76例眼肌麻痹的病因及其特点

Etiology and clinical features of 76 cases of ophthalmoplegia

目的:了解不同病因所致眼肌麻痹患者的临床特点,探讨其诊断及鉴别诊断方法。方法:回顾分析连续收治的76例以眼肌麻痹为主要症状患者的临床表现及辅助检查结果。结果:76例患者中54例(71.1%)诊断明确,其中病因以糖尿病最多见(20例,26.3%);炎症性疾病次之(14例,18.4%),包括Tolosa-Hunt综合征(THS)、Fisher综合征(FS)及眼肌麻痹性偏头痛(ophthalmoplegic migraine,OM)。糖尿病性眼肌麻痹患者最突出的临床特征为年龄大、最常累及动眼神经但无瞳孔改变。有22例(28.9%)眼肌麻痹患者未能明确诊断,包括不能排除动脉瘤及炎症性疾病者。在各种病因导致的眼动神经麻痹中,动眼神经最常受累,为49例(64.5%),展神经次之,为38例(50.0%)。结论:眼肌麻痹的病因复杂,糖尿病性及炎症性疾病是眼肌麻痹患者最常见的病因。

Objective To investigate the clinical features of ophthalmoplegia caused by various diseases and discuss the diagnosis and differential diagnosis. Methods Clinical manifestations and laboratory findings of 76 consecutive in-patients presented predominantly with the symptom of ophthalmoplegia were analysed respectively. Results Of the 54 well diagnosed cases （71.1%） among these 76 patients, diabetes （26.3%） was the most common cause and 14 cases （18.4%） were due to inflammatory diseases, including Tolosa-Hunt syndrome, Fisher syndrome and ophthalmoplegic migraine. Old age and ocular motor nerve involvement without pupil change were distinguishing features of diabetic ophthalmoplegia. The origin was undetermined in 22 cases （28.9%）, some of which were possibly caused by aneurysm or inflammatory diseases. Among all cases, ocular motor nerve （64.5%） and abducent nerve （50.0%） were most frequently affected. Conclusions The etiology of ophthalmoplegia is quite complex, and diabetes and inflammatory diseases are the most common causes for ophthalmoplegia.