50例动眼神经麻痹的临床研究
摘要
目的:分析动眼神经麻痹的病因、临床特点、辅助检查、治疗及预后情况。
方法:搜集大连医科大学附属第二医院神经科2002年1月至2007年6月眼肌麻痹的89例住院患者的临床资料,对50例动眼神经麻痹的患者进行回顾性分析,所有病例均行颅脑CT或MRI检查,35例临床高度怀疑为颅内动脉瘤者行DSA检查,10例做神经传导速度,4例行腰穿检查,针对不同的病因诊断进行相应处理(控制血糖、神经营养、改善循环,抗感染、激素冲击、动脉瘤栓塞术、外科手术夹闭动脉瘤等)。分析其病因组成、临床表现、早期行DSA检查的必要性及预后情况。
结果:
1、动眼神经麻痹的病因包括颅内动脉瘤20例(40%),为首要病因,进一步分析表明绝大多数(80.0%)患者动脉瘤位于后交通动脉。其次为脑干血管病8例(16%),均为缺血性。糖尿病性动眼神经麻痹6例(12%),痛性眼肌麻痹5例(10%)。其它少见病因包括动眼神经感染3例,颈内动脉海绵窦瘘、横窦血栓、细菌性脑膜炎及脑干脑炎各1例。经过一系列检查(如DSA、MR、CT及血糖等)仍不能明确原因4例(8%)。
2、对临床高度怀疑为动脉瘤所致动眼神经麻痹的35例患者行DSA检查,20例显示为颅内动脉瘤(占57.1%);15例未发现动脉瘤者病因分别为脑干梗死5例,动眼神经本身感染3例,糖尿病性动眼神经麻痹及痛性眼肌麻痹各2例,横窦血栓1例,病因不明2例。
3、在颅内动脉瘤所致动眼神经麻痹中合并蛛网膜下腔出血8例(40.0%),3例死亡(37.5%)。
4、30%患者经过一定时期治疗病情好转,但治愈率仅为22%,多达48%的患者症状无改善(6%死亡)。
结论:
1、引起动眼神经麻痹的病因复杂多样,有些甚至危及生命;一些即使无生命危险,但长期遗留下来的复视也给病人造成很大痛苦。宜针对不同临床特点进行必要的辅助检查如(DSA、MR等),以达到早期病因诊断。
2、对于临床高度怀疑为颅内动脉瘤患者宜尽早行DSA检查,未发现动脉瘤者再进一步行相关检查明确病因。
3、各种原因的动眼神经麻痹患者预后不佳,仍需临床资料不断积累才能确定各种病因最佳治疗方案。
Objectives:To analyze the causes,clinical manifestations,methods of examination,treatment and prognosis of oculomotor nerve palsy.
Methods:50 cases with oculomotor nerve palsy were retrospectively analyzed,all these cases were selected from 89 cases with Ophthalmoplegia admitted to the Second Affiliated Hospital of Dalian Medical University during January 2002 to June 2007.All cases underwent CT or MRI scan.35 cases with suspected intracranial aneurysms underwent DSA,10 cases added nerve conduction velocity examination,4 case underwent lumbar puncture. Appropriate treatment was given according to different diagnosis,including controlling blood glucose,nerve nutrition,improving microcirculation, anti- infection,the impact of hormones,aneurysm embolization,surgical clipping of aneurysm,etc.The causes,clinical manifestations,the necessity for early DSA and prognosis were analyzed.
Results:
1.The main cause of oculomotor nerve palsy was intracranial aneurysm,found in 20(40%) cases in this study,Further analysis showed that majority(80.0 %)aneurysms located in posterior communicating artery.The ischemic stroke of brain stem was found in 8(16%)cases,diabetic oculomotor nerve paralysis in 6(12%)cases,painful ophthalmoplegia in 5(10%)cases.Other rare causes include oculomotor nerve infections in 3 cases,carotid-cavernous fistula,thrombosis of transverse sinus,bacterial meningitis and encephalitis of the brain stem,4(8%)cases could not find the final cause even after varied examinations including DSA,MR,CT and blood glucose etc.
2.DSA was underwent in 35 cases suspected with intracranial aneurysms.As a result,aneurysms were found in 20(57.1%)cases.Futher analysis of 15 cases without aneurysms showed brain stem infarction in 5 cases,oculomotor nerve infection in 3 cases,diabetic oculomotor nerve paralysis in 2 cases,painful ophthalmoplegia in 2 cases,and transverse sinus thrombosis in 1 case.Etiology could not be defined in 2 case.
3.Subarachnoid hemorrhage was caused by rupture of intracranial aneurysms in 8(40.0%)cases,3(37.5%)cases of which died.
4.30% of the cases improved after a certain period of treatment,but the cure rate was only 22%,up to 48% of cases showed no improvement(6% death).
Conclusions:
1.Many causes can cause oculomotor nerve palsy,some are even life- threatening.Though some causes are not dangerous,but the long-term diplopia also cause great suffering to patients.To achieve early diagnosis,necessary examinations such as DSA,MR,etc.should be perfouned according to the clinical features.
2.DSA should be perfouned as soon as possible for patients with highly suspected intracranial aneurysms.Then further relevant examinations should be chosen to clear the cause for patients without aneurysms.
3、There was always unfavorable prognosis for oculomotor nerve palsy caused by various reasons ,more clinical data were needed to draw the conclusion concerning the best treatment.
