血管病相关性眼肌麻痹病因的研究进展

Study Progress of Etiology of Ophthalmoplegia Associated with Vascular Disease

眼肌麻痹是神经内科、眼科、神经眼科的常见体征。根据病变部位,血管病相关的眼肌麻痹可分为核上型、核型、核间型、周围神经型,不同型别的眼肌麻痹有不同的病因。核上型、核型及核间型眼肌麻痹多见于卒中,其中核型眼肌麻痹以动眼神经核受累最常见。周围神经型眼肌麻痹病因众多,如糖尿病性眼肌麻痹、动脉瘤、颈内动脉海绵窦瘘等。糖尿病性眼肌麻痹多累及动眼神经,瞳孔受累较轻,一般数周后开始恢复;动脉瘤和颈内动脉海绵窦瘘所致眼肌麻痹需行数字减影血管造影(digital subraction angiography,DSA)明确诊断;垂体卒中所致眼肌麻痹症状严重,需紧急处理;海绵窦血栓形成所致眼肌麻痹多由感染所致,以抗感染治疗为主;眼肌麻痹性偏头痛多见于青年女性,多为良性病程。临床对眼肌麻痹患者需仔细询问病史,予以适当的辅助检查,及时明确诊断。

Ophthalmoplegia are common symptoms of neurologic, ophthalmologic, and neuro-ophthalmologic diseases. According to the lesion site, ophthalmoplegia associated with vascular disease could be classified as supranuclear, nuclear, internuclear and peripheral-nerve types. Different types are triggered by different causes. Supranuclear, nuclear and internuclear ophthalmoplegia are frequently reported in patients with stroke, and oculomotor-nucleus involvement is the most common in nuclear ophthalmoplegia. Peripheral-nerve type arises from numerous causes, such as diabetic ophthalmoplegia, aneurysm, internal carotid cavernous sinus fistulas, etc. Diabetic ophthalmoplegia often involves oculomotor nerve, while pupil involvement is lighter, the patients with the disease generally start to recover after a few weeks. It is required to perform digital subtraction angiography （DSA） for diagnosing aneurysm and internal carotid cavernous sinus fistulas. The patients with pituitary apoplexy show serious symptoms, and need emergency treatment. Most of cavernous sinus thrombosis are caused by infection, so anti-infection therapy is the primary principle. Ophthalmoplegia migraine are often seen in young women and mostly present a benign course. Clinical doctors should ask the history of disease carefully, and give appropriate auxiliary examination, so as to make correct diagnosis and corresponding treatment, when meeting patients with ophthalmoplegia.