Ashker Lamees, Weinstein Joel M, Dias Mark, Kanev Paul, Nguyen Dan, Bonsall Dean J
Department of Ophthalmology, Penn State University, Milton S. Hershey Medical Center, Hershey, Pennsylvania 17033, USA.
J Neuroophthalmol. 2008 Sep;28(3):192-7. doi: 10.1097/WNO.0b013e318183c57c.
An 8-month-old boy presented with anisocoria, a sluggishly reactive right pupil, and cholinergic supersensitivity as the only signs of what proved months later to be compressive third cranial nerve palsy due to an arachnoid cyst. Tonic constriction and dilation, segmental iris sphincter palsy, aberrant regeneration phenomena, ductional deficits, and ptosis were absent. The initial diagnosis was postganglionic internal ophthalmoplegia attributed to a viral ciliary ganglionopathy. Nineteen months later, he had developed an incomitant exodeviation and a supraduction deficit. Brain MRI revealed a mass consistent with an arachnoid cyst compressing the third cranial nerve in the right interpeduncular cistern. Resection of the cyst led to a persistent complete third cranial nerve palsy. This is the second reported case of prolonged internal ophthalmoplegia in a young child as a manifestation of a compressive third cranial nerve palsy. Our patient serves as a reminder that isolated internal ophthalmoplegia with cholinergic supersensitivity is compatible with a preganglionic compressive third nerve lesion, particularly in a young child.
一名8个月大的男童出现瞳孔不等大、右侧瞳孔反应迟钝以及胆碱能超敏反应，数月后经证实这些症状是由蛛网膜囊肿导致的动眼神经受压性麻痹的唯一表现。未出现强直性收缩和扩张、节段性虹膜括约肌麻痹、异常再生现象、眼球运动障碍及上睑下垂。初步诊断为病毒性睫状神经节病变所致的节后性眼内肌麻痹。19个月后，他出现了非共同性外斜视和上转不足。脑部磁共振成像显示在右侧脚间池有一个与压迫动眼神经的蛛网膜囊肿相符的肿块。囊肿切除术后导致动眼神经持续完全麻痹。这是第二例报道的幼儿因动眼神经受压性麻痹而出现长时间眼内肌麻痹的病例。我们的患者提醒我们，孤立性眼内肌麻痹伴胆碱能超敏反应与节前性动眼神经受压性病变相符，尤其是在幼儿中。
