以眼肌麻痹为唯一或主要表现的脑干梗死临床特点研究

发布时间：2018-06-25 22:58

本文选题：脑干梗死 + 眼肌麻痹　；参考：《中风与神经疾病杂志》2017年02期

【摘要】：目的研究以眼肌麻痹为唯一或主要表现的脑干梗死患者临床和影像学表现、预后及探索其病因及发病机制。方法回顾性连续收集2010年-2016年间在我院神经内科经临床和影像学诊断证实的20例以眼肌麻痹为唯一或主要表现的脑干梗死住院患者的临床资料,分析眼肌麻痹的类型、伴随神经系统症状和体征、病灶特点、责任血管、危险因素及疾病预后。结果 20例以眼肌麻痹为唯一或主要表现的脑干梗死患者的眼肌麻痹表现为:核下性(1例),核性(9例),核间性(10例)。核性眼肌麻痹以动眼神经不全麻痹最常见(78%);核间性眼肌麻痹以前核间性眼肌麻痹多见(60%)。孤立性眼肌麻痹患者6例,伴随症状以头晕最多见(55%)。18例(90%)患者伴颅内多发腔隙性病灶,磁共振血管成像(magnetic resonance angiography,MRA)显示与梗死灶相关的血管狭窄或闭塞有14例(70%),常见为大脑后动脉狭窄12例(60%)。13例(65%)在住院期间眼部症状消失,消失时间以发病后2 w内最多见(50%)。经随访,14例(70%)患者在发病后3 m内眼部症状消失。比较孤立性眼肌麻痹组(n=6)与非孤立眼肌麻痹组(n=14)临床、影像特点及实验室指标方面差异,非孤立眼肌麻痹组空腹血糖值更高,差异有统计学意义(P0.05)。结论脑干梗死引起的眼肌麻痹可有各种表现,以核间性眼肌麻痹最常见,核性眼肌麻痹以动眼神经不全麻痹多见。多数患者伴后循环大血管狭窄或闭塞。大部分患者预后良好,眼部症状多在发病后3 m内消失。高血糖可能导致更广泛的神经功能缺损。
[Abstract]:Objective to study the clinical and imaging manifestations, prognosis, etiology and pathogenesis of brainstem infarction with ophthalmoplegia as its sole or main manifestation. Methods the clinical data of 20 inpatients with brainstem infarction with ophthalmoplegia as the sole or main manifestation were collected retrospectively from 2010 to 2016, and the types of ophthalmoplegia were analyzed. Accompanied by neurological symptoms and signs, lesion characteristics, responsible blood vessels, risk factors and disease prognosis. Results the ophthalmoplegia of 20 patients with brainstem infarction was subnuclear (1 case), nuclear (9 cases), and internuclear (10 cases). The most common oculomotor paralysis was oculomotor paralysis (78%), and 60% (60%). In 6 patients with solitary ophthalmoplegia, dizziness was the most common symptom (55%). 18 cases (90%) had multiple intracranial lacunar lesions. Magnetic resonance angiography (magnetic resonance) revealed 14 cases (70%) with stenosis or occlusion associated with infarction, 12 cases (60%) with posterior cerebral artery stenosis, 13 cases (65%) with ocular symptoms disappeared during hospitalization, and the most frequent time of disappearance was within 2 weeks after onset (50%). The ocular symptoms disappeared in 14 patients (70%) within 3 m after onset. The clinical, imaging features and laboratory indexes were compared between the isolated ophthalmoplegia group (nong6) and the non-solitary ophthalmoplegia group (nnn14). The fasting blood glucose level in the non-isolated ophthalmoplegia group was higher than that in the non-isolated ophthalmoplegia group (P0.05). Conclusion there are various manifestations of ophthalmoplegia caused by brainstem infarction, in which internuclear ophthalmoplegia is the most common, and oculomotor paralysis is more common in nuclear ophthalmoplegia than in oculomotor nerve insufficiency. Most patients with posterior circulation large vessel stenosis or occlusion. Most of the patients had a good prognosis and most of the ocular symptoms disappeared within 3 m after onset. Hyperglycemia may lead to a broader neurological impairment.
【作者单位】：首都医科大学附属北京世纪坛医院神经内科;
【分类号】：R743.33

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