血管病相关性眼肌麻痹的病因与预后分析

doi:10.3969/j.issn.1673-5765.2018.01.004

摘要/Abstract

摘要：

目的分析血管病相关性眼肌麻痹的病因、临床特点与预后。方法回顾性系列病例研究。收集2012年12月-2016年7月在首都医科大学附属北京同仁医院神经内科就诊的血管病相关性眼肌麻痹住院患者的临床资料，包括临床表现、体格检查、既往史、实验室和影像学检查结果，随访并记录其眼肌麻痹的缓解时间，对眼肌麻痹患者的病因、临床特点与预后进行分析。结果研究共入组126例患者，结果显示：①微血管缺血性（microvascular ischemic，MVI）病变为血管病相关性眼肌麻痹最常见的病因（81.7%），其次为脑干梗死（13.5%），动脉瘤、眼肌麻痹性偏头痛、海绵窦动静脉瘘相对少见。MVI病变和脑干梗死患者中血管危险因素常见高血压、高脂血症、吸烟、糖尿病和酗酒。②MVI病变累及眼球运动神经比例依次为动眼神经（57.3%）、外展神经（26.2%）、滑车神经（16.5%）；脑干梗死所致核性眼肌麻痹以动眼神经核最常受累（70.6%）、其次为内侧纵束（17.6%）。③49.5%血管病相关性眼肌麻痹MVI病变患者可伴有头痛或眼眶周围疼痛。④88.5%血管病相关性眼肌麻痹MVI病变症状可以缓解，其中50%约在3个月内缓解，75%在6个月内缓解。结论 MVI病变为血管病相关性眼肌麻痹最常见病因，高血压、高脂血症、吸烟、糖尿病、酗酒是MVI 病变常见危险因素，治疗后大部分MVI病变患者可在半年内恢复。

文章导读： 本文对126例血管病相关性眼肌麻痹患者的病例资料进行回顾性分析，结果显示微血管缺血性病变是其主要病因，不同病因患者的临床症状有所差异，其血管危险因素多为高血压、高脂血症、吸烟、糖尿病、酗酒等。

关键词: 血管病; 眼肌麻痹; 微血管缺血性病变; 脑干梗死; 预后

Abstract:

Objective To analyze the etiology, clinical characteristics and prognosis of ophthalmoplegia associated with vascular diseases. Methods It was a retrospective case series study. The clinical data of patients with ophthalmoplegia associated with vascular diseases who received consultation in Beijing Tongren hospital, Capital Medical University from December 2012 to July 2016 were collected, including the clinical manifestations, physical examination, past history of disease, laboratory tests and imaging examinations. The patients were followed up and the remission time of ophthalmoplegia were recorded. The etiology, clinical characteristics and prognosis of ophthalmoplegia were analyzed. Results A total of 126 patients were enrolled into this study. The results were shown as below: (1) Microvascular ischemic (MVI) disease was the most common cause of ophthalmoplegia associated with vascular diseases, accounting for 81.7 percent, followed by brainstem infarction (13.5%), and aneurysm, ophthalmoplegia migraine (OM), cavernous sinus venous fistula were rare causes. The major risk factors of MVI and brainstem infarction were hypertension, hyperlipidemia, smoking, diabetes and alcoholism. (2)The oculomotor nerve was the most common involved nerve(57.3%) by MVI disease of ocular motor nerves,followed by abducens nerve (26.2%), trochlear nerve(16.5%). The ophthalmoplegia caused by brainstem infarction involved the oculomotor nucleus most (70.6%), followed by medial longitudinal fasciculus (17.6%). (3)About 49.5% MVI patients might be associated with headache or periorbital pain. (4)The symptoms of 88.5% MVI could relieve, of which about 50% within 3 months and 75% within 6 months. Conclusion MVI disease is the most common cause of ophthalmoplegia associated with vascular diseases. Hypertension, hyperlipidemia, smoking, diabetes, alcoholism are major risk factors of MVI. Most patients of MVI disease could relieve in 6 months after treatment.

Key words: Vascular disease; Ophthalmoplegia; Microvascular ischemic disease; Brainstem infarction; Prognosis

李然, 李文文, 胡晓明, 王佳伟, 景筠. 血管病相关性眼肌麻痹的病因与预后分析[J]. 中国卒中杂志, 2018, 13(01): 12-16.

LI Ran, LI Wen-Wen, HU Xiao-Ming, WANG Jia-Wei, JING Yun. An Etiology and Prognosis Analysis on Patients with Ophthalmoplegia Associated with Vascular Diseases[J]. Chinese Journal of Stroke, 2018, 13(01): 12-16.

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