延髓背外侧梗死后扫视辨距不良1例  

A case of saccadic dysmetria after dorsolateral medullary infarction

作　　者：闫焱 冯超逸 王敏 YAN Yan;FENG Chaoyi;WANG Min(Department of Ophthalmology,Eye&ENT Hospital,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

出　　处：《中国眼耳鼻喉科杂志》2025年第S1期25-27,共3页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：44岁男性,因“行走不稳伴视物不清3个月”来诊。患者3个月前因“右侧面部痛温觉减退、左侧肢体痛温觉障碍,平衡障碍、眩晕和复视”就诊于外院神经内科。颅脑磁共振成像(MRI)显示右侧延髓背外侧梗死。头颈部CT血管成像(CTA)显示右侧椎动脉闭塞。患者自诉发病时看物体有倾斜的重影,平躺的时候复视减轻,此后重影有明显好转。通过内科治疗,患者全身情况恢复较好,但在平时生活中还是感觉视物不清。神经眼科查体发现右侧鼻唇沟变浅,眼位检查各方向基本到位,马氏杆检查垂直和水平均未见明显眼位异常,眼底检查无旋转。在水平扫视检查中,向右侧扫视过冲,并可见向左的矫正性扫视,而向左侧扫视欠冲。患者直视前方,闭合眼睑,睁眼时见双眼共轭向右侧偏移。同时该患者有瞳孔不等大,右侧瞳孔小于左侧,暗光下更明显,符合中枢性Horner综合征的表现。该患者最终诊断为Wallenberg综合征(右侧延髓背外侧梗死)、同侧(右侧)侧冲、反向偏斜、中枢性Horner综合征、周围性面瘫。讨论体会:神经眼科的眼球运动检查除了眼位检查、三棱镜加遮盖试验等,还必须包括扫视、追踪、聚散、前庭眼反射和视动性眼动等检查。A 44-year-old male patient came for consultation due to“unsteady walking accompanied by blurred vision for three months”.Three months ago,the patient visited the neurology department of another hospital because of“decreased pain and temperature sensation on the right side of the face,pain and temperature sensation disorder on the left limb,balance disorder,vertigo and diplopia”.Cranial MRI showed infarction in the dorsolateral part of the right medulla oblongata.Head and neck CTA showed occlusion of the right vertebral artery.The patient reported that when the disease occurred,there were tilted double images when looking at objects,and the diplopia was alleviated when lying flat.Since then,the diplopia had improved significantly.Through medical treatment,the patient’s general condition recovered well,but he still felt that his vision was blurred in daily life.In the neuro-ophthalmic physical examination,it was found that the nasolabial groove on the right side became shallower.In the eye position examination,the eyes could basically reach the proper positions in all directions.In the Maddox rod examination,no obvious eye position abnormalities were found either vertically or horizontally.There was no rotation in the fundus examination.In the horizontal saccade examination,overshoot occurred when saccading to the right,and a corrective saccade to the left could be seen,while undershoot occurred when saccading to the left.When the patient looked straight ahead,closed his eyelids and then opened them,conjugate deviation of both eyes to the right was observed.Meanwhile,the patient had anisocoria,with the right pupil smaller than the left one,which was more obvious in dim light,consistent with the manifestation of central Horner syndrome.The patient was finally diagnosed with Wallenberg syndrome(right dorsolateral medullary infarction),ipsilateral(right)saccadic lateropulsion,skew deviation,central Horner syndrome and peripheral facial paralysis.Discussion:In addition to eye position examination,prism and al

关 键 词：WALLENBERG综合征 侧冲 反向偏斜 HORNER综合征 扫视 

分 类 号：R74[医药卫生—神经病学与精神病学]