Su Chia-Hung, Young Yi-Ho
Department of Otolaryngology, Catholic Cardinal Tien Hospital, Fu-Jen Catholic University , Taipei.
Acta Otolaryngol. 2013 Sep;133(9):916-23. doi: 10.3109/00016489.2013.783716.
Close observation of pathological eye movements such as disconjugate eye movements, multi-directional gaze nystagmus, and persistent unilateral gaze nystagmus may facilitate the effort of clinicians to arrange magnetic resonance imaging (MRI) study, because physical examinations may overlook the posterior fossa lesions.
This paper reviews our experience of patients with posterior fossa stroke via observation of pathological eye movements over the past 10 years.
Seventy patients with posterior fossa stroke manifested as acute vertiginous attack were admitted. All patients underwent examination of eye movements, MRI, and a battery of audiovestibular function tests.
Of the 70 patients, 22 (31%) demonstrated pathological eye movements including persistent (>24 h) unilateral gaze nystagmus in 12 patients, and multi-directional gaze nystagmus in 10 patients. Conjugate eyes movements were identified in 18 patients, and disconjugate eye movements were shown in 4 patients including medial longitudinal fasciculus syndrome in 1, paramedian pontine reticular formation syndrome in 1, and one and a half syndrome in 2. The vestibular test battery revealed abnormal responses for >85% of the patients in each test. MRI demonstrated infarction or hemorrhage involving the brainstem in 12 patients, cerebellum in 8 patients, and both in 2 patients.
密切观察病理性眼球运动，如眼球运动失调、多向凝视性眼球震颤和持续性单侧凝视性眼球震颤，可能有助于临床医生安排磁共振成像（MRI）检查，因为体格检查可能会忽略后颅窝病变。
本文回顾了过去10年中通过观察病理性眼球运动对后颅窝卒中患者的诊疗经验。
收治70例表现为急性眩晕发作的后颅窝卒中患者。所有患者均接受了眼球运动检查、MRI检查以及一系列听前庭功能测试。
70例患者中，22例（31%）表现出病理性眼球运动，其中12例出现持续性（>24小时）单侧凝视性眼球震颤，10例出现多向凝视性眼球震颤。18例患者出现共轭眼球运动，4例出现眼球运动失调，其中1例为内侧纵束综合征，1例为脑桥旁正中网状结构综合征，2例为一个半综合征。前庭功能测试显示，每项测试中超过85%的患者有异常反应。MRI显示12例患者脑干梗死或出血，8例患者小脑梗死或出血，2例患者脑干和小脑均有梗死或出血。
