Chou Kelvin L, Galetta Steven L, Liu Grant T, Volpe Nicholas J, Bennett Jeffrey L, Asbury Arthur K, Balcer Laura J
Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA.
J Neurol Sci. 2004 Apr 15;219(1-2):35-9. doi: 10.1016/j.jns.2003.12.003.
The role for immediate neuroimaging in patients 50 years of age or older with acute isolated third, fourth, and sixth nerve palsies is controversial. We prospectively evaluated 66 patients, aged 50 years and older (median 67 years, range 50-85), with acute isolated ocular motor mononeuropathies. Our purpose was to evaluate both the role of neuroimaging and the role of clinical assessment in determining etiology. We found that clinical features, including time to maximal diplopic symptoms, were not predictive of etiology (median 2 days to maximal diplopic symptoms for both peripheral microvascular and other etiologies). The presence of any common vascular risk factor, including diabetes mellitus, hypertension, hypercholesterolemia, or coronary artery disease, was significantly associated with peripheral microvascular etiology in this cohort (p=0.0004, Fisher's exact test). Despite the high prevalence of peripheral microvascular ischemia as an etiology in this age group, other causes were identified by magnetic resonance imaging (MRI) or computed tomography (CT) scanning in 14% of patients. Diagnoses included brainstem and skull base neoplasms, brainstem infarcts, aneurysms, demyelinating disease, and pituitary apoplexy. Neuroimaging procedures may have a role in the initial evaluation of patients 50 years of age or older with acute ocular motor mononeuropathies.
对于50岁及以上急性孤立性动眼神经、滑车神经及展神经麻痹患者，急诊神经影像学检查的作用存在争议。我们前瞻性评估了66例年龄在50岁及以上（中位年龄67岁，范围50 - 85岁）的急性孤立性动眼神经单神经病患者。我们的目的是评估神经影像学检查及临床评估在确定病因方面的作用。我们发现，临床特征，包括出现最大复视症状的时间，并不能预测病因（外周微血管病变及其他病因出现最大复视症状的中位时间均为2天）。在该队列中，任何常见血管危险因素的存在，包括糖尿病、高血压、高胆固醇血症或冠状动脉疾病，均与外周微血管病因显著相关（p = 0.0004，Fisher精确检验）。尽管外周微血管缺血作为该年龄组病因的患病率很高，但通过磁共振成像（MRI）或计算机断层扫描（CT）仍在14%的患者中发现了其他病因。诊断包括脑干及颅底肿瘤、脑干梗死、动脉瘤、脱髓鞘疾病及垂体卒中。神经影像学检查可能在50岁及以上急性动眼神经单神经病患者的初始评估中发挥作用。
