Hawke S H, Mullie M A, Hoyt W F, Hallinan J M, Halmagyi G M
Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia.
Arch Neurol. 1989 Nov;46(11):1252-5. doi: 10.1001/archneur.1989.00520470126040.
Two patients presented with painful unilateral oculomotor nerve palsies without evidence of ocular congestion or hypoxia. They were initially thought to have posterior communicating or distal internal carotid aneurysms, but had, in fact, dural-cavernous sinus shunts, draining posteriorly into the inferior petrosal sinus. One patient later developed a moderately severe congestive ophthalmopathy, and repeated selective carotid arteriograms showed that the shunt was now draining anteriorly into the superior ophthalmic vein. In the other patient, the oculomotor nerve palsy resolved without the development of any further signs. These observations support the concept that dural-cavernous sinus shunts produce symptoms that are dependent on the direction of drainage from the shunt. It is clear that the direction of drainage can change and that thrombosis of the posterior cavernous sinus determines the direction of drainage. The exact mechanism of the cranial neuropathy is, however, unknown.
两名患者出现单侧动眼神经麻痹伴疼痛，无眼充血或缺氧迹象。他们最初被认为患有后交通动脉瘤或颈内动脉远端动脉瘤，但实际上是硬脑膜-海绵窦分流，向后引流至岩下窦。一名患者后来发展为中度严重的充血性眼病，重复的选择性颈动脉造影显示分流现在向前引流至上眼静脉。在另一名患者中，动眼神经麻痹得到缓解，未出现任何进一步的体征。这些观察结果支持这样一种概念，即硬脑膜-海绵窦分流产生的症状取决于分流的引流方向。很明显，引流方向可以改变，海绵窦后部血栓形成决定了引流方向。然而，颅神经病变的确切机制尚不清楚。
