单侧性动眼神经麻痹的临床分析

目的回顾分析本科3年来收治20例单侧性动眼神经麻痹的患者,探讨其病因、治疗及预后。方法20例患者分析其临床症状,均作CT检查,进一步DSA脑血管造影,并根据诊断进行针对性处理。结果20例患者中14例为脑血管检查阳性,其中11例为后交通动脉瘤,10例经手术或介入治疗痊愈,1例破裂出血死亡。其余2例为海绵窦硬脑膜动静脉瘘,其中1例经介入治疗痊愈,1例未作治疗。另1例为后交通动脉赤腹样扩张,未作特殊治疗。结论DSA脑血管造影对病因诊断有确诊价值,动眼神经麻痹伴蛛网膜下腔出血或剧烈头痛应高度怀疑后交通动脉瘤或其他脑血管病变,早期造影及治疗极为必要。

Clinical analysis of unilateral oculomotor palsy

Objective To study the cause, treatment and prognosis of unilateral oculomotor palsy by analyzing 20 patients suffering from oculomotor palsy in recent 3 years in our department. Methods The 20 patients whose clinical symptoms were analyzed underwent CT scan and cerebral angiography (DSA) and were treated basing on the diagnosis. Results 14 of the 20 patients were found to be positive in above testing. 11 cases were diagnosed as posterior communicating artery aneurysm, one of which died from ruptured aneurysm. Of 2 cases with dural arteriovenous fistulae (DAVF) involving the cavernous sinus, one recovered by endovascular interventional therapy and the other received no other treatment. And the other one diagnosed as ampullae-like dilatation of posterior communicating artery received no special treatment. Conclusion Cerebral angiography (DSA) contributes to the affirmative diagnosis of aneurysm. Spontaneous oculomotor palsy accompanied with subarachnoid hemorrhage (SAH) or severe headache is reliably subject to posterior communicating artery aneurysm or other intracranial vessel disease. Earlier diagnosis by cerebral angiography and earlier treatment are promising for a better favorable result.