Wu G, Agrawal A, Ghanchi F D
Department of Ophthalmology, Bradford Royal Infirmary, Bradford, UK.
Eur J Ophthalmol. 2003 Apr;13(3):324-7. doi: 10.1177/112067210301300315.
To describe a patient with transient third nerve palsy as the possible presenting sign of intracranial arteriovenous malformation.
Case report.
A 24-year-old female presented to ophthalmic casualty with sudden onset binocular diplopia and was diagnosed to have right sided partial third nerve palsy. Within 30 hours the third nerve palsy had recovered completely. A MRI scan and subsequent carotid angiogram revealed a large, high flow, trans-cortical Spetzler-Martin grade 4 arteriovenous malformation. The feeder vessel of the AVM originated from the right middle cerebral artery. Superficial venous drainage was via the superficial middle cerebral vein to the right transverse sinus. The deep venous drainage was via thalamostriate veins into markedly dilated internal cerebral vein and vein of Galen (Great cerebral vein). Venous reflux was noted around the midbrain from the vein of Galen.
Transient third nerve palsy may rarely occur secondary to intracranial arteriovenous malformation. Ophthalmologists should consider neuroimaging in the investigations for transient cases of III nerve palsy in young patients.
描述一例以短暂性动眼神经麻痹为颅内动静脉畸形可能表现体征的患者。
病例报告。
一名24岁女性因突发双眼复视就诊于眼科急诊，被诊断为右侧部分动眼神经麻痹。在30小时内，动眼神经麻痹完全恢复。磁共振成像扫描及随后的颈动脉血管造影显示一个大型、高流量、经皮质的斯佩茨勒-马丁4级动静脉畸形。该动静脉畸形的供血血管起源于右侧大脑中动脉。浅静脉引流通过大脑中浅静脉至右侧横窦。深静脉引流通过丘脑纹状体静脉进入明显扩张的大脑内静脉和大脑大静脉（盖伦静脉）。从大脑大静脉可见中脑周围有静脉反流。
短暂性动眼神经麻痹很少继发于颅内动静脉畸形。眼科医生在对年轻患者的短暂性动眼神经麻痹病例进行检查时应考虑神经影像学检查。
