Atlas S W, Grossman R I, Savino P J, Schatz N J, Sergott R C, Bosley T M, Hackney D B, Goldberg H I, Bilaniuk L T, Zimmerman R A
AJNR Am J Neuroradiol. 1987 Mar-Apr;8(2):243-7.
Internuclear ophthalmoplegia is a gaze disorder characterized by impaired adduction on the side of a lesion involving the medial longitudinal fasciculus with dissociated nystagmus of the abducting eye. Eleven patients with internuclear ophthalmoplegia (nine with clinical multiple sclerosis, two with clinical infarction) underwent MR imaging with spin-echo techniques on a 1.5-T system. Nine patients also had CT. MR showed focal or nodular areas of high signal intensity on T2-weighted images in the region of the medial longitudinal fasciculus in 10 of 11 patients. In one of four patients with internuclear ophthalmoplegia who had MR after intravenous gadolinium-DTPA, an enhancing ring lesion was seen in the region of the medial longitudinal fasciculus on short TR/TE images, indicating active blood-brain-barrier disruption, which correlated with this patient's recent-onset internuclear ophthalmoplegia. CT failed to show the lesions in all nine patients examined. This report demonstrates the superiority of MR in evaluating gaze disorders attributable to brainstem dysfunction, such as internuclear ophthalmoplegia, and correlates MR findings with the relevant neuroanatomy of the medial longitudinal fasciculus.
核间性眼肌麻痹是一种凝视障碍，其特征为累及内侧纵束的病变侧内收功能受损，外展眼出现分离性眼球震颤。11例核间性眼肌麻痹患者（9例临床诊断为多发性硬化，2例临床诊断为梗死）在1.5-T系统上采用自旋回波技术进行了磁共振成像（MR）检查。9例患者还进行了CT检查。11例患者中有10例在T2加权像上显示内侧纵束区域有局灶性或结节状高信号区。4例核间性眼肌麻痹患者在静脉注射钆喷酸葡胺后进行了MR检查，其中1例在短TR/TE像上内侧纵束区域可见强化环形病变，提示血脑屏障有活动性破坏，这与该患者近期发生的核间性眼肌麻痹相关。在所有9例接受检查的患者中，CT均未能显示病变。本报告证明了MR在评估由脑干功能障碍引起的凝视障碍（如核间性眼肌麻痹）方面的优越性，并将MR表现与内侧纵束的相关神经解剖结构进行了关联。
