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.     

首诊于眼科的颅内静脉窦血栓形成的临床分析

目的:探讨颅内静脉窦血栓形成的病因,相关眼科的临床表现、误诊情况及治疗方法.方法:前瞻性研究解放军总医院神经外科住院期间(2007-01),1mo中因首诊于眼科而误诊的4例CVST病例的临床表现、辅助检查、治疗及预后.结果:此病多以视力下降、头痛、恶心、视乳头水肿而首诊于眼科,此4例患者均有视力下降的症状,全部有视乳头水肿及颅压高等临床表现.阻塞部位均为横窦.结论:本病并不少见,早期容易漏诊误治,对于CVST患者,视力下降、视乳头水肿是其常见表现,可以通过DSA(经数字减影血管造影)做出早期诊断,对于颅内高压的症状应高度怀疑CVST.     

首诊眼科的颈动脉海绵窦瘘患者的影像学检查分析

目的分析首诊于眼科的颈动脉海绵窦瘘患者的影像学表现,并讨论其诊断意义。方法对有临床表现11例(12只眼)颈动脉海绵窦瘘患者采用B超、CT和/或MR I检查。结果三种影像学检查均发现眼上静脉扩张、眼外肌肥大、眶内脂肪垫增厚;部分CT或MR I检查还显示扩张的海绵窦。结论医学影像学在颈动脉海绵窦瘘检查中具有特征性的影像表现。对于首诊眼科的此类患者应联合采用多种影像学检查以明确诊断,避免造成误诊。     

首诊眼科的外伤性动静脉海绵窦瘘分析

目的探讨外伤性动静脉海绵窦瘘(TCCF)患者的眼科临床特点、影像学检查特点及其诊断与治疗。方法回顾性分析5例首诊眼科的TCCF患者的临床资料。结果 5例TCCF经血管内介入治疗后,症状体征均消退,瘘口消失。结论 DSA检查及血管内栓塞技术是较理想的诊断及治疗方法,超声、CT、MRI等影像学检查对 TCCF的诊断各有所长,可作为辅助手段。     

累及视路的脑血管病——烟雾病的眼部临床表现

烟雾病又称moyamoya病，是一种少见的慢性脑血管疾病，部分患者伴有眼部临床表现，甚至首诊以视觉变化为主诉，又因其神经系统症状无明显特异性，临床较易误诊或漏诊。随着神经外科学及神经血管影像学技术的发展，本病受到越来越多的认识。我们对我院脑外科确诊的91例烟雾病患者进行回顾性研究，分析其伴有的眼科临床表现。     

首诊眼科的前床突脑膜瘤临床分析

目的 探讨首诊眼科的前床突脑膜瘤的临床表现与特点.方法 对14例病例进行回顾性分析,对其临床表现、解剖特点、影像学特点、视野及VEP表现进行分析总结.结果 在首诊眼科的14例患者中,以视力下降为主要表现的共8例,占本组病例的57.14%;头疼、头晕为主7例,占50%;以动眼神经压迫症状为主3例,占21.4%;意外发现1例.7例行中心视野检查其表现与肿瘤压迫部位基本相符,6例行VEP检查全部表现异常;14例行MRI检查,均可见占位性病变;9例CT检查者,有2例未查见占位性病变,MRI、CT两者联合有助于明确诊断.结论 对用眼疾病难以解释的视力减退和(或)眼肌麻痹的患者,应行头颅影像学检查排除有无颅内占位性病变,即使无明显眼底改变也应做视野检查,以避免漏诊.     

以眼后段为主要表现的眼部梅毒临床分析

目的观察首诊于眼科以后葡萄膜炎表现为主的眼部梅毒的临床表现和治疗。方法对我院2007年1月至2011年4月期间以眼部表现为首发症状就诊于我院眼科,经临床及血清学检查确诊的梅毒性眼病28例(37只眼)患者的临床资料进行回顾性分析,总结其临床特征及治疗预后。结果所有28例(37只眼)患者均以视力下降、眼前黑影飘动或视野遮挡感等为起病症状或主要症状首诊于眼科而被确诊为梅毒。其中男21例,女7例,年龄30～74岁,平均51岁。双眼发病9例,单眼发病19例。梅毒血清学检查梅毒螺旋体颗粒凝集试验(TP-PA)和梅毒快速血浆反应素试验(RPR)均为阳性,RPR的滴度由1:8至1:256。所有患者HIV检测均为阴性。结合眼部表现、眼底检查和荧光素眼底血管造影(FFA)检查诊断为视神经炎5只眼,视网膜血管炎7只眼,视神经视网膜炎8只眼,脉络膜视网膜炎17只眼。诊断明确后行正规驱梅治疗,患者眼部炎症均控制,视力提高,眼底病变消退,RPR转阴或滴度降低。结论梅毒性眼病临床表现形式多样,缺乏特异性表现,诊断存在一定困难。因此,对于病因不明的葡萄膜炎患者,应及时进行相关的血清学检查。一经确诊梅毒,给予及时对症、对因的治疗。     

