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.     

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     

伴眼部表现的颈内动脉动脉瘤的临床分析

目的 分析伴眼部表现的颈内动脉动脉瘤(AICA)的部位、大小及眼部表现临床特点.方法 回顾性分析2001年12月至2009年6月于解放军总医院眼科就诊的42例AICA患者的临床资料,分析伴眼部表现的AICA发生部位、大小及眼部表现临床特点.结果 42例伴眼部表现的AICA患者中,发生于床突旁23例,巨大动脉瘤23例,眼部主要表现分别为患侧眼视力显著下降25例、动眼神经麻痹21例、展神经麻痹7例及不同程度视野改变.结论 AICA眼部表现主要为患侧眼视力显著下降、不同程度视野缺损、动眼神经麻痹、展神经麻痹等.伴眼部表现的AICA以床突旁为主,多为巨大动脉瘤.     

不同部位颅内动脉瘤与眼部症状的临床分析

目的 探讨颅内不同部位的动脉瘤引起眼部不同改变的应用解剖及临床表现.方法 回顾性分析近10年在解放军总医院神经外科和介入科确诊为颅内动脉瘤的232例患者,对其中有眼部改变的46例进行综合分析.结果 在46例颅内动脉瘤患者中,后交通动脉瘤有24例(占52.1%),海绵窦段动脉瘤9例(占19.57%),发动脉瘤4例(占8.70%),小脑上动脉瘤3例(占6.52%),颈内动脉瘤2例(占4.34%),前交通动脉瘤2例(占4.34%),大脑前动脉瘤2例(占4.34%);在受累及的颅神经中,动眼神经最多,有31例(占67.39%),其次为视神经7例(占15.22%),外展神经和三叉神经各6例(占13.04%),滑车神经最少,有2例(占4.35%);因眼肌麻痹、复视到眼科首诊的有9例(占19.56%).结论 颅内不同部位的动脉瘤可引起相应的眼部改变,有一定相关性,但无明显特异性,与瘤体位置、大小、形状、生长方向有关.     

大脑后交通动脉瘤与动眼神经麻痹

报告１０２例大脑后交通动脉瘤，其中伴有动眼神经麻痹者６１例，１８．６％的动眼神经麻痹作为后交通动脉瘤的首发体征症状出现于动脉瘤破裂之前，作者强调于原因不明的动眼神经麻痹应高度怀疑交通动脉瘤所致，以便早期诊断及治疗。     

颅内动脉瘤合并视野缺损的诊断分析

目的 探讨颅内动脉瘤合并视野缺损在眼科诊断的分析.方法 回顾近4年确诊为颅内动脉瘤合并视野缺损的12例患者,其中大脑前动脉动脉瘤5例,前交通动脉瘤4例,颈内动脉动脉瘤3例,对此进行分析.结果 12例均以视野缺损为首发症状,误诊为缺血性视神经疾病9例、球后视神经炎2例、正常眼压型青光眼1例,结论对于视野缺损患者应进一步检查,必要时做脑血管数字减影血管造影(DSA),以防误诊误治.     

颅内动脉瘤合并视野缺损的诊断分析

目的 探讨颅内动脉瘤合并视野缺损在眼科诊断的分析.方法 回顾近4年确诊为颅内动脉瘤合并视野缺损的12例患者,其中大脑前动脉动脉瘤5例,前交通动脉瘤4例,颈内动脉动脉瘤3例,对此进行分析.结果 12例均以视野缺损为首发症状,误诊为缺血性视神经疾病9例、球后视神经炎2例、正常眼压型青光眼1例,结论对于视野缺损患者应进一步检查,必要时做脑血管数字减影血管造影(DSA),以防误诊误治.     

颅内动脉瘤合并视野缺损的诊断分析

目的 探讨颅内动脉瘤合并视野缺损在眼科诊断的分析.方法 回顾近4年确诊为颅内动脉瘤合并视野缺损的12例患者,其中大脑前动脉动脉瘤5例,前交通动脉瘤4例,颈内动脉动脉瘤3例,对此进行分析.结果 12例均以视野缺损为首发症状,误诊为缺血性视神经疾病9例、球后视神经炎2例、正常眼压型青光眼1例,结论对于视野缺损患者应进一步检查,必要时做脑血管数字减影血管造影(DSA),以防误诊误治.     

颅内动脉瘤合并视野缺损的诊断分析

目的 探讨颅内动脉瘤合并视野缺损在眼科诊断的分析.方法 回顾近4年确诊为颅内动脉瘤合并视野缺损的12例患者,其中大脑前动脉动脉瘤5例,前交通动脉瘤4例,颈内动脉动脉瘤3例,对此进行分析.结果 12例均以视野缺损为首发症状,误诊为缺血性视神经疾病9例、球后视神经炎2例、正常眼压型青光眼1例,结论对于视野缺损患者应进一步检查,必要时做脑血管数字减影血管造影(DSA),以防误诊误治.     

