Tetas Pont Roser, Freeman Courtenay, Dennis Ruth, Hartley Claudia, Beltran Elsa
Comparative Ophthalmology Unit, Animal Health Trust, Lanwades Park, Kentford CB8 7UU, UK.
Neurology/Neurosurgery Unit, Animal Health Trust, Lanwades Park, Kentford CB8 7UU, UK.
Vet Radiol Ultrasound. 2017 May;58(3):334-343. doi: 10.1111/vru.12478. Epub 2017 Feb 8.
Ophthalmoplegia/ophthalmoparesis (internal, external, or both) has been reported in dogs secondary to neoplasia affecting the oculomotor nerve and is usually given a poor prognosis. The purpose of this retrospective study was to describe the clinical findings, magnetic resonance imaging (MRI) findings, management, outcome, and follow-up in a group of canine cases with idiopathic oculomotor neuropathy. Inclusion criteria included cases with ophthalmoplegia/ophthalmoparesis (internal, external or both) as sole neuroophthalmologic signs, complete ophthalmic and neurologic examination, head MRI, and a minimum follow-up period of 1 year. Dogs with progressive neurological signs not related to oculomotor neuropathy were excluded. Fourteen cases met the inclusion criteria. All cases were unilaterally affected. Magnetic resonance imaging showed equivocal enlargement of the oculomotor nerve in three cases, mild enlargement in five, and marked enlargement in six. Contrast enhancement was present in 12 cases, being marked in six. When present, the contrast enhancement was focal in eight cases and diffuse in four. The median follow-up time was 25 months. External ophthalmoparesis improved in seven cases, five cases under no treatment and two under systemic corticosteroid therapy. The clinical signs in the other seven cases remained unchanged. Idiopathic oculomotor neuropathy should be included as a differential diagnosis in dogs presenting with unilateral ophthalmoplegia/ophthalmoparesis (internal, external, or both) with the absence of other neurologic and ophthalmic signs, and with the MRI findings restricted to the oculomotor nerve. Idiopathic oculomotor neuropathy has a good prognosis as the clinical signs do not deteriorate and they can improve without treatment.
已有报道称,继发于影响动眼神经的肿瘤时,犬会出现眼肌麻痹/眼肌轻瘫(内直肌、外直肌或两者皆有),通常预后不良。本回顾性研究的目的是描述一组特发性动眼神经病变犬病例的临床症状、磁共振成像(MRI)表现、治疗、结局及随访情况。纳入标准包括以眼肌麻痹/眼肌轻瘫(内直肌、外直肌或两者皆有)作为唯一神经眼科体征的病例、完整的眼科和神经科检查、头部MRI以及至少1年的随访期。排除有与动眼神经病变无关的进行性神经体征的犬。14例病例符合纳入标准。所有病例均为单侧受累。磁共振成像显示,3例动眼神经有可疑增粗,5例轻度增粗,6例明显增粗。12例有对比增强,其中6例明显增强。如有对比增强,8例为局灶性,4例为弥漫性。中位随访时间为25个月。7例犬的外直肌轻瘫有所改善,5例未经治疗,2例接受全身皮质类固醇治疗。其他7例犬的临床症状未变。对于出现单侧眼肌麻痹/眼肌轻瘫(内直肌、外直肌或两者皆有)且无其他神经和眼科体征、MRI表现局限于动眼神经的犬,应将特发性动眼神经病变纳入鉴别诊断。特发性动眼神经病变预后良好,因为临床症状不会恶化,且无需治疗即可改善。