复方樟柳碱注射液治疗前部缺血性视神经病变的疗效观察

目的观察局部注射复方樟柳碱注射液治疗前部缺血性视神经病变的临床疗效。方法将80例80只眼前部缺血性视神经病变的患者随机分为对照组和治疗组。对照组给予扩血管药物、营养神经药物等治疗,治疗组在对照组基础上在患侧颞浅动脉旁皮下注射复方樟柳碱注射液。2周为1个疗程,共治疗2个疗程。结果治疗组总有效率95%(38/40),对照组为80%(32/40),2组比较差异有统计学意义(P0.05)。结论复方樟柳碱注射液治疗前部缺血性视神经病变有显著疗效。     

鼠神经生长因子联合穴位针灸治疗动眼神经麻痹疗效分析

目的探讨鼠神经生长因子（NGF）注射液联合穴位针灸治疗动眼神经麻痹的临床疗效。方法动眼神经麻痹患者共50例,进行鼠神经生长因子联合穴位针灸治疗,30μg/次肌内注射,1次/d,10d一疗程,根据病情轻重可酌情增加疗程。结果 治疗后各种症状均有明显提高,上睑下垂恢复正常,眼位由外斜到正位,视力明显改善。结论 鼠神经生长因子注射液联合穴位针灸治疗动眼神经病变有明显效果。     

复方樟柳碱联合维生素B_(12)眼局部注射治疗前部缺血性视神经病变的临床观察

目的观察复方樟柳碱联合维生素B12眼局部注射治疗前部缺血性视神经病变的疗效。方法将临床确诊AION病例75例(100眼)随机分为对照组、治疗组1、治疗组2。对照组给予复方樟柳碱注射液2mL患眼颞浅动脉旁皮下注射,1次/d;治疗组1给予复方樟柳碱注射液2mL患眼颞浅动脉旁皮下注射,维生素B12注射液0.2mL,肌内注射,1次/d;治疗组2给予复方樟柳碱注射液2mL患眼颞浅动脉旁皮下注射,维生素B120.2mL,经Tenon囊球后注射治疗;均以14d为1疗程,共3个疗程,观察比较3组矫正视力、视野以及眼底变化情况。结果 3组视力、视野均显著改善,差异均有统计学意义(P0.05);治疗组2临床疗效总有效率88.24%,明显高于对照组77.18%及治疗组1的79.41%,差异均有统计学意义(P0.05)。结论复方樟柳碱联合维生素B12眼局部注射治疗AION疗效良好,值得临床推广使用。     

胰岛素低血糖合并药物治疗神经衰弱的对照研究

目的探讨胰岛素低血糖疗法合并药物治疗神经衰弱的临床疗效。方法选择439例符合CCMD-3神经衰弱诊断标准的患并随机分为两组：胰岛素低血糖合并药物治疗组(n=218);早纯药物治疗(n=221),疗程一个月。结果①前的有效率高于后;②从靶症状分析,前封情绪障碍和睡眠障碍的疗效好,而后封缓解紧张性疼痛效果明显。结论胰岛素低血糖合并药物是治疗神经衰弱的有效方法。     

复方樟柳碱治疗缺血性视神经病变疗效分析

目的探讨颞浅动脉旁注射复方樟柳碱注射液治疗缺血性视神经病变的疗效。方法采用随机对照研究方法,将缺血性视神经病变患者40例(44眼)随机分为治疗组25例(27眼),对照组15例(17眼)。治疗组采用复方樟柳碱用颞浅动脉旁注射,疗程28 d;对照组给予灯盏花素注射液(主要含灯盏乙素、少量灯盏甲素及其他黄酮类成分)50 mg加入250mL生理盐水中静滴,1次/d,疗程28 d。以视力和视野作为观察和评估指标,比较2组的疗效。结果治疗组有效率74%,对照组有效率53%,治疗组疗效优于对照组(P<0.01)。结论颞浅动脉旁注射复方樟柳碱治疗缺血性视神经病变效果较好,值得推广应用。     

