Department of Neurology, Eginition Hospital, University of Athens, Greece.
J Neurol Sci. 2013 Aug 15;331(1-2):145-9. doi: 10.1016/j.jns.2013.05.036. Epub 2013 Jun 21.
Although reports of single cases of painful ophthalmoplegia (PO) are common, studies considering larger case series are lacking. Here, we aimed to determine the relative frequencies of ocular neuropathies, the causes, the usefulness of diagnostic procedures and the role of steroid treatment in PO.
Between January 2006 and September 2012, 149 patients' charts who presented with diplopia in our emergency department were studied retrospectively. 34 of them met the inclusion criteria that included recent (≤3 days) symptom onset and a minimum of diagnostic work.
32% of single or combined ocular motor nerve palsies were of diabetic microvascular etiology and most of them were IIIrd or VIth nerve neuropathies. The most useful, in terms of sensitivity and specificity of diagnostic test in the acute setting was ESR, whereas MR-angiography and focused cavernous sinus imaging led to diagnosis in the post-acute phase. Pain response to steroids was non-specific, in contrast to palsy improvement after steroid administration which was indicative of Tolosa-Hunt syndrome or temporal arteritis.
Although acute and subacute PO might be intuitively associated with Tolosa-Hunt syndrome or sinister pathology such as aneurysmal hemorrhage, our data show that these causes are far less common than diabetic microvascular palsies. Brain CT, MR-imaging of brainstem, cerebellum or hemispheres, CSF analysis and pain response to steroids are nonspecific and hence less helpful in order to arrive at a diagnosis. Instead, improved ocular motility after steroid treatment, as well as MR-angiography and cavernous sinus imaging appear more useful for this purpose.
尽管单发性痛性眼肌麻痹（PO）的报告较为常见，但缺乏考虑较大病例系列的研究。在此，我们旨在确定眼部神经病变的相对频率、病因、诊断程序的有用性以及类固醇治疗在 PO 中的作用。
回顾性研究了 2006 年 1 月至 2012 年 9 月期间在我院急诊就诊并伴有复视的 149 名患者的病历。其中 34 名患者符合纳入标准，包括近期（≤3 天）发病和至少进行了诊断性检查。
单发性或多发性眼运动神经麻痹中 32%为糖尿病微血管病因，其中大多数为第 III 或第 VI 脑神经病变。在急性发病时，ESR 是最有用的诊断测试，具有较高的敏感性和特异性，而 MR 血管造影和聚焦海绵窦成像则在发病后阶段有助于诊断。类固醇治疗后的疼痛反应是非特异性的，而类固醇治疗后眼肌麻痹的改善则提示托洛萨-亨特综合征或颞动脉炎。
尽管急性和亚急性 PO 可能直观地与托洛萨-亨特综合征或恶性病变（如动脉瘤性出血）相关，但我们的数据表明，这些病因远不如糖尿病微血管病变常见。脑 CT、脑桥、小脑或半球的 MRI、CSF 分析以及类固醇治疗后的疼痛反应均不具有特异性，因此对诊断帮助不大。相反，类固醇治疗后眼肌运动的改善，以及 MR 血管造影和海绵窦成像对诊断更有帮助。
