孤立性滑车神经麻痹伴中脑周围蛛网膜下腔出血。
Isolated trochlear nerve palsy with perimesencephalic subarachnoid haemorrhage.
作者信息
Adachi Koji, Hironaka Kouhei, Suzuki Hisaharu, Oharazawa Hideaki
机构信息
Department of Neurosurgery, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan.
出版信息
BMJ Case Rep. 2012 Jul 9;2012:bcr2012006175. doi: 10.1136/bcr.2012.006175.
Perimesencephalic subarachnoid haemorrhage is usually asymptomatic other than meningeal irritation sign. The authors report a case of subarachnoid haemorrhage at the quadrigeminal cistern showing ipsilateral trochlear nerve palsy and discuss the pathogenesis. A 71-year-old man with a history of diabetes mellitus and acute myocardial infarction presented with diplopia. He underwent CT, which revealed subarachnoid haemorrhage at the left quadrigeminal cistern. Neurological examination revealed left isolated trochlear nerve palsy, with results otherwise normal. The diagnosis of perimesencephalic subarachnoid haemorrhage was established on neuroimaging. The amount of haemorrhage is related to symptoms. A dense clot in the quadrigeminal cistern might have been the cause of trochlear nerve palsy.
中脑周围蛛网膜下腔出血通常除脑膜刺激征外无其他症状。作者报告一例四叠体池蛛网膜下腔出血病例，该病例表现为同侧滑车神经麻痹，并对其发病机制进行了讨论。一名有糖尿病和急性心肌梗死病史的71岁男性出现复视。他接受了CT检查，结果显示左四叠体池蛛网膜下腔出血。神经学检查发现左侧孤立性滑车神经麻痹，其他检查结果正常。神经影像学检查确诊为中脑周围蛛网膜下腔出血。出血量与症状相关。四叠体池内的密集血凝块可能是滑车神经麻痹的原因。
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