首诊于眼科的颈动脉海绵窦瘘36例临床分析

目的 探讨首诊于眼科的颈动脉海绵窦瘘(CCF)的临床特征,提高眼科医生的认识水平。方法回顾性病例研究。收集2014年3月至2020年11月在四川大学华西医院眼科首诊的36例(37只眼) CCF患者的临床资料,分析其眼部表现、辅助检查、诊断、治疗及预后。结果 36例患者中,眼部表现以结膜充血水肿、眼球突出、眼睑肿胀和血管鸣多见,分别为33例、24例、18例和16例。首诊于眼科门诊时诊断CCF 16例,误诊20例,包括结膜炎(7例)、甲状腺相关眼病(6例)、青光眼(5例)等。本组病例均于我院或外院神经外科行DSA检查确诊,其中选择行CCF介入栓塞术23例,随访4～10个月,病情好转22例,术后复发1例,因费用、年龄等原因选择保守治疗或观察共13例。结论 CCF可因眼部症状首诊于眼科,结膜血管充盈扩张是其特征。对可疑患者应及时行影像检查,转神经外科行DSA检查进一步确诊和治疗。     

首诊于眼科的颈动脉海绵窦瘘的临床分析和鉴别诊断

目的:分析首诊于眼科的颈动脉海绵窦瘘(carotid cavernous fistula,CCF)的临床特征和鉴别诊断,提高眼科医师对该病的诊断和治疗水平。方法:病例回顾性研究。回顾11例首诊于眼科的CCF的临床表现、诊断、鉴别诊断和治疗。结果:其中9例有不同程度的外伤史,眼部临床表现以搏动性突眼为特征,易误诊为眼眶炎性假瘤、眶内动脉瘤以及甲状腺相关性眼病等。经DSA确诊后血管内球囊栓塞治疗可获得较好疗效。结论:眼科医师应该加强对该病的认识,认真询问病史,结合特征性的临床表现以及脑血管造影检查可提高该病的诊断率。血管内栓塞治疗是CCF的首选,效果肯定。     

以急性虹膜睫状体炎首诊的糖尿病5例分析

急性虹膜睫状体炎是眼科门诊的常见病,具有诊断明确、病因不易查明和治疗有效的特点,也有部分患者出现易复发的情况。我们在临床中对首诊眼科的这类患者检查空腹血糖,发现有5例患者患有糖尿病,报告如下。     

Ophthalmic manifestations of perineural spread of facial skin malignancy

Facial skin malignancy, when complicated by perineural spread (PNS), can lead to devastating orbital, intracranial and paranasal sinus involvement, the management of which requires a multidiscipli-nary approach and which itself may be devastating. Adequate surgical excision with frozen section control, and specific inspection of histological specimens for perineural invasion, are essential to avoid this problem. This report presents four patients who manifested such involvement, and emphasises the importance of recognition of such ominous symptoms as facial pain, paraesthesiae and weakness. Thorough neuro-ophthalmic examination is mandatory to detect signs of nerve involvement which may indicate perineural spread both at the initial assessment of primary tumour and at suspected recurrence. In this series, the most common sensory and motor nerves affected were, respectively, single, small branches of the ophthalmic and facial nerves.     

Ophthalmic manifestations of perineural spread of facial skin malignancy

Facial skin malignancy, when complicated by perineural spread (PNS), can lead to devastating orbital, intracranial and paranasal sinus involvement, the management of which requires a multidisciplinary approach and which itself may be devastating. Adequate surgical excision with frozen section control, and specific inspection of histological specimens for perineural invasion, are essential to avoid this problem. This report presents four patients who manifested such involvement, and emphasises the importance of recognition of such ominous symptoms as facial pain, paraesthesiae and weakness. Thorough neuro-ophthalmic examination is mandatory to detect signs of nerve involvement which may indicate perineural spread both at the initial assessment of primary tumour and at suspected recurrence. In this series, the most common sensory and motor nerves affected were, respectively, single, small branches of the ophthalmic and facial nerves.     

