眼眶肌炎的CT和临床表现分析

目的 分析眼眶肌炎的CT和临床表现 ,加深对该病的认识。方法 对 17例有完整CT检查资料和临床资料的眼眶肌炎患者进行了随访、实验室检查和皮质激素治疗等。结果 单眼发病 16例 ,双眼发病 1例 ,CT呈 1条肌肉受累 14例 ,眼球附着处增粗 11例 ,眶周痛、眼球突出和眼球运动受限分别为 17例 ,结膜充血水肿 16例 ,眼睑红肿 13例 ,复视 9例。结论 CT能准确显示眼眶肌炎的眼肌形态和周围结构变化 ,结合其临床表现、实验室检查和随访诊断性皮质激素治疗有助于正确诊断。

眼眶肌炎误诊为颈动脉海绵窦瘘1例

患者，女，52岁。因右侧头痛、复视伴右眼睑肿胀15 d入院。患者于15 d前出现右侧头部持续性胀痛，伴双眼复视，右侧眼睑肿胀，于当地医院治疗（具体不详）后眼睑肿胀较前明显好转，仍感右侧头部胀痛、双眼复视。查体：意识清楚，言语正常，伸舌居中，右侧眼睑稍肿胀，双侧眼球无红肿、突出，双侧眼睑无下垂，双眼闭合好，右侧眼球向上、向下、外展活动稍受限，内收活动无受限，左侧眼球各方向活动无受限，双侧瞳孔正大等圆，直径约2．5 mm，对光反射灵敏，双侧眼动脉听诊未闻及异常血管杂音。四肢肌力正常。病理征未引出。初步诊断：颈动脉海绵窦瘘。进一步行头颅MR＋MRA检查示：（1）轻度脑萎缩；（2）右眼内直肌增粗；（3）头颅MRA未见明显异常（见图1）。考虑眼眶肌炎，予口服泼尼松片40 mg，每天1次，逐渐减量，1个月后症状基本消失，随访6个月未复发。

眼眶肌炎(附4例报告)

眼眶肌炎作为一组具有典型临床急、慢性发病特征的非特异性眼眶炎症,由于其发病独特,临床上易与眼型Graves病相混淆,近年来引起人们在诊断上的重视。此病归類于眼眶炎性假瘤的一個临床亚型,还是/或作为一种独立的眼外肌炎症疾病,值得探讨。本文报告近年来我院收治记录完整的4例眼眶肌炎。 1 临床资料 例1 女,30岁,住院号197380。

复发性眼肌麻痹为主要症状的眼眶肌炎(法)

Introduction. We report a case of orbital myositis revealed by a relapsing and initally painless ophthalmoplegia. Case report. A50- year- old patient suddenly presented with an isolated palsy of the right lateral rectus muscle which recovered in 3 weeks after a short- lasting corticosteroid therapy but relapsed. Cerebral and orbital imaging were normal. Orbital pain with a fluctuating course occurred 6 months later. Two years after the clinical onset, orbital CT scan revealed a fusiform hypertrophy of the right lateral rectus muscle which was enhanced by contrast. After corticosteroid treatment, the symptoms improved and CT scan became normal. Conclusion. Orbital myositis may not be ruled out in case of painless ophthalmoplegia and systematic and repeated imaging is necessary.

反复发作的眼肌麻痹为主要表现的眼眶肌炎(法国)

Introduction. We report a case of orbital myositis revealed by a relapsing and initally painless ophthalmoplegia. Case report. A 50-year-old patient suddenl y presented with an isolated palsy of the right lateral rectus muscle which reco vered in 3 weeks after a short-lasting corticosteroid therapy but relapsed. Cer ebral and orbital imaging were normal. Orbital pain with a fluctuating course oc curred 6 months later. Two years after the clinical onset, orbital CT scan revea led a fusiform hypertrophy of the right lateral rectus muscle which was enhanced by contrast.After corticosteroid treatment, the symptoms improved and CT scan b ecame normal. Conclusion. Orbital myositis may not be ruled out in case of painl ess ophthalmoplegia and systematic and repeated imaging is necessary.

