眼外肌和神经的高分辨率磁共振成像显示了动眼神经麻痹的各种病因。
High-resolution magnetic resonance imaging of the extraocular muscles and nerves demonstrates various etiologies of third nerve palsy.
作者信息
Kau Hui-Chuan, Tsai Chieh-Chih, Ortube Maria C, Demer Joseph L
机构信息
Jules Stein Eye Institute and Department of Ophthalmology, University of California, Los Angeles, California 90095, USA.
出版信息
Am J Ophthalmol. 2007 Feb;143(2):280-287. doi: 10.1016/j.ajo.2006.10.035. Epub 2006 Nov 27.
PURPOSE
The etiology of third nerve palsy is usually diagnosed by history, motility examination, and presence of lid and pupil involvement, as well as cranial and vascular imaging. We used high-resolution magnetic resonance imaging (hrMRI) of the oculomotor nerve and affected extraocular muscles (EOMs) to investigate oculomotor palsy.
DESIGN
Prospective, noncomparative, observational case series in an academic referral setting.
METHODS
Twelve patients with nonaneurysmal oculomotor palsy of 0.75 to 252 months' duration were studied. In the orbit and along the intracranial oculomotor nerve, hrMRI at 1- to 2-mm thickness was performed. Coronal plane images of each orbit were obtained in multiple, controlled gaze positions. Structural abnormalities of the oculomotor nerve and associated changes in EOM volume and contractility were evaluated.
RESULTS
Cases were categorized as tumor related, congenital, diabetic, traumatic, and idiopathic according to clinical characteristics and hrMRI findings. Reduction of volume and contractility of affected EOMs were noted in six patients; however, there was no marked EOMs atrophy in two cases of diabetic oculomotor palsy, and there were four cases of aberrant regeneration. hrMRI demonstrated the oculomotor nerve at the midbrain and at EOMs in all cases, and in two cases with previous normal neuroimaging elsewhere that demonstrated contrast-enhancing tumors on the oculomotor nerve. One patient with apparently unilateral congenital inferior division oculomotor palsy had no detectable ipsilateral and a hypoplastic contralateral oculomotor nerve exiting the midbrain.
CONCLUSIONS
hrMRI provides valuable information in patients with oculomotor palsy, such as structural abnormalities of the orbit and oculomotor nerve, and atrophy and diminished contractility of innervated EOMs. This information could be helpful in diagnosis and management of oculomotor palsy.
目的
动眼神经麻痹的病因通常通过病史、眼球运动检查、眼睑和瞳孔受累情况以及头颅和血管成像来诊断。我们使用动眼神经和受累眼外肌的高分辨率磁共振成像（hrMRI）来研究动眼神经麻痹。
设计
在学术转诊机构进行的前瞻性、非对照、观察性病例系列研究。
方法
对12例病程为0.75至252个月的非动脉瘤性动眼神经麻痹患者进行研究。在眼眶及颅内动眼神经走行部位，进行层厚1至2毫米的hrMRI检查。在多个可控注视位置获取每个眼眶的冠状面图像。评估动眼神经的结构异常以及眼外肌体积和收缩性的相关变化。
结果
根据临床特征和hrMRI结果，病例分为肿瘤相关、先天性、糖尿病性、外伤性和特发性。6例患者出现受累眼外肌体积减小和收缩性降低；然而，2例糖尿病性动眼神经麻痹患者未出现明显的眼外肌萎缩，且有4例出现异常再生。hrMRI在所有病例中均显示了中脑处的动眼神经及眼外肌，2例既往其他部位神经影像学检查正常的患者在动眼神经上显示有强化肿瘤。1例明显单侧先天性动眼神经下支麻痹患者，未检测到同侧动眼神经从中脑发出，对侧动眼神经发育不全。
结论
hrMRI为动眼神经麻痹患者提供了有价值的信息，如眼眶和动眼神经的结构异常，以及受支配眼外肌的萎缩和收缩性降低。这些信息有助于动眼神经麻痹的诊断和治疗。
Zotero 插件