脑干梗死早期眼球运动异常的特点  

Features of ocular motor abnormality in early stage of brainstem infarction

作　　者：董莹[1] 魏世辉[2] 皮裕琍[1] 郭青[1] 杨姝杰[3] 

机构地区：[1]解放军总医院第一附属医院眼科,北京市100048 [2]解放军总医院眼科,北京市100853 [3]解放军总医院第一附属医院放射科,北京市100048

出　　处：《眼科新进展》2010年第5期475-477,485,共4页Recent Advances in Ophthalmology

摘　　要：目的分析脑干梗死早期眼球运动异常的特点,评价其在早期诊断中的意义。方法收集287例脑干梗死患者的临床资料,选取其中以复视为首发症状的24例患者。回顾性分析所纳入患者的眼部表现、伴随症状及相关检查。结果24例患者中男19例,女5例;发病年龄42～81岁,中位数为64岁。发病危险因素:83.3%(20/24)患者有高血压病史,37.5%(9/24)患冠心病,29.2%(7/24)患糖尿病,12.5%(3/24)患房颤。在伴随症状中,87.5%的患者伴有头晕,16.7%伴有恶心,16.7%伴有肢体共济失调,8.3%伴有眩晕,4.2%伴有对侧肢体无力。发病部位:脑桥梗死14例(58.3%),中脑9例(37.5%),延髓1例(4.2%)。中脑梗死患者的眼肌麻痹均为核性动眼神经麻痹,其中眼球内转异常出现最多(8例)。脑桥梗死引起的眼球运动异常表现多样,有3例表现为核间性眼肌麻痹,3例外展神经麻痹,2例核性动眼神经麻痹,1例为不全性Horner综合征,10例伴有眼球震颤。结论脑干梗死患者眼球运动异常的主要特点包括核性眼肌麻痹、核间性眼肌麻痹、眼球震颤等,神经眼科体征对脑干梗死早期诊断具有提示作用。Objective To investigate the characters of ocular motor abnormality in the early stage of brainstem infarction,and evaluate their value in the early diagnosis.Methods Two hundreds and eighty-seven patients with brainstem infarction were collected,in which 24 cases who were initially broke out as diplopia were chosen.Their clinical features,correlated examination and its related examination were retrospectively analyzed.Results There were 19 men and 5 women aged from 42 years old to 81 years old（Median：64 years old）.The risk factors included hypertension in 20 cases（83.3%）,coronary heart disease in 9 cases（37.5%）,diabetes mellitus in 7 cases（29.2%）,atrial fibrillation in 3 cases（12.5%）.About 87.5% of patients complained with dizziness,and 16.7% with nausea,16.7% with limb ataxia,8.3% with vertigo,4.2% with limb weak.The infarcts of 9 patients（37.5%）were located in midbrain,14 patients（58.3%）in pons and 1 patient（4.2%）in medulla.Nuclear oculomotor nerve palsies were seen in the midbrain infarction,in which medial rectus weakness（8 cases）was dominant compared with other ocular muscles.The oculomotor disturbances of pons infarction were various,which included internuclear ophthalmoplegia in 3 cases,the abduct nerve palsy in 3 cases,the oculomotor nerve palsy in 2 cases,the pero-Horner syndrome in 1 case,and nystagmus in 10 cases.Conclusion In brainstem infarction,the characters of ocular motor abnormality mainly include nuclear ophthalmoplegia,internuclear ophthalmoplegia and nystagmus,which play the important roles in the early diagnosis.

关 键 词：脑干梗死 眼肌麻痹 神经眼科体征 诊断 

分 类 号：R777.2[医药卫生—眼科]