颅底动脉瘤的眼部改变

报告１４６例颅底动脉瘤的眼部改变，常见为头痛、眼痛、视力减退、复视、上睑下垂。颅神经麻痹以动眼神经最易受累，外展神经次之，滑车及三叉神经最少。动眼神经麻痹时最常见的表现为提上睑肌及瞳孔纤维受累。视交叉附近动脉瘤的视野改变均不呈现典型的颞侧偏盲。     

糖尿病性动眼神经麻痹临床分析

目的探讨糖尿病性动眼神经不全麻痹的临床特点及预后。方法回顾分析21例糖尿病性动眼神经麻痹患者临床表现、治疗过程及转归。结果糖尿病性动眼神经麻痹通常以复视、上睑下垂、眼球运动受限为主要表现,但临床上以眼痛及同侧额部疼痛为首发症状的也并不少见,少数病例有瞳孔受累。经改善循环、营养神经等治疗,全部患者在8～12周内治愈。随访观察6～48个月。结论糖尿病是后天性动眼神经麻痹较常见病因,诊断正确、及时治疗,效果满意。     

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。     

老年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。方法对57例(57只眼)进行常规的眼科检查和眼肌学检查,以内科检查及实验室血生化检查确诊糖尿病;部分患者行头颅影像学检查。结果 57例老年糖尿病患者均为单眼患病,受累颅神经以动眼神经最多,占53%为30只眼,外展神经麻痹占24%为14只眼,滑车神经麻痹占16%为9只眼。复合颅神经(Ⅲ,Ⅳ)麻痹占7%为4只眼。动眼神经麻痹中7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,高血脂症。结论老年糖尿病患者易合并眼肌麻痹,其微血管病变是临床发病的病理基础。     

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     

误诊为动眼神经麻痹的单纯眼肌型重症肌无力一例

患者,男,74岁,反复双眼上睑下垂、复视8个月余,于2011年4月18日入解放军总医院眼科诊治,既往有糖尿病史20年,高血压病史10年.2010年6月19日,患者晨起时无明显诱因出现右眼上睑下垂,伴复视,向上看时较明显.查体见右眼完全性上睑下垂,眼球向上运动受限,无瞳孔扩大.行头颅CT平扫示:多发腔隙性脑梗死.诊断:(1)右眼动眼神经麻痹.(2)多发腔隙性脑梗死.给予改善微循环、营养神经、扩张血管类药物治疗41 d,右眼上睑下垂治愈,眼球运动受限好转.     

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     

伴有眼部表现的颅内动脉瘤初探

目的 探讨颅内动脉瘤与其眼部表现的规律.设计 回顾性病例系列.研究对象 91例颅内动脉瘤患者.方法回顾2005年1月至2007年12月解放军总医院神经外科收治的颅内动脉瘤患者的病历.具有眼部症状的患者均进行脑血管数字减影检查,施行手术或介人治疗.主要指标 颅内动脉瘤位置、大小以及瘤顶指向和不同程度的眼科症状.结果 9l例颅内动脉瘤患者中合并眼部表现者23例(25.27%).其中后交通动脉瘤12例(52.17%),颈内动脉岩段及颈内动脉床突旁段动脉瘤各2例(8.70%),颈内动脉眼动脉段、大脑前动脉、大脑中动脉、小脑后下动脉、海绵窦段、颈动脉原始三叉动脉、颈内动脉分叉处动脉瘤各1例(4.35%).后交通动脉瘤的眼部症状以程度不同的动眼神经麻痹为主.床突旁段、颈动脉原始三叉动脉、颈内动脉岩段动脉瘤患者分别出现视力下降、外展神经麻痹及发作性复视.患者术前皆未进行详细的眼科检查.术后最长随访1年,动脉瘤栓塞术后患者皆未出现眼部症状改善,瘤颈夹闭术后患者眼部症状改变有限或无改善.结论 半数的伴有眼部表现的颅内动脉瘤为后交通动脉瘤,以动眼神经麻痹为眼部主要表现.颅内动脉瘤患者应及时进行眼科会诊.     

