Hatori K, Urabe T, Kanazawa A, Mizuno Y
Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan.
No To Shinkei. 1991 Oct;43(10):965-8.
We report a 46-year-old, non-hypertensive man who suddenly developed isolated right trochlear nerve palsy. His diplopia was most prominent in the left lower gaze, and partially alleviated by head tilt to the left or by anteflexion of the neck. His CT scans showed a small high density area consistent with a hemorrhage in the lateral side of the right mesencephalic tectum. His MRI (T2-weighted images) showed a lesion consisting of mixed high- and iso-intensity areas with linear low intensity areas. The margin of the lesion was irregular and nodular. Cerebral angiography (prolonged injection) showed small feeding arteries (or capillaries) in the late arterial phase and dilated draining veins in the venous phase. No tumor stain, early draining veins, or capillary brushes were present. We thought he had an angioma (vascular malformation). AVM seemed unlikely. Review of the literature revealed that trochlear nerve palsy caused by a mesencephalic angioma is extremely rare. MRI and cerebral angiography (prolonged injection) seemed useful for the diagnosis of angiomas (Vascular malformations).
我们报告一名46岁的非高血压男性，他突然出现孤立性右滑车神经麻痹。他的复视在左下注视时最为明显，向左头倾或颈部前屈可部分缓解。他的CT扫描显示在右中脑顶盖外侧有一个与出血相符的小高密度区。他的MRI（T2加权图像）显示一个由高信号和等信号混合区域以及线性低信号区域组成的病变。病变边缘不规则且呈结节状。脑血管造影（延长注射）显示在动脉晚期有小的供血动脉（或毛细血管），在静脉期有扩张的引流静脉。未见肿瘤染色、早期引流静脉或毛细血管刷状影。我们认为他患有血管瘤（血管畸形）。动静脉畸形似乎不太可能。文献回顾显示，由中脑血管瘤引起的滑车神经麻痹极为罕见。MRI和脑血管造影（延长注射）似乎对血管瘤（血管畸形）的诊断有用。
