老年动眼神经麻痹56例临床分析

Clinical analysis of 56 elderly patients with oculomotor nerve palsy

目的分析首诊动眼神经麻痹的病因及临床特点。方法对2008年1月—2016年12月第四军医大学西京医院神经内科、眼科病房收治以动眼神经麻痹为首诊症状的动眼神经麻痹老年患者56例进行回顾分析。结果56例患者均单眼发病,其中完全性动眼神经麻痹15例(26.8%),不完全动眼神经麻痹41例(73.2%)。病因诊断明确42例:动脉瘤19例(33.9%),糖尿病15例(26.8%),痛性眼肌麻痹1例(1.8%),Miller-Fisher综合征1例(1.8%),外伤1例(1.8%),神经梅毒1例(1.8%),鞍区占位2例(3.6%),松果体肿瘤1例(1.8%),中枢神经系统血液病1例(1.8%),病因诊断不明14例(25.0%)。动脉瘤以完全性眼肌麻痹居多(63.2%),糖尿病患者均为不完全眼肌麻痹(100%)。动脉瘤患者19例中行动脉瘤栓塞术18例,随访6个月症状均有改善;1例因蛛网膜下腔出血出现意识昏迷、症状较重,曾多次抢救,未行动脉瘤栓塞术,家属放弃治疗出院后3 d死亡。15例糖尿病患者均给予降糖治疗,随访6个月症状完全缓解7例;明显改善8例。其余患者给予对症治疗,症状略有好转。结论老年患者动眼神经麻痹中,完全性动眼神经麻痹以动脉瘤最常见,不完全动眼神经麻痹以糖尿病为首要病因。早期及时诊治,大部分患者症状可以改善,甚至完全缓解。

Objective To analyze the etiology and clinical characteristics of the first diagnosis of oculomotor nerve palsy.Methods To review the auxiliary examinations and symptoms of patients in Xijing Hospital from Jan 2008 to Dec 2016 as the first symptom of oculomotor nerve palsy.Results 56 patients contracted unilateral oculomotor nerve palsy.15 cases（26.8%） were complete oculomotor nerve palsy and 41 cases（73.2%） were incomplete oculomotor nerve palsy.There were19 cases with aneurysm（33.9%）,15 cases with diabetes（26.8%）,1 cases with painful ophthalmoplegia（1.8%）,1 cases with Miller Fisher syndrome（1.8%）.1 cases with traumatism（1.8%）,1 cases with neurosyphilis（1.8%）,2 cases with sellar tumourd（3.6%）,1 cases with pineal gland the tumor（1.8%）,1 cases with central nervous system blood disease（1.8%）,and 14 cases with unknown causes（25%）.Majority of patients with aneurysm were attacked complete ophthalmoplegia（63.2%）.All diabetes patients were attacked incomplete ophthalmoplegia（100%）.Conclusion In elderly patients with oculomotor paralysis,aneurysm was the most common cause inducing complete oculomotor paralysis and diabetes was the primary cause of incomplete oculomotor paralysis.After receiving early and timely diagnosis and treatment,many patients ＇ symptoms improved or even completely released.