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。

Analysis of 80 cases of extraocular muscles paralysis with diplopia

Objective To evaluate clinical features of extraocular muscles paralysis that initially presented with di -plopia.Methods Eighty cases with extraocular muscles paralysis were analyzed for causes of disease by reviewing medical history, a thorough physical examination and a complete eye examination .The clinical features were studied .Results Twenty-four patients with extraocular muscles paralysis were caused by diabetes , including oculomotor nerve paralysis （ 16 cases）, abducent nerve paralysis （6 cases）, and combination of oculomotor nerve and abducent nerve paralysis （2 cases）. Twenty cases were caused by cerebrovascular diseases , and 18 cases were caused by arteriosclerosis resulted oculomotor and abducent nerve paralysis .Ten cases were caused by intracranial aneurysms ,two cases by myasthenia gravis ,one case by so-matization disorder ,two by intracranial tumors ,one by multiple sclerosis ,one by neurosyphilis ,and 1 by brainstem encepha-litis.Conclusions Many neurological diseases can cause nerve ophthalmic signs such as diplopia .The most common cau-ses including diabetic ophthalmoplegia , cerebrovascular disease , and aneurysms ophthalmoplegia .Atherosclerosis is also an important cause.Other etiologies include myasthenia gravis （ocular）, somatoform disorders, intracranial mass, etc.The e-tiology of patients with extraocular muscles paralysis and diplopia is complex and easy to be misjudged .Therefore,much at-tention should be paid to the exact diagnosis and proper management .