Encephalopathy,Chiasmal Compression,Ophthalmoplegia, and Diabetes Insipidus in Pituitary Apoplexy

ABSTRACT

Pituitary apoplexy with haemorrhage is a potentially life-threatening condition, and a rare cause of third nerve palsies. The range of vision loss and ophthalmoplegia seen in cases of apoplexy reflects the variability of cranial structures compressed by mass effect. The pathophysiology of extraocular muscle limitation and facial paraesthesia occurs with compression of the cavernous sinus, which contains cranial nerves III, IV, VI, and the ophthalmic branch of V. Blood supply to adjacent structures may be also compromised, causing additional loss of function. This case report of a patient with diabetes insipidus and a third nerve palsy illustrates the anatomic basis of the presenting signs of pituitary apoplexy, and the necessity for prompt neuroimaging if it is suspected.     

脑干肿瘤患者眼部临床表现分析

目的 分析脑干肿瘤患者眼部临床表现特点,避免误诊、漏诊.方法 采用回顾性系列病例研究.收集1993至2007年间诊断为脑干肿瘤的57例患者的临床资料.分析所纳入患者的眼部表现、磁共振检查及病理检查结果.结果 本组病例中胶质瘤患者51例,占89.5%(51/57),海绵状血管瘤4例,血管母细胞瘤、转移瘤各1例.胶质瘤患者中,男性37例,女性14例,首发年龄5-55岁,中位数年龄为23岁,发病高峰见于10-35岁.脑干肿瘤患者常见眼部临床表现包括复视、眼球运动障碍、眼震、双侧瞳孔不等大和面瘫等,其中以复视为首发表现者占12.3%(7/57).各神经眼科体征总发生率分别为:动眼神经麻痹17.5%(10/57),滑车神经麻痹1.8%(1/57),三叉神经麻痹5.3%(3/57),外展神经麻痹35.1%(20/57),面神经麻痹14.0%(8/57),视乳头水肿19.3%(11/57),眼球震颤21.1%(12/57),双侧瞳孔不等大10.5%(6/57).结论 脑干肿瘤患者常有眼部异常表现,核性眼肌麻痹、眼震等神经眼科体征为脑干肿瘤的诊断提供了有益的线索.     

Heerfordt syndrome with unilateral facial nerve palsy: a rare presentation of sarcoidosis

BACKGROUND: Heerfordt syndrome is rare and is characterized by fever, uveitis, parotid gland enlargement, and facial nerve palsy. We hereby present a case of Heerfordt syndrome with unilateral facial nerve palsy as a presentation of sarcoidosis. HISTORY AND SIGNS: A 29-year-old male patient from Sri Lanka presented with eye redness OU, blurred vision OD, fever, headache, night sweat, fatigue, and weight loss (5 kg over 1 month). Examination revealed mild anterior uveitis OU, mild vitritis OD, fundus whitish lesions OU, left otalgia, taste disorders, bilateral parotid gland enlargement, and left facial nerve palsy. Work-up for infection or tumour was negative. Chest computed tomography and transbronchial lymph node biopsy set the diagnosis of sarcoidosis. THERAPY AND OUTCOME: The patient recovered completely within 2 months under therapy with prednisone and azathioprine. One year after onset of treatment, no recurrence was noted. CONCLUSIONS: Heerfordt syndrome is a rare manifestation of neurosarcoidosis and has to be included in the differential diagnosis of facial nerve palsy.     

中枢性疾病伴神经眼科病征的临床分析

目的总结分析神经外科患者伴神经眼科传人系统及传出系统症状和体征的临床表现,避免漏诊及误诊。方法通过病例回顾性调查,收集我院2012年3月至2012年5月在神经外科病区住院的547例患者,筛选出资料完整的有神经眼科症状和体征的患者进行系统分析。结果共有115例患者出现神经眼科的临床表现,其中颅内占位性病变为79例（68．7．0％）,颅内血管源性病变36例（31．3．0％）。另外仅累及传人系统病变者83例（72．4％）,仅累及传出系统病变者18例（15．70％）,传入和传出系统皆累及者14例（11．9％）,传人系统病变远多于传出系统病变。结论对首诊于眼科的神经外科患者要进行全面的神经眼科传入／传出系统检查,对有黑喙、复视、视力下降,视野变化、眼球运动异常等的患者及时行相应影像学检查,从而发现神经外科的相关疾病,争取早期治疗的时机。     

Sarcoidosis of the anterior optic pathways. A diagnostic discussion

Two anatomo-clinical cases of neuro-ophthalmic sarcoidosis are reported where recognition of systemic involvement was delayed because unusual and quite isolate visual symptoms were present. The first patient had granulomas involving the intracranial optic nerve, presenting as optic nerve glioma. The second case presented as a chiasmal syndrome sharing unusual perimetric evolution. This binasal hemianopsia was probably the consequence of pre-chiasmal circulatory changes. Neuro-ophthalmic sarcoidosis should be included in the differential diagnosis of any involvement of the anterior visual pathways since these localizations are not as rare as was formerly thought. Improved awareness of this condition is a result of better neurodiagnostic studies by computed tomography which was not accurate enough a few years ago.     

