215例脑梗死患者神经眼科临床分析

Clinical analysis of neurophthalmological features on cerebral infarction

目的了解脑梗死患者的神经眼科表现,以指导临床诊治。方法回顾性分析2009年6月1日到2010年6月1日解放军总医院神经内科住院的脑梗死患者215例,调查有神经眼科表现患者的一般情况、神经眼科症状、体征及影像学资料。结果 1.有神经眼科表现的脑梗死患者有49例,占22.48%。2.引起神经眼科表现的脑梗死类型主要为腔隙性脑梗死、脑干梗死、枕叶梗死、小脑梗死,少见的是基底节、丘脑和额叶梗死,未发现单独颞叶或顶叶梗死伴神经眼科症状的患者。3.脑梗死的神经眼科症状主要有复视、视物旋转、视野缺损和视力下降,体征依次为眼球运动障碍、眼球震颤、眼睑下垂、瞳孔异常、眼睑闭合不全和视盘水肿。4.复视多见于脑干梗死,视物旋转多见于脑干或小脑梗死,视野缺损以枕叶梗死居多,眼球运动障碍多见于脑干或基底节梗死,眼球震颤多见于脑干梗死。结论 1.神经眼科表现为脑梗死患者常见临床表现,应引起临床重视;2.不同的临床表现提示不同部位的梗死,临床应重视对高级视觉的检查以发现颞叶和顶叶梗死。

OBJECTIVE To study the neurophthalmological features of cerebral infarction（CI）to direct a better clinical treatment.METHODS We collected 215 CI patients in neurology department of the PLA General Hospital from June 1,2009 to June 1,2010,and surveyed the neurophthalmological clinical features,then used statistical analysis to get the conclusion.RESULTS 1.There were 49 patients who had neurophthalmological symptoms and signs,accounting for 22.48%.2.All lesions of CI patients were located by MRI or CT.The common styles of CI were lacunar infarction,brainstem infarction,occipital lobe infarction,cerebellar infarction and the rarely styles were basal ganglia,thalamus and frontal lobe infarction.There were no patient who had neurophthalmological disorders due to pure parietal and temporal lobe infarction.3.The neurophthalmological symptoms were diplopia dizziness,visual field defect and visual deterioration.The neurophthalmological signs were eye movement disorders,nystagmus,ptosis,pupil disorders and incomplete closure of eyelid.4.Diplopia mainly happened in brainstem infarction,dizziness mainly happened in brainstem or cerebellar infarction,visual field defect mainly happened in occipital lobe infarction,eye movement disorders mainly happened in brainstem or basal ganglia infarction,and nystagmus mainly happened in brainstem infarction.CONCLUSIONS 1.Neurophthalmological symptoms and signs were common clinical manifestations of CI patients and we should pay more attention to it.2.Different styles of abnormalities suggested different parts of infarction.Clinical doctor should pay more attention to the examination of advanced visual function to find parietal and temporal lobe infarction.