动眼神经麻痹的定位诊断及治疗进展

动眼神经麻痹是一种可由多种病因导致的眼球运动异常、上睑下垂及瞳孔受损的疾病,是非共同性斜视的重要病因之一。动眼神经麻痹的临床表现为上睑下垂、眼球上转、内转、下转受限、患眼瞳孔散大及对光反应迟钝或消失。常见病因有脑血管疾病、头部外伤、肿瘤、炎症及内分泌代谢疾病等。本文着重从动眼神经的解剖路径、定位诊断、常见病因及治疗等方面,对动眼神经麻痹的临床特征及处理原则进行概述。     

A case of multiple cranial nerve palsies as the initial ophthalmic presentation of antiphospholipid syndrome

PURPOSE: To report a case of third, fourth, and six cranial nerve palsies with antiphospholipid syndrome (APS). METHODS: Medical records of a 16-year-old female diagnosed with idiopathic intracranial hypertension (IIH) in primary APS were reviewed. RESULTS: A 16-year-old female presented with headache and diplopia. Ocular examinations revealed marked bilateral disc edema. She was unable to depress, adduct, and abduct in left eye and had limited abduction in the right eye. Cerebrospinal fluid had a normal composition and a pressure of 400 mmH20. Lupus anticoagulant and IgG anticardiolipin antibody were positive. There was no clinical evidence of other autoimmune disease. Brain magnetic resonance (MR) imaging, MR angiography, and conventional angiogram with venous phase were normal. She was diagnosed with bilateral sixth, and left third and fourth cranial nerve palsies secondary to idiopathic intracranial hypertension in primary APS. CONCLUSIONS: To our knowledge this is the first reported case of concurrent third, fourth, and sixth cranial nerve palsies in a patient with primary APS.     

Horner's Syndrome and Contralateral Abducens Nerve Palsy Associated with Zoster Meningitis

A 55-year-old woman presented with diplopia following painful skin eruptions on the right upper extremity. On presentation, she was found to have 35 prism diopters of esotropia and an abduction limitation in the left eye. Two weeks later, she developed blepharoptosis and anisocoria with a smaller pupil in the right eye, which increased in the darkness. Cerebrospinal fluid analysis showed pleocytosis and a positive result for immunoglobulin G antibody to varicella zoster virus. She was diagnosed to have zoster meningitis with Horner''s syndrome and contralateral abducens nerve palsy. After intravenous antiviral and steroid treatments, the vesicular eruptions and abducens nerve palsy improved. Horner''s syndrome and diplopia resolved after six months. Here we present the first report of Horner''s syndrome and contralateral abducens nerve palsy associated with zoster meningitis.     

The Forgotten Syndrome? Four Cases of Gradenigo’s Syndrome and a Review of the Literature

Background: Gradenigo’s Syndrome (GS) is defined as the clinical triad of acute otitis media, ipsilateral sixth nerve palsy, and pain in the distribution of the first and the second branches of the fifth nerve. The purpose of this study is to review the literature and report 4 cases of GS.

Methods: The study is a retrospective case series and a review of the literature. Four consecutive patients (aged 5–70 years) treated by otolaryngologists and ophthalmologists for GS in the Capital region of Denmark from 2003 to 2015 are presented. Diagnosis is based on the clinical triad, and in 3 of 4 patients, neuroimaging supports the diagnosis. Follow-up was continued until both the sixth nerve palsy and the ear infection had resolved. Diagnostic work-up and treatment profile are described.

Results: In 3 of our 4 reported patients, the presentation of GS was classic with a history of acute otitis media and ipsilateral sixth nerve palsy. One case presented as a chronic case with a sixth nerve palsy secondary to chronic suppurative otitis media (CSOM), with a relapse 6 years later.

Conclusion: GS is a rare and potentially life-threatening complication to otitis media. GS can present in an acute and chronic form, and should be a differential diagnosis in the workup of unexplained sixth nerve palsy.     