Ehrlichiosis optic neuritis

PURPOSE: To describe a case of ehrlichiosis optic neuritis. DESIGN: Single observational case report. METHODS: A 41-year-old woman with symptoms and clinical and imaging signs consistent with optic neuritis presented to a tertiary care academic center for comprehensive neuro-ophthalmic evaluation. Main outcome measures included preoptic and postoptic neuritis polyvalent ehrlichiosis titers and magnetic resonance imaging (MRI) of orbits with gadolinium. RESULTS: Ehrlichiosis titers drawn 11 days before onset of eye symptoms were negative. Titers drawn 7 days after symptoms began were positive. The optic nerve enhanced with gadolinium on MRI. CONCLUSIONS: Ehrlichiosis can cause optic neuritis and should be considered in patients with optic neuritis after a febrile, flu-like illness in an endemic area.     

Pituitary Ring Sign Plus Sphenoid Sinus Mucosal Thickening: Neuroimaging Signs of Pituitary Apoplexy

Two magnetic resonance imaging (MRI) signs of pituitary apoplexy are the “pituitary ring sign” and “sphenoid sinus mucosal thickening”. The occurrence of both these MRI signs together in patients with ischaemic pituitary apoplexy was investigated. A literature review searching the terms “pituitary ring sign” and “sphenoid sinus mucosal thickening” in the context of pituitary apoplexy from 1990 until present was performed. To be included in the study, each case had to have ischaemic pituitary apoplexy defined as acute expansion of a pituitary adenoma or, less commonly, in a non-adenomatous gland, from infarction without haemorrhage or very little haemorrhage and a T1-weighted MRI of the brain with contrast that displayed both “sphenoid sinus mucosal thickening” and a “pituitary ring sign” either on an actual study (the author’s cases) or in a figure in an article from the literature that could be reviewed and clearly illustrate these two signs. Twelve cases of ischaemic pituitary apoplexy were found, all with MRI images that showed both of these signs. Ten cases from the literature (3 of which were published by this author) plus an additional 2 recently evaluated in our hospital, totalled the 12 cases. Thus, 5 of the total 12 cases were evaluated by this author. Of these 12 patients, both headache and visual loss were present in 5 patients, headache alone was indicated in 5 patients (10 of the 12 presented with headache), and no initial symptoms identified in 2 patients (incidentally found non-functioning pituitary adenomas on MRI). These findings indicate that each sign (“pituitary ring sign” and “sphenoid sinus mucosal thickening”) may exist alone with or without pituitary apoplexy, yet both signs together in the appropriate clinical context is a strong predictor of pituitary apoplexy.     

面神经显微手术治疗周围性面瘫47例

目的 探讨不同面神经疾病致周围性面瘫显微手术方式的选择及其疗效.方法 对21例外伤性面瘫、2例医源性面神经损伤、2例面神经瘤、9例贝尔面瘫及13例中耳胆脂瘤所致的周围性面瘫,行不同进路面神经显微减压、改道或移植手术,术后随访1～5年,按面瘫H-B分级法评判面神经功能恢复程度.结果 21例颞骨骨折面瘫,伤后1～2周手术15例,术后面神经功能恢复I级13例(86.7%),Ⅲ级2例;伤后3～4周手术5例,面神经功能恢复Ⅱ级3例,Ⅲ级2例;伤后8周手术1例,仅Ⅳ级恢复.医源性面瘫2例,术后面神经功能分别为Ⅱ和Ⅱ～Ⅲ级恢复.2例面神经瘤切除后所致者,术后面神经功能恢复Ⅰ～Ⅱ级1例,Ⅲ级1例.9例贝尔面瘫8～12周手术后Ⅰ级2例,Ⅱ级4例,Ⅲ级3例.13例中耳胆脂瘤在1周内手术,Ⅰ、Ⅱ、Ⅲ级恢复例数分别为9、3、1例.结论 对于不同原因所致周围性面瘫患者,选择合适的时机及术式,经面神经减压、移植或改道吻合术后,均能取得良好效果,但应严格掌握适应证.(中国眼耳鼻喉科杂志,2009,9:29-30)