眼部带状疱疹并发动眼神经麻痹的临床分析
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摘要
目的探讨眼部带状疱疹并发动眼神经麻痹的临床特点。方法分析1例眼部带状疱疹并发动眼神经不全麻痹的诊治过程,结合文献并分析该疾病的病因、发病机制、临床表现、鉴别诊断、治疗措施及预后。结果本例患者以右侧头面部皮疹伴疼痛为首发症状,皮疹区逐渐出现成簇样水泡,右侧眼睑肿胀、抬举费力,伴视物成双。入院时查体右侧三叉神经眼支分布区皮肤可见疱疹。右眼结膜充血、流泪。右侧动眼神经不全麻痹。入院后给予更昔洛韦静脉滴注抗水痘-带状疱疹病毒、醋酸波尼松口服,辅以维生素B_1和维生素B_(12)等治疗,症状明显恢复。结论对于尚未出现疱疹的头痛患者,应考虑到有无带状疱疹感染可能。眼部带状疱疹,可出现眼睛感染,伴完全或不完全动眼神经麻痹症状。需要与Tolosa-Hunt综合征、颅内动脉瘤、糖尿病等疾病相鉴别。治疗上需尽早给予抗病毒、激素、营养神经、针灸理疗等联合手段。该病早期诊断,早期治疗后,预后较好,部分患者可有后遗症。
Objective To study the clinical characteristics of herpes zoster ophthalmicus with oculomotor nerve palsy, improve awareness of the disease and reduce misdiagnosis and mistreatment. Method We analyzed the diagnosis and treatment of one patient of herpes zoster ophthalmicus with oculomotor nerve palsy, reviewed the literature and summarized the pathogeny,pathogenesis,clinical manifestations,differential diagnosis, treatment and prognosis of herpes zoster ophthalmicus with oculomotor nerve palsy. Results In this case, the rash of the right head and face with headache was a starting manifestation, the rash area was gradually grown clustered blisters. Accompanied by diplopia, the right eyelid was gradually swollen and lifted with weakness. Herpes was seen in the area of the right ophthalmic branch of the trigeminal nerve. The conjunctiva of the right eye was congested. The right oculomotor nerve was not completely paralyzed. After admission, antiviral and hormones were given, supplemented by nutritional nerve, acupuncture and so on, and the symptoms obviously recovered. Conclusion For headache without herpes, we should consider whether there was herpes zoster infection. Herpes zoster ophthalmicus can cause eye infections, accompanied by complete or incomplete oculomotor palsy. It should be differentiated from Tolosa-Hunt syndrome, intracranial aneurysms, diabetes and other diseases. Early treatment should be combined with antiviral, hormone, nutritional nerve, acupuncture and physical therapy. Early diagnosis and early treatment would result in better prognosis and some patients would leave neuralgia.
Objective To study the clinical characteristics of herpes zoster ophthalmicus with oculomotor nerve palsy, improve awareness of the disease and reduce misdiagnosis and mistreatment. Method We analyzed the diagnosis and treatment of one patient of herpes zoster ophthalmicus with oculomotor nerve palsy, reviewed the literature and summarized the pathogeny,pathogenesis,clinical manifestations,differential diagnosis, treatment and prognosis of herpes zoster ophthalmicus with oculomotor nerve palsy. Results In this case, the rash of the right head and face with headache was a starting manifestation, the rash area was gradually grown clustered blisters. Accompanied by diplopia, the right eyelid was gradually swollen and lifted with weakness. Herpes was seen in the area of the right ophthalmic branch of the trigeminal nerve. The conjunctiva of the right eye was congested. The right oculomotor nerve was not completely paralyzed. After admission, antiviral and hormones were given, supplemented by nutritional nerve, acupuncture and so on, and the symptoms obviously recovered. Conclusion For headache without herpes, we should consider whether there was herpes zoster infection. Herpes zoster ophthalmicus can cause eye infections, accompanied by complete or incomplete oculomotor palsy. It should be differentiated from Tolosa-Hunt syndrome, intracranial aneurysms, diabetes and other diseases. Early treatment should be combined with antiviral, hormone, nutritional nerve, acupuncture and physical therapy. Early diagnosis and early treatment would result in better prognosis and some patients would leave neuralgia.
引文
[1]Kalogeropoulos CD,Bassukas ID,Moschos MM,et al.Eye and periocular skin involvement in herpes zoster infection[J].Med Hypothesis Discov Innov Ophthalmol,2015,4(4):142-156.
[2]Sengupta N,Taha Y,Scott FT,et al.Varicella-zoster-virus genotypes in East London:a prospective study in patients with herpes zoster[J].J Infect Di,2007,196(7):1014-1020.
[3]Taha Y,Scott FT,Parker SP,et al.Reactivation of 2 genetically distinct varicella-zoster viruses in the same individual[J].Clin Infect Dis,2006,43(10):1301-1303.
[4]Kennedy PG,Cohrs RJ.Varicella-zoster virus human ganglionic latency:a current summary[J].J Neurovirol,2010,16(6):411-418.
[5]Sundstr?m K,Weibull CE,S?derberg-L?fdal K,et al.Incidence of herpes zoster and associated events including stroke-a population based cohort study[J].BMC Infect Dis,2015,15:488-497.
