单侧动眼神经麻痹的诊治与预后

Diagnosis,treatment and prognosis of unilateral oculomotor paralysis.

目的探讨单侧动眼神经麻痹的病因、诊断、治疗和预后。方法回顾分析我院3年来收治的36例单纯动眼神经麻痹患者,随访3个月～1年。结果 35例患者中25例诊断后交通动脉瘤,其中22例单发性,3例为多发性,14例伴发蛛网膜下隙出血;5例脑干梗死;3例糖尿病动眼神经麻痹;2例动眼神经炎。针对病因进行治疗。21例痊愈,10例好转,2例无效,3例死亡。接受动脉瘤手术的患者23例,痊愈17例,好转5例,死亡1例。结论后交通动脉瘤为单侧动眼神经麻痹的最常见病因。多学科会诊及CT、MRI、CTA、DSA等检查有利于病因诊断。动脉瘤患者尽早手术治疗,对术后动眼神经麻痹恢复极为重要。

Objective To explore the etiopathogenetis,diaagnosis,treatment and prognos is of unilateral oculomotor palsy.Methods Ophthalmology diagnosis for 35 patients with unilomotor oculomotor palsy,follow up from 3months to 1 year.Results 35 cases were diagnosed in 25 cases of aneurysms,including 22 cases of single and 3 cases of multiple,associated with 14 cases of subarachnoid hemorrhage;5 cases of brain stem infarction;three cases of diabetic oculomotor nerve palsy;2 cases of nerve inflammation,and were treated basing on the diagnosis.21 cases recovered,10 cases improved and 2 cases ineffective,3 patients died.Acceptance of surgery in patients with aneurysms in 23 cases,17 cases fully recovered,5 cases improved and 1 died.Conclusion Posterior communicating artery aneurysm is the most common cause of oculomotor nerve palsy.Multidisciplinary consultation and some imaging methods,such as CT、MRI、CTA and DSA,are effective to the etiological diagnosis early surgery help recover the oculomotor nerve function of patients with aneurysms.