Tocco Pierluigi, Fenzi Flavio, Cerini Roberto, Monaco Salvatore
Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
BMJ Case Rep. 2011 Nov 15;2011:bcr1020114930. doi: 10.1136/bcr.10.2011.4930.
A 33-year-old woman with a long history of typical migraine without aura developed a pupillary-involving right third nerve palsy, after a typical migraine attack. The right pupil was 5 mm and showed delayed direct and consensual photomotor responses; the left pupil was 3 mm and reactive. Pupillary reaction to convergence was slow on the right eye. Ptosis, impaired elevation of the eye and weakened adduction were noted in the right eye. CT scan of the brain showed no abnormalities, whereas a CT digital cerebral angiography revealed a fetal-type right posterior cerebral artery (PCA). MRI disclosed thickening and contrast-enhancement of the cisternal portion of the right oculomotor nerve. A lumbar puncture, performed 5 days after the onset of ocular symptoms, yielded acellular cerebrospinal fluid (CSF) with normal protein and glucose levels. Ptosis and diplopia recovered within a week, whereas blurred vision, anisocoria and accommodation deficit subsided after 10 weeks.
一名有长期无先兆典型偏头痛病史的33岁女性，在一次典型偏头痛发作后出现了累及瞳孔的右侧动眼神经麻痹。右侧瞳孔直径5毫米，直接和间接光反射延迟；左侧瞳孔直径3毫米，反应正常。右眼对集合的瞳孔反应缓慢。右眼可见上睑下垂、眼球上抬受限和内收减弱。脑部CT扫描未发现异常，而CT数字脑血管造影显示右侧大脑后动脉（PCA）呈胎儿型。MRI显示右侧动眼神经脑池段增粗并强化。眼部症状出现5天后进行腰椎穿刺，脑脊液无细胞，蛋白和葡萄糖水平正常。上睑下垂和复视在一周内恢复，而视力模糊、瞳孔不等大和调节障碍在10周后消退。