颅内动脉瘤合并视野缺损的诊断分析

目的 探讨颅内动脉瘤合并视野缺损在眼科诊断的分析.方法 回顾近4年确诊为颅内动脉瘤合并视野缺损的12例患者,其中大脑前动脉动脉瘤5例,前交通动脉瘤4例,颈内动脉动脉瘤3例,对此进行分析.结果 12例均以视野缺损为首发症状,误诊为缺血性视神经疾病9例、球后视神经炎2例、正常眼压型青光眼1例,结论对于视野缺损患者应进一步检查,必要时做脑血管数字减影血管造影(DSA),以防误诊误治.     

眼动脉瘤眼部表现的临床探讨

目的:探讨眼动脉瘤所引起的眼部改变。方法:回顾性分析2003-08/2009-03首都医科大学附属北京天坛医院神经外科收治的44例眼动脉瘤患者的临床资料。结果:眼动脉瘤患者44例以眼部改变为首发者14例(32%)。视力下降者12例(27%),其中单眼者10例(23%),双眼者2例(5%);视野缺损者10例(23%)(双眼2例,单眼8例);复视者2例(5%);上睑下垂者4例(9%);误诊为球后视神经炎2例,青光眼1例。结论:眼动脉动脉瘤患者可引起眼部改变,最常见的表现为视力下降和视野缺损。     

Purtscher-like retinopathy and Horner’s syndrome following coil embolization of an intracavernous carotid artery aneurysm

Background Coil embolization is a non-invasive method for treating intracranial vascular malformations by inducing thrombus formation. It is particularly useful in management of cerebral aneurysms and avoids the risks associated with surgical clipping. Occasionally, embolic complications occur which result in transient or permanent loss of vision.Methods Case report of a 29-year-old Caucasian woman who underwent coil embolization and balloon occlusion of an intracavernous carotid aneurysm. Shortly thereafter she described visual changes and a droopy eyelid.Results Examination revealed pupillary miosis and mild ptosis of the right upper lid. Perimetry showed an arcuate scotoma superiorly and an inferonasal step in the right eye. Fundus examination revealed multiple cotton-wool spots along the peripapillary area and along the temporal vascular arcades reminiscent of Purtscher retinopathy. After 4 weeks, she had marked improvement in her visual symptoms. Most of the cotton-wool spots had resolved and the visual field had normalized. However, the ptosis and anisocoria remained unchanged.Conclusions Coil embolization is a non-invasive method for treating carotid aneurysms. However, it carries the risk of ophthalmic events, warranting baseline ophthalmic examinations prior to such intervention.     

颅内动脉瘤与眼科改变

随着颅内动脉瘤诊断技术的不断进步,越来越多的早期颅内动脉瘤患者被发现,避免了因动脉瘤破裂而导致的严重并发症的发生,为患者争取了宝贵的治疗时机,大大降低了疾病的致残率和死亡率。同时更多的颅内动脉瘤患者的临床症状与眼科有关,甚至可以是首发症状。详细了解颅内不同部位动脉瘤与眼科改变的密切关系有助于眼科医师及时捕捉颅内动脉瘤的相关信息,做到早发现、早诊断、早治疗。     

颅内动脉瘤的眼部表现

颅内动脉瘤是神经系统常见的疾病,大部分动脉瘤破裂前通常无明显临床表现,破裂后常引起严重并发症,并危及患者生命.部分颅内动脉瘤可有眼部表现,如视乳头水肿、视网膜出血、玻璃体出血、视力下降、视野缺损、动眼神经麻痹、外展神经麻痹及三叉神经病变等.颅内动脉瘤的主要影像学诊断方法有电子计算机断层扫描、磁共振血管造影、数字减影血管造影,其中数字减影血管造影是诊断颅内动脉瘤的金标准.颅内动脉瘤主要依靠手术治疗,包括显微手术夹闭、血管内介入治疗,手术方式的选择应该根据病情及医疗条件综合考虑.     

