眼科首诊的脑血管疾病32例临床分析

目的探讨以眼部损害为表现的脑血管病的病因和临床特点。方法回顾分析32例以眼部损害为表现（白诉视力障碍、复视或上睑下垂）的脑血管病患者临床资料。结果32例患者中，双侧视乳头水肿4例（11．11％），同向偏盲2例（5．56％），皮质盲1例（2．78％），同向象限盲11例（30．56％），外展神经麻痹6例（16．67％），动眼神经麻痹12例（33．33％），其中部分患者同时存在2种眼部损害。经过影像学检查后诊断脑干梗死10例（31．3％），枕叶梗死6例（18．8％），分水岭梗死4例（12．5％），基底动脉尖综合征1例（3．1％），枕叶出血2例（6．3％），后交通动脉瘤4例（12．5％），颅内静脉窦血栓5例（15．6％）。结论脑血管病可引起各种眼部损害：枕叶和后分水岭血管病变表现为同向偏盲或象限盲，脑干梗死导致核性、核间性或核下性眼肌麻痹，后交通动脉瘤导致动眼神经麻痹，颅内静脉窦血栓可引起视乳头水肿或视野损害。眼科医师应重视眼部损害与脑血管病的关系，加强影像学检查和与神经科医师间的合作，以提高诊断水平。

Objective To study of the etiology and clinical characteristics of cerebral vascular disease performancing of ophthalmic symptoms. Methods We analysised retrospectively 32 cases of cerebrovascular disease patients with clinical manifestations of visual impairment , diplopia or ptosis of the eyelid. Result Bilateral papilledema in 4 cases （ 11.11% ） , homonymous hemianopsia in 2 cases （ 5.56% ） , cortical blindness in 1 cases （ 2.78% ） , quadrantic hemianopsia in l 1 cases （ 30.56% ） , abducens nerve palsy in 6 cases （ 16.67% ） , oculomotor nerve palsy in 12 cases （ 33.33% ） .Some patients performance for two kinds of ophthalmic symptoms, l0 patients （ 31.3% ） were diagnosed as brainstem infarction, 6 patients （ 18.8% ） were diagnosed as occipital infarction, 4 patients （ 12.5% ） were diagnosed as cerebral watershed infarct, 1 patients （ 3.1% ） were diagnosed as top of basilar syndrome, 2 patients （ 6.3% ） were diagnosed as occipital hemorrhage, 4 patients （ 12.5% ） were diagnosed as posterior communicating artery aneurysm, 5 patients （ 15.6% ） were diagnosed as intracranial venous sinus thrombosis. Conclusion Cerebrovascular disease can cause ophthalmic symptoms.Occipital lobe stroke and watershed infarct often performanced of homonymous hemianosia or quadrantic hemianopsia, brainstem infarction can cause ophthalmoplegia, posterior communicating artery aneurysm can cause oculomotor nerve palsy, and Intracranial venous sinus thrombosis can cause papilledema or visual field damage.Ophthalmologists can improve our neuro-ophthalmology service by emphasizing the correlation between eye and brain, together with imaging examination and cooperation with neurologists.