脑桥点状梗死致前核间性眼肌麻痹1例

Anterior internuclear ophthalmoplegia caused by pontine punctate infarction:a case report

目的:报道并分析1例脑桥点状梗死致前核间性眼肌麻痹的患者的临床及影像特点,以期提高临床医师对此类病例的关注。方法:通过对1例脑桥点状梗死致前核间性眼肌麻痹的患者的深入剖析,阐述其临床症状的产生机制,增进对脑干各神经纤维束的解剖认识,指导临床诊疗。结果:1例67岁女性,主诉“头晕11 h余”入院。神经系统查体显示双眼左侧视时右眼内收不能,左眼可外展,伴水平眼震。头颅MRI发现右侧脑桥背侧点状急性期小梗死灶。结合病史、查体、辅助检查结果诊断为脑桥梗死。给予患者阿司匹林、氯吡格雷、阿托伐他汀、丁苯酞、倍他司汀等治疗,症状好转出院,1月后随访患者症状恢复正常。结论:脑干结构精密复杂,发生病变多出现邻近的神经核团以及纤维束受损的表现单纯累及内侧纵束(medial longitudinal faseieulus,MLF)的脑干点状梗死报道较少,故一线医生应增进对脑干各神经纤维束的解剖认识,重视临床查体,避免漏诊、误诊。

Objective:To report and analyze the clinical and imaging features of a case of anterior internuclear ophthalmoplegia caused by pontine punctate infarction,in order to raise the attention of the clinical physician.Methods:Through in-depth analysis of a patient with anterior internuclear ophthalmoplegia caused by pontine point infarction,this study elucidates the mechanism of its clinical symptoms,enhances the anatomical understanding of various nerve fiber bundles in the brainstem,and guides clinical diagnosis and treatment.Results:A 67-year-old woman was admitted to hospital complaining of“feeling vertigo for more than 11 hours”.Physical examination on admission revealed that she could not adduct her right eye,and she had nystagmus.Her head MRI indicated infarction of the right pontine.She had been diagnosed with pontine infarction and treated by aspirin,clopidogrel,atorvastatin,butylphthalide,betamethasone,and so on.The symptoms improved and the patient was discharged.After one month of follow-up,the patient’s symptoms returned to normal.Conclusion:The structure of the brainstem is complex and precise,with frequent damage to adjacent nerve nuclei and fiber bundles.There are few reports of brainstem point like infarcts involving only the medial longitudinal fasciculus(MLF).Therefore,frontline doctors should enhance their understanding of the anatomy of various nerve fiber bundles in the brainstem,pay attention to clinical examination,and avoid misdiagnosis and missed diagnosis.