[6]Ota T,Yamazaki M,Toda Y,et al.A case of herpes zoster ophthalmicus preceded one week by diplopia and ophthalmalgia[J].Rinsho Sjinkeigaku,2017,57(4):163-167.
[7]Chhabra MS,Golnik KC.Recovery of ocular motor cranial nerve palsy after herpes zoster ophthalmicus[J].J Neuroophthalmol,2014,34(1):20-22.
[8]Puri LR,Shrestha GB,Shah DN,et al.Ocular manifestations in herpes zoster ophthalmicus[J].Nepal J Ophthalmol,2011,3(2):165-171.
[9]Daswani M,Bhosale N,Shah VM.et al.Rare case of herpes zoster ophthalmicus with orbital myositis,oculomotor nerve palsy and anterior uveitis[J].Indian J Dermatol Venereol Leprol,2017,83(3):365-367.
[10]何洋,刘广志,高旭光.额面部带状疱疹伴对侧动眼神经麻痹一例[J].中华临床医师杂志(电子版),2011,5(17):5239.
[11]Vaphiades MS,Roberson GH.Imaging of oculomotor(Third)cranial nerve palsy[J].Neurol Clin,2017,35(1):101-113.
[12]Fan S,Stojanovic D,Malvankar-Mehta MS,et al.Treatment of herpes zoster ophthalmicus:a systematic review and Canadian costcomparison[J].Can j Ophthalmol,2018,53(2):117-123.
[13]Calin MA,Parasca SV.In vivo study of age-related changes in the optical properties of the skin[J].Lasers Med Sci,2010,25(2):269-274.
[14]Ryu WY,Kim NY,Kwon YH,et al.Herpes zoster ophthalmicus with isolated trochlear nerve palsy in an otherwise healthy 13-year-old girl[J].J Aapos,2014,18(2):193-195.
[15]Johnson JL,Amzat R,Martin N,et al.Herpes zoster ophthalmicus[J].Prim Care,2015,42(3):285-303.
[16]Freund PR,Chen SH.Herpes zoster ophthalmicus[J].CMAJ,2018,28,190(21):E656.
[17]孟宪芙.三叉神经带状疱疹临床分析[J].中国实用神经疾病杂志,2015,18(6):34-36.
[2]Sengupta N,Taha Y,Scott FT,et al.Varicella-zoster-virus genotypes in East London:a prospective study in patients with herpes zoster[J].J Infect Di,2007,196(7):1014-1020.
[3]Taha Y,Scott FT,Parker SP,et al.Reactivation of 2 genetically distinct varicella-zoster viruses in the same individual[J].Clin Infect Dis,2006,43(10):1301-1303.
[4]Kennedy PG,Cohrs RJ.Varicella-zoster virus human ganglionic latency:a current summary[J].J Neurovirol,2010,16(6):411-418.
[5]Sundstr?m K,Weibull CE,S?derberg-L?fdal K,et al.Incidence of herpes zoster and associated events including stroke-a population based cohort study[J].BMC Infect Dis,2015,15:488-497.
[6]Ota T,Yamazaki M,Toda Y,et al.A case of herpes zoster ophthalmicus preceded one week by diplopia and ophthalmalgia[J].Rinsho Sjinkeigaku,2017,57(4):163-167.
[7]Chhabra MS,Golnik KC.Recovery of ocular motor cranial nerve palsy after herpes zoster ophthalmicus[J].J Neuroophthalmol,2014,34(1):20-22.
[8]Puri LR,Shrestha GB,Shah DN,et al.Ocular manifestations in herpes zoster ophthalmicus[J].Nepal J Ophthalmol,2011,3(2):165-171.
[9]Daswani M,Bhosale N,Shah VM.et al.Rare case of herpes zoster ophthalmicus with orbital myositis,oculomotor nerve palsy and anterior uveitis[J].Indian J Dermatol Venereol Leprol,2017,83(3):365-367.
[10]何洋,刘广志,高旭光.额面部带状疱疹伴对侧动眼神经麻痹一例[J].中华临床医师杂志(电子版),2011,5(17):5239.
[11]Vaphiades MS,Roberson GH.Imaging of oculomotor(Third)cranial nerve palsy[J].Neurol Clin,2017,35(1):101-113.
[12]Fan S,Stojanovic D,Malvankar-Mehta MS,et al.Treatment of herpes zoster ophthalmicus:a systematic review and Canadian costcomparison[J].Can j Ophthalmol,2018,53(2):117-123.
[13]Calin MA,Parasca SV.In vivo study of age-related changes in the optical properties of the skin[J].Lasers Med Sci,2010,25(2):269-274.
[14]Ryu WY,Kim NY,Kwon YH,et al.Herpes zoster ophthalmicus with isolated trochlear nerve palsy in an otherwise healthy 13-year-old girl[J].J Aapos,2014,18(2):193-195.
[15]Johnson JL,Amzat R,Martin N,et al.Herpes zoster ophthalmicus[J].Prim Care,2015,42(3):285-303.
[16]Freund PR,Chen SH.Herpes zoster ophthalmicus[J].CMAJ,2018,28,190(21):E656.
[17]孟宪芙.三叉神经带状疱疹临床分析[J].中国实用神经疾病杂志,2015,18(6):34-36.