Chernov Dmitriy, Karavassilis Maria Elizabeth, Hassan Farida, Bhandari Mohit
Acute Medicine, Watford General Hospital, Watford, UK
Gastroenterology, Watford General Hospital, Watford, Hertfordshire, UK.
BMJ Case Rep. 2019 Oct 31;12(10):e229503. doi: 10.1136/bcr-2019-229503.
A 73-year-old man presented to accident and emergency with headache and diplopia. Examination of the eye movements revealed a bilateral complete horizontal gaze palsy. On admission, a CT scan of the brain was performed, which was unremarkable. An MRI of the brain was then performed, which confirmed tiny acute infarcts involving the pons and the right cerebellum. This man was promptly treated with aspirin 300 mg one time per day, as per the stroke pathway. Further diagnostic workup later revealed atrial flutter. This man was therefore commenced on apixaban. The differential diagnoses for bilateral gaze palsy include the following: multiple sclerosis, infarction, haemorrhage and space occupying lesion. Bilateral gaze palsy is often associated with other neurological symptoms.
一名73岁男性因头痛和复视前往急诊。眼部运动检查发现双侧完全性水平凝视麻痹。入院时进行了脑部CT扫描，结果无异常。随后进行了脑部MRI检查，证实脑桥和右侧小脑有微小急性梗死灶。按照中风治疗流程，该男子立即开始每天服用一次300毫克阿司匹林。进一步的诊断检查后来发现了心房扑动。因此，该男子开始服用阿哌沙班。双侧凝视麻痹的鉴别诊断包括以下几种：多发性硬化、梗死、出血和占位性病变。双侧凝视麻痹常伴有其他神经症状。
