Buckley Edward G, Ellis Forrest D, Postel Eric, Saunders Timothy
Duke University Eye Center, Durham, NC, USA
J AAPOS. 2005 Feb;9(1):12-6. doi: 10.1016/j.jaapos.2004.11.011.
Paradoxical patterns of extraocular muscle, eyelid, or pupillary movements can occur following injury between divisions of the oculomotor nerve, trigeminal and abducens nerves, and trigeminal and oculomotor nerves. We report three cases of unusual ocular motility and eyelid movements that are a result of aberrant connections between the abducens and oculomotor nerves.
Three patients with unusual eye movement abnormalities after trauma were studied. A complete ophthalmic examination plus neuroradiologic evaluation were performed.
Each patient manifested an aberrant connection between the 6th and 3rd cranial nerves resulting in third nerve function during sixth nerve stimulation. Two patients demonstrated complete third nerve palsies except for adduction on attempted abduction. The third showed improved bilateral ptosis on abduction.
The neuroanatomical abnormalities involve intraorbital structures in one patient and central nervous system pathways in the others. Explanations such as retrograde regeneration, ephaptic transmission, or denervation supersensitivity do not appear to explain these unusual eye movements. The most likely mechanism involves some form of peripheral neuronal misdirection. These rare sixth to third nerve misdirection cases add support to the "neuronal misdirection hypothesis" of aberrant eye movements after trauma.
动眼神经、三叉神经与展神经以及三叉神经与动眼神经分支损伤后，可出现眼外肌、眼睑或瞳孔运动的反常模式。我们报告3例因展神经与动眼神经之间存在异常连接而导致的异常眼球运动和眼睑运动病例。
对3例外伤后出现异常眼球运动异常的患者进行研究。进行了全面的眼科检查及神经放射学评估。
每名患者均表现出第6对和第3对脑神经之间的异常连接，导致在第6对神经刺激时出现第3对神经功能。2例患者除试图外展时内收外，表现为完全性第3对神经麻痹。第3例患者外展时双侧上睑下垂改善。
神经解剖学异常在1例患者中累及眶内结构，在其他患者中累及中枢神经系统通路。逆行再生、ephaptic传递或去神经超敏反应等解释似乎无法解释这些异常眼球运动。最可能的机制涉及某种形式的外周神经元错向。这些罕见的第6对至第3对神经错向病例为创伤后异常眼球运动的“神经元错向假说”提供了支持。
