动眼神经麻痹临床特征及病因分析--单中心研究  

Clinical characteristics and etiology of oculomotor nerve palsy:a single center study

作　　者：冯超逸 孙平 陈伟民 汤建军 赵桂宪 李振新 孙兴怀 沙炎 洪汝建 王敏 陈倩[1] 田国红 FENG Chaoyi;SUN Ping;CHEN Weimin;TANG Jianjun;ZHAO Guixian;LI Zhenxin;SUN Xinghuai;SHA Yan;HONG Rujian;WANG Min;CHEN Qian;TIAN Guohong(Department of Ophthalmology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;Department of Neurology,Deji Hospital,Shanghai 200331,China;Department of Neurology,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Radiology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;NHC Key Laboratory of Myopia(Fudan University),Key Laboratory of Visual Impairment and Restoration(Fudan University),Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院眼科,上海200031 [2]上海德济医院神经内科,上海200331 [3]复旦大学附属华山医院神经科,上海200040 [4]复旦大学附属眼耳鼻喉科医院放射科,上海200031 [5]国家卫健委及中国医学科学院近视眼重点实验室(复旦大学),上海市视觉损害与重建重点实验室(复旦大学),上海200031

出　　处：《中国眼耳鼻喉科杂志》2022年第1期42-46,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

基　　金：国家重点研发计划“干细胞及转化研究”重点专项(2020YFA0112700)。

摘　　要：目的总结首诊眼科的动眼神经麻痹患者的临床特征及病因。方法单中心病例回顾性分析。收集2013年5月~2021年8月间复旦大学附属眼耳鼻喉科医院神经眼科就诊及转诊诊断为动眼神经麻痹者资料,对其人口学特征、发病特征、临床及影像学表现、病因以及转归进行分析。结果143例确诊为动眼神经麻痹患者,其中男性74例、女性69例;平均年龄为(45.2±20.6)岁(3~89岁);平均病程为(2.9±7.6)年。单纯性动眼神经麻痹110例(76.9%),合并其他脑神经及神经系统疾病的33例(23.1%)。病因依次为外伤(23例,16%)、炎症(23例,16%)、缺血(21例,14.7%)、肿瘤(20例,14.0%)及动脉瘤/动静脉瘘(18例,12.6%)等。其他病因包括核性、放射损伤及医源性等。少见病因包括周期性发作性动眼神经麻痹伴痉挛发作、神经肌强直等。2例患者病因不明。81例患者预后良好,后无明显上睑下垂及复视。结论动眼神经麻痹是导致上睑下垂及复视的重要疾患,老年人群中缺血性占比高;动脉瘤/动静脉瘘虽然仅占12.6%,但危及生命,为神经眼科急症。Objective To evaluate the clinical characteristics and pathogenesis of patients first diagnosed with oculomotor nerve palsy by ophthalmologists.Methods Retrospetive study.Oculomotor nerve palsy presenting to the Neuro-Ophthalmology center in Eye&ENT Hospital of Fundan University between May 2013 and August 2021 were collected.The demographic data together with the ophthalmologic examinations were evaluated.Results All together 143 patients(male=74,female=69)were included with mean age of 45.2±20.6 years(3 to 89)and the mean course was 2.9±7.6 years.Isolated oculomotor nerve palsy was diagnosed in 110 cases(76.9%)and other 33 cases(23.1%)with comorbid multi-cranial nerve involvement.The etiology included trauma(23 cases,16%),inflammatory(23 cases,16%),ischemia(21 cases,14.7%),tumor(20 cases,14%),aneurysm/fistula(18 cases,12.6%)and et al.Other etiology included nucleus damage,radiology lesion,and iatrogenic injury.Rare causes included periodic paroxysmal oculomotor nerve palsies with cyclic spams and neuromyotonia.There were two cases with unknown diagnosis.Among all of them,81 cases acquired a favorable outcome without ptosis and diplopia.Conclusions Oculomotor nerve palsy is one of the common causes leading to ptosis and diplopia.Ischemic condition is still the main etiology in elders.Although aneurysm/fistula accounted for only 12.6%in this study,they were life threatening and were neuro-ophthalmologic emergency.

关 键 词：动眼神经麻痹 动脉瘤 海绵窦综合征 多脑神经麻痹 眶尖综合征 瞳孔 

分 类 号：R77[医药卫生—眼科]