脑桥出血后肥大性下橄榄核变性伴垂直钟摆样眼震1例  

Hypertrophic olivary degeneration with vertical pendulum nystagmus after pontinehemorrhage: a case report

作　　者：李晓琴 杜鹃 曾阳桥 陈薇 陶涛 LI Xiaoqin;DU Juan;ZENG Yangqiao;CHEN Wei;TAO Tao(The Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院,四川泸州646000

出　　处：《中国实用神经疾病杂志》2024年第1期104-107,共4页Chinese Journal of Practical Nervous Diseases

基　　金：四川省教育厅自然科学基金项目(编号:15ZA0168);泸州市科技计划项目[编号:2014-S-45(6/12)]。

摘　　要：目的报道1例以垂直钟摆样眼震为突出体征的肥大性下橄榄核变性,以提高对该病的认识水平。方法回顾性分析1例脑桥出血后继发肥大性下橄榄核变性患者,结合文献对其临床表现、影像特点及发病机制进行讨论。结果中年男性,48岁,脑桥出血2个月后出现行走不稳、视物浮动,体格检查见双眼自发及凝视诱发的垂直钟摆样眼震,头颅MRI示双侧下橄榄核区体积增大及T2WI、FLAIR高信号,结合症状、体征及影像学表现,考虑脑桥出血后导致的双侧肥大性下橄榄核变性,予以抗血小板聚集、改善脑循环、止晕等对症治疗,患者头晕及肢体无力好转,但眼震仍持续存在。结论垂直钟摆样眼震可为肥大性下橄榄核变性的罕见表现,若在脑桥出血恢复期迟发性出现,需警惕肥大性下橄榄核变性可能,尽早完善头颅MRI有助于明确诊断,避免漏诊、误诊。Objective To report a case of hypertrophic olivary degeneration with vertical pendulum nystagmus as a prominent sign in order to raise the level of awareness of the disease.Methods A patient with hypertrophic olivary degeneration secondary to pontine hemorrhage was retrospectively analyzed,and his clinical presentation,imaging features,and pathogenesis were discussed in the light of the literature.Results A 48-year-old male patient with pontine hemorrhage presented with unsteadiness in walking and floating vision 2 months after the hemorrhage.Physical examination showed spontaneous and gaze-induced vertical pendulum nystagmus in both eyes,and MRI showed increased volume and T2WI and FLAIR high signal in the bilateral inferior olivary nucleus area.Combining the symptoms,signs and imaging findings,bilateral hypertrophic olivary degeneration due to pontine hemorrhage was considered.After treatment with antiplatelet aggregation,improvement of cerebral circulation,and halting of dizziness,the patient’s dizziness and limb weakness improved,but nystagmus persisted.Conclusion Vertical pendulum nystagmus can be a rare manifestation of hypertrophic olivary degeneration.If it occurs late during the recovery period of pontine hemorrhage,we need to be alert to the possibility of hypertrophic olivary degeneration,and the early improvement of MRI can help to make a clear diagnosis,avoiding missed diagnosis and misdiagnosis.

关 键 词：脑桥出血 肥大性下橄榄核变性 钟摆样眼震 垂直眼震 神经变性疾病 

分 类 号：R743.34[医药卫生—神经病学与精神病学]