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。     

A Prospective Study of the Causes and Magnetic Resonance Imaging Findings in Adult Isolated Non-traumatic Unilateral Abducens Palsy in Taiwan

The objective of this study was to investigate the causes of acute isolated non-traumatic unilateral abducens palsy in adults and to evaluate the diagnostic relevance of Magnetic Resonance Imaging (MRI). This prospective study included a total of 40 patients presenting with acute isolated unilateral non-traumatic abducens palsy from January 2002 to June 2008 at Buddhst Tzu Chi General Hospital, Hualien. A standardized MRI protocol was performed within 1 week of the patient's first visit. In 23 patients (57.5%) a lesion was identified on the initial MRI relevant to the sixth nerve palsy. In 8 patients (20%) the cause was nasopharyngeal carcinoma. The MRI was positive in 4 out of 15 diabetic patients, and in 5 out of 12 patients with hypertension. MRI demonstrated the aetiology in 57.5% of cases of acute isolated non-traumatic unilateral abducens palsy, with nasopharyngeal carcinoma being a common cause in our study. We suggest a complete MRI study of the brain and the orbits, with axial, coronal and sagittal imaging, the use of intravenous contrast, and fat suppression techniques in acute adult isolated non-traumatic unilateral abducens palsy.     

Midbrain angioma with disconjugate vertical gaze palsy

Loss of depression in one eye with contralateral loss of elevation is rare. It has been attributed to a subnuclear lesion of the oculomotor nerve nuclear complex. We present a patient with these signs who has an arteriovenous malformation occupying his rostral midbrain. We argue that attributing these findings to a subnuclear lesion of the oculomotor nerve complex does not take into consideration the secondary, vertical action of the obliques.     

Isolated Fourth Nerve Palsy in Tuberculous Meningitis

Tuberculous meningitis is a type of subacute meningitis and like other intracranial processes can compromise ocular motor nerves, causing palsies. Trochlear nerve is an unusual isolated manifestation in this type of pathology. The authors report a 5-year-old boy presented in their clinic with a trochlear nerve palsy as unique neurological manifestation of tuberculous meningitis. Treatment with complete anti-tuberculous therapy and botulinum A toxin was needed to get the complete resolution of the nerve palsy. In tuberculous meningitis, the presence of high protein levels and higher number of cells in cerebrospinal fluid is associated with cranial nerve involvement. Usually cranial nerve palsies occur in combination. VI cranial nerve alone or a combined disorder of VI and III cranial nerves are the palsies most frequently presented. Much less common is an isolated disorder of IV cranial nerve in the course of meningitis. The length of full treatment with anti-tuberculous therapy in this case was of 1 year. The persistence of palsy 1 month after the beginning of the symptoms indicated the possibility of a botulinum toxin injection with complete resolution of the process without disability, ocular motility has remained normal on follow-up.     

Pediatric ocular motor cranial nerve palsy: Demographics and etiological profile

Purpose:The aim of this study was to describe epidemiological and clinical characteristics of pediatric ocular motor cranial nerve palsy.Methods:This was a retrospective record-based study, carried out at a tertiary eye care hospital in India, between January 2011 and January 2015 and included patients up to 16 years of age at the time of presentation, diagnosed with third, fourth, sixth nerve palsy or a combination of these with other cranial nerve palsy. Data analyzed included demographic details, etiologies, presence or absence of amblyopia, relevant investigations, and management.Results:A total of 90 cases were included in the study. Eighty patients (88.88%) presented with isolated nerve palsy. Forty-three patients (47.77%) had congenital nerve palsy. The most common nerve involved was third (n = 35, 38.88%) followed by sixth (n = 23, 25.55%) and fourth nerve (n = 22, 24.44%). Most common cause of third and fourth cranial nerve palsy was congenital (n = 18, 51.42% and n = 17, 77.30%, respectively), while it was trauma for the sixth nerve (n = 7, 30.40%). Amblyopia was most frequently associated with third cranial nerve palsy (n = 27, 77.14%). The radio-imaging yield was maximum (n = 7, 70%) for combined cranial nerve palsy. Overall 44 (48.88%) patients were managed conservatively, while 46 (51.11%) patients needed squint with or without ptosis surgery.Conclusion:The most common ocular motor cranial nerve involved in the pediatric population was the third cranial nerve, and it was found to be the most amblyogenic in this age group. The neuroimaging yield was maximum for combined cranial nerve palsy. The most common conservatively managed nerve palsy in this study group was the fourth nerve palsy.