糖尿病并发动眼神经麻痹9例临床报告

<正> 临床资料 1.一般资料:男性5例,女性4例;年龄为50—65岁,平均58岁;有糖尿病史者5例(4—10年),均间断性药物治疗,隐性糖尿病4例;两侧交替性动眼神经麻痹1例,单侧复发性动眼神经麻痹1例。 2.主要临床表现:上睑下垂,眼球向内,上、下运动受限(瞳孔正常)9例。同侧额部眼球后和眼眶疼痛伴三叉神经第1支分布区痛觉减退8例。下肢腱反射减弱或消失8例。     

甲基强的松龙治疗急性球后视神经炎

目的探讨甲基强的松龙及地塞米松冲击治疗急性球后视神经炎疗效。方法对39例(48眼)急性球后视神经炎患者随机分组,甲基强的松龙治疗组20例(25眼),对照组19例(23眼)。结果应用药物治疗后,治疗组中疗效显著占84%,对照组52.2%,差异有显著性(P<0.05)。结论甲基强的松龙冲击治疗急性球后视神经炎疗效显著,优于地塞米松。     

纤溶酶经颈动脉注射治疗急性期脑梗死42例临床观察

目的 观察纤溶酶经颈动脉注射治疗急性期脑梗死的临床疗效.方法 选取110例定位于颈内动脉系统的急性脑梗死患者,随机分为治疗组(n=42)和对照组(n=68),2组均给予常规改善循环、营养神经治疗,治疗组在此基础上将100 U纤溶酶溶于20 mL生理盐水中,经患侧颈动脉注入,隔日1次,共3次.对治疗前后神经功能缺损程度进行评定,观察2组患者病情变化.结果 2组神经功能缺损评分比较差异有统计学意义(P<0.01),且治疗组未见严重不良反应.结论 颈动脉注射纤溶酶治疗急性期脑梗死安全、有效.     

前列地尔治疗2型糖尿病周围神经病变临床分析

目的 观察前列地尔(alprostadil injection)治疗2型糖尿病周围神经病变(diabetic peripheral neuropathy)的疗效及其安全性.方法 符合入选标准的本院患者80例,分为治疗组(n=40)和对照组(n=40).治疗组1次/d静脉注射凯时针剂10 μg,对照组1次/d肌内注射甲钴...     

动眼神经麻痹的临床特点及预后分析

目的观察动眼神经麻痹的临床特点及预后,为动眼神经麻痹的鉴别诊断及治疗提供理论指导。方法我院2008-09-2013-09收治68例动眼神经麻痹患者,对其病因、检查结果及预后进行分析总结。结果全部患者均表现为不同程度的上睑下垂、眼球转动受限伴外下斜,其中伴瞳孔损伤27例(39.7%),伴瞳孔轻微散大13例(19.1%),对光反射不灵敏,患者均无中心视力受损表现;糖尿病、动脉瘤是最主要的致病原因,其构成比分别为39.7%、30.9%,51~70岁年龄段动眼神经麻痹的发病率最高,占61.8%;治愈53例(77.9%),好转10例(14.7%),无效3例(4.4%),死亡2例(2.9%),有效率为92.6%。结论动眼神经麻痹的临床症状以上睑下垂、眼球转动受限为主,其发病原因多与糖尿病、动脉瘤、脑干病变有关,且多数患者预后不佳,因此,应在做好病因检查、对因治疗的同时,强化患者及时就诊意识,以促进神经损伤的早期逆转,保证其预后及生活质量。     

Anatomical and physiological characteristics of vestibular neurons mediating the vertical vestibulo-ocular reflexes of the squirrel monkey