Intracranial pressure and skull remodeling

In this article we review bony changes resulting from alterations in intracranial pressure (ICP) and the implications for ophthalmologists and the patients for whom we care. Before addressing ophthalmic implications, we will begin with a brief overview of bone remodeling. Bony changes seen with chronic intracranial hypotension and hypertension will be discussed. The primary objective of this review was to bring attention to bony changes seen with chronic intracranial hypotension. Intracranial hypotension skull remodeling can result in enophthalmos. In advanced disease enophthalmos develops to a degree that is truly disfiguring. The most common finding for which subjects are referred is ocular surface disease, related to loss of contact between the eyelids and the cornea. Other abnormalities seen include abnormal ocular motility and optic atrophy. Recognition of such changes is important to allow for diagnosis and treatment prior to advanced clinical deterioration. Routine radiographic assessment of bony changes may allow for the identification of patient with abnormal ICP prior to the development of clinically significant disease.     

Intraorbital aneurysm of the ophthalmic artery: a rare cause of apex orbitae compression syndrome

PURPOSE: The purpose of this study was to report the case of a patient with a saccular, intraorbital aneurysm of the ophthalmic artery and to analyze the correlation between clinical symptoms and aneurysm localization with regard to the literature. METHOD: We correlated the patient's clinical findings with anatomical substrates on magnetic resonance imaging and angiographic studies. RESULTS: A 64-year-old woman presented with a rapidly progressive loss of visual acuity in her right eye, temporo-basal visual field defects, a temporal pallor of the optic disc and third and sixth nerve palsies. This apex orbitae compression syndrome was due to an aneurysm of the proximal intraorbital segment of the ophthalmic artery at a position inferolateral to the optic nerve, inferior to the third and medial to the sixth cranial nerve. CONCLUSION: The symptoms caused by an aneurysm of the ophthalmic artery depend on its localization and spatial relationship to neural structures. While aneurysms of the intracranial and distal intraorbital segments may remain asymptomatic, those arising from the intracanalicular segment become clinically apparent with optic nerve conduction disorders. Aneurysms in the proximal intraorbital segment additionally provoke oculomotor disturbances due to compression of the third and sixth cranial nerves.     

微重力环境引起宇航员眼部改变及其机制的研究进展

宇航员进入微重力环境后可出现一系列眼部改变,这些改变若得不到及时干预或治疗,将导致宇航 员出现长期或永久的视力损害,不仅影响飞行任务的执行,还威胁宇航员的人身安全。尽管目前宇 航员出现这些眼部改变的确切机制尚不明确,但相关研究已发现,宇航员进入微重力环境后会出现 颅内压升高、神经系统改变、生化改变及淋巴、静脉系统循环障碍,这些可能都参与了疾病的发生 与发展。现归纳国内外近50年来关于宇航员进入微重力环境后出现的眼部改变及其可能的发生机制, 以期寻找针对这些眼部改变的预防和治疗措施,为宇航员筛查、训练及防治工作提供相关理论支持。     

The causes of a decrease in eye function in open-angle glaucoma

On the grounds of the analysis of 123 case histories of patients with open-angle glaucoma, for the period of 5-20 years, as well as clinical and sectional observations, the authors make a conclusion that in a part of patients the cause of progression of glaucomatous process in normalized intraocular pressure is a descending atrophy of the optic nerve. It is connected with sclerotic changes in the internal carotid and ophthalmic arteries exerting pulsating pressure on intracranial portions of the optic tract (a "basal factor" of glaucoma).     

The source of sensory fibres of the inferior conjunctiva of monkeys

Dissection, light and electron microscopy combined with degeneration induced by intracranial nerve lesions and superficial nerve transection were used to trace the sources of sensory fibres of the inferior conjunctiva of cynomolgus monkeys. Most nerves destined for the inferior conjunctiva were branches of the lacrimal nerve and entered the inferior eyelid laterally. Following unilateral opthalmic neurotomy in three monkeys and combined ophthalmic/maxillary neurotomy in one monkey, substantial and regular degenerative changes were observed in the nerves and nerve-fibre bundles of the inferior conjunctiva. Following intracranial lesions of the maxillary nerve and of the infra-orbital nerve at its facial hiatus, conjunctival nerves showing induced changes were infrequent (four animals) or (absent animal). The results indicate that the inferior conjunctiva is innervated mainly by the ophthalmic nerve contrary to the popular notion that it is innervated mainly or wholly by the infra-orbital branch of the maxillary nerve.     

Intraorbital ophthalmic artery aneurysms

Angiographically documented aneurysms of the intraorbital ophthalmic artery are extremely rare. Two cases are presented of intra-orbital ophthalmic artery aneurysms, both associated with arteriovenous malformation (AVM). There have only been isolated reports documenting this combination of vascular anomalies. In the first case, the aneurysm was treated conservatively and in the second case, after staging angiography and interventional embolization, the aneurysm was removed along with the associated AVM. The clinical presentation, pathogenesis and management of this rare combination of vascular anomalies is briefly discussed.