算机断层扫描检查未见异常。为进一步治疗前来我院眼科。患者既往体健 ,高血压 3年 ,否认外伤史。查体 :T 36 5 ,P 80次 /分 ,R 2 0次 /分 ,BP 16 0 / 70mmHg神志清 ,精神差 ,头颅无畸形 ,心肺腹未见异常。视力 :右眼0 1,左眼无光感。右眼上睑下垂 ,眼外展位 ,向内、向上、向下活动受限 ,向内不能过中线 ,结膜轻度充血 ,角膜清 ,前房深浅正常 ,瞳孔散大约 7mm ,对光…     

Transient partial oculomotor nerve paresis with posterior communicating artery aneurysm. A case report

A 38-year-old woman is described who developed a partial right oculomotor paresis which cleared spontaneously prior to clipping of an associated nonhemorrhagic bilobate right anterior communicating artery aneurysm.     

Third nerve palsy due to cerebral artery aneurysm in a child

We report a case of cerebral aneurysm in a seven-year-old girl who presented with subacutely progressive third nerve palsy. To our knowledge this is the youngest reported patient with this condition. Confusion with myasthenia gravis occurred because of improvement in the patient's ptosis after intravenous edrophonium chloride. Cerebral CT revealed a hyperdense mass that was characterised on cerebral angiography as an aneurysm of the posterior communicating artery. Another occult aneurysm of the posterior cerebral artery was found at surgery. This case demonstrates that third nerve palsy due to cerebral aneurysm may affect patients at a younger age than has previously been recognised. Therefore we suggest that even young children should have aneurysm excluded by cerebral CT and angiography if they present with acquired third nerve palsy involving the pupil. In addition this case highlights the false-positive results that may occur with the edrophonium chloride test for myasthenia gravis.     

Nomogram model for predicting oculomotor nerve palsy in patients with intracranial aneurysm

AIM: To explore the risk factors of oculomotor nerve palsy (ONP) in patients with intracranial aneurysm (IA) and develop a nomogram model for predicting ONP of IA patients.METHODS: A total of 329 IA patients were included. Logistic regression analysis was applied to identify independent factors, which were then integrated into the nomogram model. The performance of the nomogram model was evaluated by calibration curve, receiver operating curve (ROC), and decision curve analysis.RESULTS: Univariate and multivariate logistic regression analysis indicated posterior communicating artery (PCoA) aneurysm [hazard ratio (HR)=17.13, P<0.001] and aneurysm diameter (HR=1.31, P<0.001) were independent risk factors of ONP in IA patients. Based on the results of logistic regression analysis, a nomogram model for predicting the ONP in IA patients was constructed. The calibration curve indicated the nomogram had a good agreement between the predictions and observations. The nomogram showed a high predictive accuracy and discriminative ability with an area under the curve (AUC) of 0.863. The decision curve analysis showed that the nomogram was powerful in the clinical decision. PCoA aneurysm (HR=3.38, P=0.015) was identified to be the only independent risk factor for ONP severity.CONCLUSION: PCoA aneurysm and aneurysm diameter are independent risk factors of ONP in IA patients. The nomogram established is performed reliably and accurately for predicting ONP. PCoA aneurysm is the only independent risk factor for ONP severity.     

Ptosis as the sole manifestation of compression of the oculomotor nerve by an aneurysm of the posterior communicating artery

Oculomotor palsy secondary to a berry aneurysm is usually present with pupillary dilatation, followed by other signs of third cranial nerve dysfunction, including oculomotor paresis and ptosis. Partial paralysis of the nerve with pupil sparing has been observed, but ptosis as the sole sign of oculomotor paralysis has not previously been reported until now.     

老年人糖尿病并发动眼神经不全麻痹分析

目的探讨老年人糖尿病合并动眼神经不全麻痹的临床特点及诊治。方法对14例(14只眼)老年人糖尿病并发动眼神经不全麻痹患者的临床资料进行分析。结果14例中8例以单侧眼睑下垂、6例以复视为首发表现,伴头痛、眼球运动受限,但瞳孔未受累。14例均治愈,治愈时间3～10周。结论该病多为急性发病,疗效与血糖水平及病程无关,积极治疗原发病及对症处理神经系统病变可取得满意效果。