Bogousslavsky J, Pedrazzi P L, Borruat F X, Regli F
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Switzerland.
Eur Neurol. 1991;31(2):72-6. doi: 10.1159/000116650.
When blood flow through the internal and external carotid arteries is completely interrupted by ipsilateral common carotid artery occlusion, the arterial orbital circulation may be more compromised than the brain supply. We studied a pure and extreme example of this situation in a patient who presented with acute orbital infarction, but no cerebral ischemia on clinical, CT and single-photon emission computerized tomography (SPECT) grounds. Ipsilateral blindness corresponded to retinal, choroidal and optic nerve infarction. The pattern of ophthalmoplegia, with relative sparing of adduction, was more compatible with a muscle than a nerve dysfunction, but a reactive dilated pupil, corneal anesthesia, and orbital pain suggested that the intraorbital branches of the ocular motor nerves and ophthalmic division of the trigeminal nerve were not spared. In addition, signs of widespread ocular ischemia were present. Sequential examinations documented the evolution pattern over 1 year. The absence of an orbital collateral supply from the contralateral external carotid and muscular cervical arteries systems, which contrasted with an adequate middle cerebral artery supply via the contralateral internal carotid artery, may explain this isolated and complete form of orbital ischemia due to common carotid artery occlusion.
当同侧颈总动脉闭塞导致颈内动脉和颈外动脉血流完全中断时，眼眶的动脉循环可能比脑供血受到更严重的损害。我们研究了一名患者的这种情况的一个纯粹且极端的例子，该患者出现急性眼眶梗死，但临床、CT及单光子发射计算机断层扫描（SPECT）检查均未发现脑缺血。同侧失明与视网膜、脉络膜及视神经梗死相关。眼肌麻痹表现为内收相对保留，这种模式更符合肌肉而非神经功能障碍，但反应性瞳孔散大、角膜感觉缺失及眼眶疼痛提示动眼神经眶内分支及三叉神经眼支未幸免。此外，还存在广泛眼部缺血的体征。连续检查记录了1年中的病情演变模式。与对侧颈内动脉通过大脑中动脉提供充足供血形成对比的是，对侧颈外动脉及颈肌动脉系统未形成眼眶侧支供血，这可能解释了因颈总动脉闭塞导致的这种孤立且完全的眼眶缺血形式。