方法:搜集大连医科大学附属第二医院神经科2002年1月至2007年6月眼肌麻痹的89例住院患者的临床资料,对50例动眼神经麻痹的患者进行回顾性分析,所有病例均行颅脑CT或MRI检查,35例临床高度怀疑为颅内动脉瘤者行DSA检查,10例做神经传导速度,4例行腰穿检查,针对不同的病因诊断进行相应处理(控制血糖、神经营养、改善循环,抗感染、激素冲击、动脉瘤栓塞术、外科手术夹闭动脉瘤等)。分析其病因组成、临床表现、早期行DSA检查的必要性及预后情况。
结果:
1、动眼神经麻痹的病因包括颅内动脉瘤20例(40%),为首要病因,进一步分析表明绝大多数(80.0%)患者动脉瘤位于后交通动脉。其次为脑干血管病8例(16%),均为缺血性。糖尿病性动眼神经麻痹6例(12%),痛性眼肌麻痹5例(10%)。其它少见病因包括动眼神经感染3例,颈内动脉海绵窦瘘、横窦血栓、细菌性脑膜炎及脑干脑炎各1例。经过一系列检查(如DSA、MR、CT及血糖等)仍不能明确原因4例(8%)。
2、对临床高度怀疑为动脉瘤所致动眼神经麻痹的35例患者行DSA检查,20例显示为颅内动脉瘤(占57.1%);15例未发现动脉瘤者病因分别为脑干梗死5例,动眼神经本身感染3例,糖尿病性动眼神经麻痹及痛性眼肌麻痹各2例,横窦血栓1例,病因不明2例。
3、在颅内动脉瘤所致动眼神经麻痹中合并蛛网膜下腔出血8例(40.0%),3例死亡(37.5%)。
4、30%患者经过一定时期治疗病情好转,但治愈率仅为22%,多达48%的患者症状无改善(6%死亡)。
结论:
1、引起动眼神经麻痹的病因复杂多样,有些甚至危及生命;一些即使无生命危险,但长期遗留下来的复视也给病人造成很大痛苦。宜针对不同临床特点进行必要的辅助检查如(DSA、MR等),以达到早期病因诊断。
2、对于临床高度怀疑为颅内动脉瘤患者宜尽早行DSA检查,未发现动脉瘤者再进一步行相关检查明确病因。
3、各种原因的动眼神经麻痹患者预后不佳,仍需临床资料不断积累才能确定各种病因最佳治疗方案。
Objectives:To analyze the causes,clinical manifestations,methods of examination,treatment and prognosis of oculomotor nerve palsy.
Methods:50 cases with oculomotor nerve palsy were retrospectively analyzed,all these cases were selected from 89 cases with Ophthalmoplegia admitted to the Second Affiliated Hospital of Dalian Medical University during January 2002 to June 2007.All cases underwent CT or MRI scan.35 cases with suspected intracranial aneurysms underwent DSA,10 cases added nerve conduction velocity examination,4 case underwent lumbar puncture. Appropriate treatment was given according to different diagnosis,including controlling blood glucose,nerve nutrition,improving microcirculation, anti- infection,the impact of hormones,aneurysm embolization,surgical clipping of aneurysm,etc.The causes,clinical manifestations,the necessity for early DSA and prognosis were analyzed.
Results:
1.The main cause of oculomotor nerve palsy was intracranial aneurysm,found in 20(40%) cases in this study,Further analysis showed that majority(80.0 %)aneurysms located in posterior communicating artery.The ischemic stroke of brain stem was found in 8(16%)cases,diabetic oculomotor nerve paralysis in 6(12%)cases,painful ophthalmoplegia in 5(10%)cases.Other rare causes include oculomotor nerve infections in 3 cases,carotid-cavernous fistula,thrombosis of transverse sinus,bacterial meningitis and encephalitis of the brain stem,4(8%)cases could not find the final cause even after varied examinations including DSA,MR,CT and blood glucose etc.
2.DSA was underwent in 35 cases suspected with intracranial aneurysms.As a result,aneurysms were found in 20(57.1%)cases.Futher analysis of 15 cases without aneurysms showed brain stem infarction in 5 cases,oculomotor nerve infection in 3 cases,diabetic oculomotor nerve paralysis in 2 cases,painful ophthalmoplegia in 2 cases,and transverse sinus thrombosis in 1 case.Etiology could not be defined in 2 case.
3.Subarachnoid hemorrhage was caused by rupture of intracranial aneurysms in 8(40.0%)cases,3(37.5%)cases of which died.
4.30% of the cases improved after a certain period of treatment,but the cure rate was only 22%,up to 48% of cases showed no improvement(6% death).
Conclusions:
1.Many causes can cause oculomotor nerve palsy,some are even life- threatening.Though some causes are not dangerous,but the long-term diplopia also cause great suffering to patients.To achieve early diagnosis,necessary examinations such as DSA,MR,etc.should be perfouned according to the clinical features.
2.DSA should be perfouned as soon as possible for patients with highly suspected intracranial aneurysms.Then further relevant examinations should be chosen to clear the cause for patients without aneurysms.
3、There was always unfavorable prognosis for oculomotor nerve palsy caused by various reasons ,more clinical data were needed to draw the conclusion concerning the best treatment.
引文
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36. De Silva DA,Siow HC.A case report of ophthalmoplegic migraine:a differential diagnosis of third nerve palsy.Cephalalgia,2005,25:827-830.
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