The morphology of 35 vestibular neurons whose firing rate was related to vertical eye movements was studied by injection of horseradish peroxidase intracellularly into physiologically identified vestibular axons in alert squirrel monkeys. The intracellularly injected cells were readily classified into four main groups. One group of cells, down position-vestibular-pause neurons (down PVPs; N = 12), increased their firing rate during downward eye positions, paused during saccades, and were located in the medial vestibular nucleus (MV) and the adjacent ventrolateral vestibular nucleus (VLV). They had axons that crossed the midline and ascended in the medial longitudinal fasciculus (MLF) to terminate in the trochlear nucleus, the lateral aspect of the caudal oculomotor nucleus, and the dorsal aspect of the rostral oculomotor nucleus. A second group of cells (N = 15) were also located in the MV and VLV, but increased their firing rate during upward eye positions, and paused during saccades. These cells had axons that crossed the midline and ascended in the contralateral MLF to terminate in the medial aspect of the oculomotor nucleus. A third group of cells (N = 4) were located in the superior vestibular nucleus, generated bursts of spikes during upward saccades, and increased their tonic firing rate during upward eye positions. These cells had axons that ascended laterally to the ipsilateral MLF to terminate in regions of the trochlear and oculomotor nuclei similar to those in which down PVPs terminated. A fourth group of cells (N = 4), located in the VLV, had axons that projected to the spinal cord, although they had firing rates that were significantly correlated with vertical eye position. Electrical stimulation of the vestibular nerve evoked spikes at monosynaptic latencies in each of the above classes of cells, six of which were injected with horseradish peroxidase. Each group of cells had collateral projections to other areas of the brainstem. Some of the neurons that projected to the contralateral trochlear and oculomotor nuclei had collaterals that crossed the midline to terminate in the oculomotor nucleus ipsilateral to the soma, and some gave rise to small collaterals that terminated in the abducens nucleus. Other areas of the brainstem that received collateral inputs from neurons projecting to oculomotor and trochlear nuclei included the interstitial nucleus of Cajal, the caudal part of the dorsal raphe nucleus, the nucleus raphe obscurus, Roller's nucleus, the intermediate and caudal interstitial nuclei of the MLF, and the nucleus prepositus.     

赛莱乐与甲钴胺联合治疗糖尿病周围神经病变的疗效观察

目的 观察赛莱乐与甲钴胺联合治疗糖尿病周围神经病变(DPN)的疗效。方法 采用赛莱乐与甲钴胺联合治疗DPN38例,与采用甲钴胺治疗的30例作对照。结果 治疗组及对照组治疗后症状均明显改善(P<0.001)。治疗后治疗组症状严重程度评分明显低于对照组(P<0.001)。治疗组神经传导速度改善明显优于对照组(P<0.05)。结论 赛莱乐与甲钴胺联合治疗DPN有较好疗效。     

Could visual neglect induce amblyopia?

Oculomotor nerve disease is a common cause of diplopia. When strabismus is present, absence of diplopia has to induce the research of either uncovering of visual fields or monocular suppression, amblyopia or blindness. We describe the case of a 41-year-old woman presenting with right oculomotor paresis and left object-centred visual neglect due to a right fronto-parietal haemorrhage expanding to the right peri-mesencephalic cisterna caused by the rupture of a right middle cerebral artery aneurysm. She never complained of diplopia despite binocular vision and progressive recovery of strabismus, excluding uncovering of visual fields. Since all other causes were excluded in this case, we hypothesise that the absence of diplopia was due to the object-centred visual neglect. Partial internal right oculomotor paresis causes an ocular deviation in abduction; the image being perceived deviated contralaterally to the left. Thus, in our case, the neglect of the left image is equivalent to a right monocular functional blindness. However, bell cancellation test clearly worsened when assessed in left monocular vision confirming that eye patching can worsen attentional visual neglect. In conclusion, our case argues for the possibility of a functional monocular blindness induced by visual neglect. We think that in presence of strabismus, absence of diplopia should induce the search for hemispatial visual neglect when supratentorial lesions are suspected.     

