眼外肌麻痹患者257例的临床特征及病因分析  

Analysis the clinical characteristic and etiology of external ophthalmoplegia 257 cases

作　　者：雷涛[1] 李正仪[2] 刘轩[3] 王润生[4] 洪舟 

机构地区：[1]西安交通大学医学院附属广仁医院(西安市第四医院)神经内科,710004 [2]西安交通大学第一医院神经内科 [3]西安交通大学第一医院眼科 [4]西安交通大学医学院附属广仁医院(西安市第四医院)眼科,710004 [5]西安市第五医院急诊科

出　　处：《中华临床医师杂志（电子版）》2013年第23期128-131,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨眼外肌麻痹的临床特征和病因。方法收集并回顾性分析257例眼外肌麻痹患者的临床资料,记录病史、临床表现以及相应的神经内科、眼科、内分泌科和影像学检查结果。结果单纯上眼睑下垂80例,单纯双眼复视131例,上眼睑下垂和双眼复视39例;单侧眼外肌麻痹223例,双侧眼外肌麻痹32例;外直肌麻痹84例,动眼神经支配的眼外肌麻痹178例,上斜肌麻痹24例;82例伴有眼眶局部疼痛,12例伴有瞳孔扩大;眼球运动神经病变163例,神经-肌肉接头病变69例,眼外肌病变25例。在163例眼球运动神经病变患者中,单个眼球运动神经麻痹148例,占90.8%;多个眼球运动神经麻痹15例,占9.2%。眼球运动神经周围性损害110例,占67.5%,核性损害16例,占9.8%,核间性损害13例,占8.0%,核上性损害24例占14.7%。确诊的病因有14种,包括重症肌无力,糖尿病性眼球运动神经损伤,动脉硬化缺血性眼球运动神经损伤,局部非特异性炎症,外伤性,局部占位性病变,甲状腺病变,颅内压增高,颅内后交通动脉瘤,线粒体脑肌病,颈内动脉海绵窦瘘,远隔部位肿瘤,多发性硬化,局部注射肉毒素,进行性肌营养不良。结论眼外肌麻痹的常见症状是双眼复视和上眼睑下垂,单侧眼外肌麻痹发生率高于双侧眼外肌麻痹,动眼神经支配的眼外肌麻痹发生率最高。眼眶部疼痛和瞳孔改变是常见的伴随症状。眼球运动神经性眼外肌麻痹患者并发高血压病、糖尿病的比例较高。眼外肌麻痹患者需要常规检查血糖,甲功、眼眶CT、头颅CT和(或)MRI、新斯的明试验,伴有瞳孔扩大时需要DSA排除颅内动脉瘤。Objective To discussion the clinical characteristics and etiology of external ophthalmoplegia. Methods Collected and retrospectively analyzed the etiology and clinical characteristic of 257 external ophthalmoplegia patients. Records of the patient history, clinical manifestations and corresponding neurological department of internal medicine, Ophthalmology, Endocrinology and Radiographic examination. Results Simple ptosis in 80 cases, 131 cases of simple binocular diplopia, ptosis and diplopia in 39 cases, 7 cases of eyeball fixation. 223 cases of unilateral paralysis of extraocular muscle, 32 cases of bilateral extraocular muscle paralysis. The levator paralysis in 119 cases, unilateral put on 98 cases of eyelid muscle paralysis, bilateral put on 21 cases of eyelid muscle paralysis. 84 cases of lateral rectus muscle palsy, 56 cases of unilateral lateral rectus muscle palsy, 6 cases of bilateral lateral rectus paralysis.178 cases of extraocular ophthalmoplegia of oculomotor control, 40 cases with complete paralysis, 117 cases with incomplete paralysis, combined with other extraocular ophthalmoplegia in 21 cases. Superior oblique palsy in 24 cases, alone of superior oblique palsy in 17 cases, combined with other extraocular ophthalmoplegia in 7 cases. 82 cases with orbital local pain, 12 cases with mydriasis. In 163 cases of ocular motor neuropathy patients, single oculomotor nerve palsy in 148 cases, accounting for 90.8%, 15 cases of multiple oculomotor nerve paralysis, 9.2%. Eye movement nerve injury in 110 cases, accounting for 67.5%, 16 cases, nuclear damage was 9.8%, between nuclear damage in 13 cases, accounting for 8%, nuclear damage 24 cases accounted for 14.7%.There are 14 kinds of external ophthalmoplegia etiology in this group. including myasthenia gravis, diabetic oculomotor nerve injury, atherosclerosis and ischemic ocular motor nerve injury, local nonspecific inflammatory, traumatic, local space-occupying lesions, thyroid disease, Increased intracranial pressure, intracranial posterior communicating

关 键 词：眼肌麻痹 疾病特征 病因 

分 类 号：R777.4[医药卫生—眼科]