成人眼球扑动-眼阵挛三例临床分析

Clinical analysis of three cases of ocular flutter-opsoclonus in adults

目的 通过对3例成人眼球扑动-眼阵挛患者的临床资料进行分析并结合文献复习,总结其特点,提高临床对该体征的认识.方法 对2014年7月至2017年7月于我院收治的3例眼球扑动-眼阵挛患者进行回顾性分析,包括临床特征、脑脊液检查、头颅影像学、病因及治疗等,并对患者进行电话随访.结果 例1男性,68岁,临床表现为眼球扑动、眩晕、肌阵挛、共济失调及意识障碍,脑脊液细胞数、蛋白均轻度增高,头颅MRI示缺血灶,SPECT提示左额叶及枕叶灌注减低,其病因为肺癌副肿瘤综合征,未经特殊治疗后症状好转,1年后因肺癌死亡;例2男性,66岁,临床表现为眼球扑动、眩晕、共济失调、意识障碍及发热,脑脊液蛋白水平显著增高,头颅MRI示缺血灶,其病因考虑为EB病毒感染,予抗病毒、类固醇治疗后症状好转,2年内无复发.例3女性,34岁,临床表现为眼阵挛、振动幻视、眩晕、共济失调、意识障碍及发热,头颅MRI示中脑病变,其病因为病毒性脑干脑炎,经抗病毒、类固醇、静脉用丙种球蛋白及氯硝西泮治疗后症状好转,2年内无复发.结论 感染和肿瘤是成人眼球扑动-眼阵挛的常见原因,其治疗应包括病因（感染或肿瘤）治疗和免疫抑制治疗.眼球扑动-眼阵挛的预后因病因的不同而具有较大差异.

Objective Through an analysis of three cases of ocular flutter-opsoclonus in adults and a review of the relevant literature,we summarized its characteritics to improve the clinical awareness of this sign.Methods Three cases of adult-onset ocular flutter-opsoclonus from July 2014 to July 2017 were retrospectively analyzed in terms of clinical features,cerebrospinal fluid （CSF） analysis,brain imaging,etiologies and treatment,and followed up through telephone calls.Results Case 1：A 68-year-old man presented with ocular flutter,vertigo,myoclonus,ataxia and conscious disturbance.CSF analysis demonstrated pleocytosis and mildly elevated protein level.Brain MR imaging revealed ischemia,and SPECT showed hypoperfusion involving left frontal and occipital lobes.Paraneoplastic syndrome was considered as the etiology.The symptoms subsided without any specific treatment.He died from lung cancer within one year.Case 2：A 66-year-old man presented with ocular flutter,vertigo,ataxia,conscious disturbance and fever.CSF protein level was severely elevated.Brain MR imaging revealed ischemia.Epstein-Barr virus infection was considered as the etiology.The symptoms improved with the administration of antiviral drugs and steroid.Relapse was not observed in the two-year follow-up.Case 3：A 34-year-old woman presented with opsoclonus,oscillopsia,vertigo,ataxia,conscious disturbance and fever.MR imaging showed midbrain lesions.Viral brainstem encephalitis was considered as the etiology.The symptoms improved with the administration of antiviral drugs,steroid,intravenous immunoglobulin and clonazepam.Relapse was not observed in the two-year follow-up.Conclusions Infection and tumors are common etiologies of ocular flutter-opsoclonus.Treatment includes etiological management for infection or tumors and immunosuppressive therapy.The clinical outcomes vary with the underlying etiologies.