Diplopia in Wallenberg's syndrome]

The incidence and mechanism of diplopia were investigated in 31 patients with Wallenberg's syndrome resulting from acute dorsolateral medullary infarction. Diplopia was found in 10 of 31 patients (32%), with 5 patients reporting vertical diplopia alone and 5 reporting vertical and horizontal diplopia. Diplopia in Wallenberg's syndrome is considered to be caused by a lesion involving the otolith-ocular system. Vertical diplopia is simply explained by ocular skew deviation due to a lesion involving the vestibular nucleus; in which the affected eye becomes deviated inferiorly. In this situation, rotation of the eye due to ocular tilt reaction also occurs. Concomitant horizontal diplopia may require involvement of the medial longitudinal fasciculus (MLF), which produces skew deviation in mirror image; the unaffected eye becomes deviated inferiorly. When downward deviation of the eye affected by dysfunction of the vestibular nucleus and that due to MLF dysfunction affecting the other eye are comparable, only horizontal diplopia becomes apparent. MLF syndrome may be accompanied by paralytic pontine exotropia (PPE) or non-paralytic pontine exotropia (NPPE), both of which may also participate in the appearance of horizontal diplopia.     

Botulinum toxin and painful peripheral neuropathies: what should be expected?

Botulinum toxin type A (BTX-A) is a potent neurotoxin that blocks acetylcholine release from presynaptic nerve terminals by cleaving the SNARE complex. BTX-A has been reported to have analgesic effects independent of its action on muscle tone. The most robust results have been observed in patients with neuropathic pain. Neuropathic pain due to peripheral lesions has been the most widely studied. BTX-A has shown its efficacy on pain and allodynia in various animal models of inflammatory neuropathic pain. The only randomized, double-blind, placebo-controlled trial in patients with focal painful neuropathies due to nerve trauma or postherpetic neuralgia demonstrated significant effects on average pain intensity from 2 weeks after the injections to 14 weeks. Most patients reported pain during the injections, but there were no further local or systemic side effects. The efficacy of BTX-A in painful peripheral neuropathies has been more recently studied. Results were positive in the only study in an animal model of peripheral neuropathy. One study in patients with diabetic painful peripheral neuropathy demonstrated a significant decrease in Visual Analog Scale. In conclusion, one session of multiple intradermal injection of BTX-A produces long-lasting analgesic effects in patients with focal painful neuropathies and diabetic neuropathic pain, and is particularly well tolerated. The findings are consistent with a reduction of peripheral sensitisation, the place of a possible central effect remaining to define. Further studies are needed to assess some important issues, i.e. BTX-A efficacy in patients with small fiber neuropathies and the relevance of early and repeated injections. Future studies could also provide valuable insights into pathophysiology of neuropathic pain.     

Lateral gaze disturbance in a case of Wallenberg's syndrome

A 63-year-old Caucasian man was admitted for Wallenberg's syndrome following a left vertebral artery thrombosis. In addition to the classical symptoms, an axial lateropulsion to the left and ocular motor disorders (vertical diplopia, tonic deviation of the gaze to the left, skew deviation and horizonto-rotatory nystagmus) were present. These clinical signs are unusual, but in common Wallenberg's syndrome, neurophysiological tests often reveal slight abnormalities of oculomotor function: impairment of jerks, skew deviation, lateral deviation of the gaze in darkness. Interruption of cerebellar pathways is thought to be the cause of these symptoms. Their existence does not seem to change the outcome of these cases.     

恩再适联合甲钴铵对难治性糖尿病周围神经病变的疗效观察

目的 观察恩再适与甲钴铵(弥可保)联合治疗难治性糖尿病周围神经病变的疗效.方法 50例难治性糖尿病周围神经病变患者分为对照组和治疗组,对照组25例,单用弥可保肌注,500μg/d,连用4周;治疗组25例,在对照组基础上,加用恩再适肌注,3ml/d, 连用4周 .结果 治疗组有效率达92%,明显高于对照组48%(P＜0.01);神经传导速度改善也明显优于对照组(P＜0.01).结论 恩再适与弥可保联合应用可明显提高糖尿病周围神经病变的治疗效果.     