英夫利昔单抗治疗顽固性特发性眼眶炎症(慢性眼眶肌炎)

To report results of treatment with a monoclonal antibody (infliximab) directe d against tumor necrosis factor α.in seven patients with chronic and difficult -to-control idiopathic orbital inflammation (orbital myositis). Observational case series. Retrospective data were collected from seven patients who had idiop athic orbital inflammation and who were evaluated at three medical centers. All patients were treated with infliximab after the failure of traditional therapy, which included corticosteroids, radiotherapy, or anti-inflammatory chemotherape utic agents. All seven patients had a favorable response to treatment with infli ximab. One patient with Behc.et disease required supplemental oral corticosteroi ds. Pain, swelling, and need for concomitant corticosteroids were the primary me asures of treatment success. Symptoms of comorbid disease in four patients also improved (Crohn disease in two, Behcet disease in one, and psoriasis in one). Th ere were no untoward effects of treatment after a mean follow-up of 15.7 months (range, 4 to 31 months). Treatment with infliximab appears to offer another th erapeutic option in cases of recalcitrant or recurrent idiopathic orbital inflam mation in which conventional treatment fails.

双侧特发性眼眶肌炎

Introduction.Orbital myositis is an idiopathic inflammation of the extraoccular muscles.It is often included under the broad description of orbital pseudotumor.It is commonly a unilateral affection.Case report.We report one case of bilateral orbital myositis in a 45-year-old woman.The first symptoms were diplopia and acute bilateral orbital pain exacerbated by eye movements.Physical examination especially neurological was normal.Serum creatine kinase and biological thyroid function were normal.CT scan found a bilateral enlargement of rectus oculi medialis and lateralis.Clinical improvement was obtained a few days after oral corticosteroid treatment with remission of all signs.Conclusion.Orbital myositis is a rare entity.90-95p.cent of cases are unilateral.Bilateral forms are exceptional and in this case require search for specific etiologies particularly thyroid ophthalmopathy.There is controversy concerning treatment options but corticosteroids are still the most common first choice therapy with good outcome.

急性或亚急性眼眶肌炎(附10例报告)

眼眶肌炎是一种眼眶非特异性综合病变,目前病因不明,设想与免疫机制有关。患者眼部临床表现有急性眼球疼痛、复视、眼球突出、眼眶肿胀、上睑下垂,结膜水肿、眼外肌功能受损。文献报导此病见于患慢性病的年青人或继发于上呼吸道感染。

英夫利西单抗成功治疗难治性眼眶肌炎一例

患者女,24岁.因间断右眼眶疼痛1年余,右眼球运动障碍并复视7个月于2009年3月就诊于北京协和医院.患者自 2007年7月渐感右眼眶疼痛,2008年8月加重,出现右眼不能下视、复视.外院头颅核磁共振显像（MRI）示：右眼上直肌增粗（图1）,诊为特发性眼眶炎性假瘤（IOIP）.2008年11月起泼尼松60 mg/d口服,症状改善后泼尼松每2周减5 mg,减至35 mg/d时病情反复,为进一步诊治入院.发病以来否认发热、皮疹、肌痛、肌无力,无口腔溃疡、关节肿痛、雷诺现象.无特殊接触史或家族史.入院体格检查：右眶周肿胀、眼睑下垂、眼球上下活动受限,无眼球凸出、视力下降;心、肺、腹无异常体征;四肢肌肉无压痛、肌力Ⅴ级.入院查血常规正常,血红细胞沉降率5 mm/1 h,C反应蛋白＜31mg/L,肌酸激酶、甲状腺功能正常,抗核抗体、抗可提取核抗原抗体、抗中性粒细胞胞质抗体均阴性.