周围性动眼神经麻痹临床特点与病因分析

doi:10.3969/j.issn.1672-6731.2020.08.016

摘要/Abstract

摘要：

目的总结分析动眼神经麻痹病因及临床特征。方法与结果 对2019年1-10月确诊动眼神经麻痹患者的临床资料进行回顾分析，共32例患者，17例（53.13%）呈急性发病、15例（46.88%）为亚急性发病；单眼受累30例（93.75%）、双眼同时受累2例（6.25%）；伴头痛10例（31.25%），瞳孔受累8例（25%）。病因诊断为微循环障碍（16例占50%）、非特异性炎症（11例占34.38%）、后交通动脉瘤（2例占6.25%），以及中脑梗死（1例占3.13%）、脑干脱髓鞘病变（1例占3.13%）和嗜酸性粒细胞增多症（1例占3.13%）。针对不同病因，分别采取改善循环（微循环障碍和中脑梗死）、抗炎及抑制炎症反应（非特异性炎症、脑干脱髓鞘病变及嗜酸性粒细胞增多症）或介入治疗（后交通动脉瘤）；治疗后31例（96.88%）症状缓解、1例（3.13%）预后不良。结论微循环障碍是导致动眼神经麻痹的主要病因，颅内动脉瘤是其最危险的病因。患眼疼痛和瞳孔受累并非颅内动脉瘤所特有的症状，积极完善相关检查明确病因并予以相应治疗，大多数患者预后良好。

关键词: 动眼神经疾病, 眼肌麻痹, 微循环, 炎症, 颅内动脉瘤

Abstract:

Objective To summarize and analyze the etiology and clinical features of the third nerve palsy (TNP). Methods and Results The clinical data of patients with TNP diagnosed from January to October 2019 were retrospectively analyzed. A total of 32 patients with TNP were included. There were 17 cases (53.12%) of acute onset and 15 cases (46.88%) of subacute onset. Monocular involvement was found in 30 cases (93.75%) and binocular involvement in 2 cases (6.25%). There were 10 cases (31.25%) with headache, and 8 cases (25%) with pupil involvement. The etiology was diagnosed as microcirculation disorder (16 cases, 50%), non-specific inflammation (11 cases, 34.38%), posterior communication aneurysm (2 cases, 6.25%), midbrain infarction (1 case, 3.13%), brain stem demystification (1 case, 3.13%) and eosinophilia (1 case, 3.13%). Improvement of circulation (microcirculation disorder and midbrain infarction), anti-inflammatory and suppressive inflammatory response (non-specific inflammation, brainstem demyelination and eosinophilia) or interventional therapy (posterior communication aneurysm) were performed. After treatment, 31 cases (96.88%) showed remission of symptoms and 1 case (3.13%) had poor prognosis. Conclusions Microcirculation disorder is the main cause of TNP, and intracranial aneurysm is the most dangerous cause. Eye pain and pupil involvement are not the specific symptoms of intracranial aneurysms. Relevant examinations can actively improve the determination of the cause and appropriate treatment. Most patients have a good prognosis.

Key words: Oculomotor nerve diseases, Ophthalmoplegia, Microcirculation, Inflammation, Intracranial aneurysm

朱丽平, 王佳伟. 周围性动眼神经麻痹临床特点与病因分析[J]. 中国现代神经疾病杂志, 2020, 20(8): 746-751.

ZHU Li-ping, WANG Jia-wei. Clinical characteristics and etiological analysis of the peripheral third nerve palsy[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(8): 746-751.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I8/746

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Clinical characteristics and etiological analysis of the peripheral third nerve palsy

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