Experimentally induced autonomic neuropathy: beneficial effect of a systemic ACTH4-9 analogue on oculomotor nerve regeneration

While the regenerating capacity of peripheral nerves has been the subject of intensive study, little is known about the regenerative capacity of the autonomic nervous system. Using an animal model, where the pupil diameter of the eye in the rat serves as a parameter of autonomic function, we studied whether systemic treatment with the neuropeptide Org 2766, a synthetic ACTH4-9, analogue, facilitates the functional recovery of parasympathetic nerve fibres after transection, and after a crush lesion of the oculomotor nerve. By simply photographing the rat's pupil under standardised conditions, we show that sectioning the oculomotor nerve leads to an immediate mydriasis, followed by spontaneous regeneration in 30 days. Systemic treatment with an ACTH4-9 analogue had no effect on the rate or quality of recovery. However, systemic treatment with an ACTH4-9 analogue after a crush lesion of the oculomotor nerve (spontaneous regeneration time 16 days) did enhance the speed of recovery of the parasympathetic nerve fibres in the oculomotor nerve, especially in the initial stages of regeneration. We conclude that the animal model used in this study is valuable for studying the regenerative capacity of the autonomic nervous system and the influence of neurotrophic peptides on autonomic neuropathies. Evidence is presented that synthetic ACTH4-9 analogue exerts beneficial neurotrophic effects, not only in peripheral sensorimotor neuropathies but also in autonomic neuropathies.     

Ocular neuromyotnia: Clinical features,physiological mechanisms,and response to therapy

Ocular neuromyotonia (ONM) is a rare disorder characterized by episodic diplopia, occurring either spontaneously or following sustained eccentric gaze. Most patients have had prior radiation therapy to the sellar and parasellar region. ONM is thought to reflect impaired muscle relaxtion due to inappropriate discharges from oculomotor, trochlear, or abducens neurons or axons with unstable cell membranes. Patients with ONM often benefit from membrane stabilizing agents such as carbamazepine. Here we describe a 71-year-old man, with no history of radiation therapy, who for 18 months had had transient episodic diplopia that occurred after down gaze. Clinical examination indicated ONM in muscles supplied by the right oculomotor nerve. Binocular scleral search coil eye movement recordings revealed a defect not only of muscle relaxation but also of maximal muscle contraction. The patient was treated with carbamazepine 200 mg per day with complete resolution of his symptoms. ONM may be more common than previously recognized, and patients with unexplained transient episodic diplopia should be specifically tested for diplopia and ocular misalignment following sustained eccentric gaze.     

A case report of syphilitic meningitis with right oculomotor nerve palsy]

A 63-year-old man presented with acute-onset right ptosis and diplopia. The patient reported having engaged in unspecified sexual activities during his third decade and was found to have positive syphilitic serological findings at the age of 56 years. No clinical symptoms were noted at this time. On admission, he showed only right oculomotor nerve palsy. The patient's intelligence, gait and sensory functions were normal. Laboratory analysis revealed positive syphilitic serological findings and examination of the cerebrospinal fluid (CSF) further revealed pleocytosis, a higher IgG index and positive syphilitic reactions. A computed tomographic scan and other imaging studies were diagnostically nonspecific. We made a diagnosis of right oculomotor nerve palsy due to syphilitic meningitis. We treated the syphilitic meningitis with intravenous injections of penicillin G (24 million units per day for 21 days). Jarisch-Herxheimer reaction and other side effects were not apparent. We first made a thorough examination of the CSF to rule out diagnosis of meningitis, and pursued methylprednisolone pulse therapy (MPP, 1 g/day for 3 days) to treat the oculomotor nerve palsy. The ptosis and diplopia showed signs of improvement following the second MPP therapy session. The present case suggests that neurosyphilis is an important differential diagnosis for presentations of unspecific oculomotor nerve palsy and that MPP therapy may prove an effective treatment for it, even where there has been the long clinical onset.