Yang Yan, Lai Chuntao, Yan Fei, Wang Jiawei
Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
Department of Radiology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
J Clin Neurol. 2020 Oct;16(4):653-658. doi: 10.3988/jcn.2020.16.4.653.
Contrast enhancement of the oculomotor nerve in MRI was recently noticed in patients with clinical ischemic isolated oculomotor nerve palsy (iIONP). The opinions about whether this is a sign of inflammation and whether or not to administer steroids vary between doctors. The study aimed to determine the associations between this enhancement and vascular-disease risk factors (VRFs) and inflammatory factors in iIONP patients.
The study recruited patients who had experienced iIONP during the previous 2 years. They were divided into groups A and B based on whether or not they exhibited an enhanced oculomotor nerve in MRI of the cavernous sinus using thin-section, fat-suppressed, and contrast-enhanced sequences. VRFs, inflammatory factors, and improvement scores were compared between the two groups.
Most (71.1%) of the 45 included iIONP patients had enhanced oculomotor nerves in MRI. VRFs, periorbital pain, elevated C-reactive protein and erythrocyte sedimentation rate, the neutrophil-to-lymphocyte ratio, and the platelet-to-lymphocyte ratio were not significantly associated with the enhancement. Four of the five patients in group A exhibited an elevated cerebrospinal fluid (CSF) IgG synthesis rate. The improvement score of eight patients who received 80 mg of methylprednisolone in addition to the routine therapy was not significantly different from the scores of the other patients (=0.485).
More than half of the iIONP patients had an enhanced oculomotor nerve in MRI. A few of them also had elevated CSF IgG synthesis rate, but no further evidence for inflammation was found. The administration of steroids seemed to have no benefit other than increasing the blood glucose level.
近期在临床孤立性动眼神经麻痹（iIONP）患者的MRI检查中发现动眼神经有强化表现。对于这是否为炎症征象以及是否应用类固醇，医生们看法不一。本研究旨在确定iIONP患者中这种强化与血管疾病危险因素（VRFs）及炎症因子之间的关联。
本研究纳入了过去2年内发生iIONP的患者。根据在海绵窦MRI检查中使用薄层、脂肪抑制和增强序列时动眼神经是否强化，将他们分为A组和B组。比较两组的VRFs、炎症因子及改善评分。
纳入的45例iIONP患者中，大多数（71.1%）在MRI检查中动眼神经有强化表现。VRFs、眶周疼痛、C反应蛋白和红细胞沉降率升高、中性粒细胞与淋巴细胞比值以及血小板与淋巴细胞比值与强化无显著关联。A组5例患者中有4例脑脊液（CSF）IgG合成率升高。除常规治疗外接受80mg甲泼尼龙治疗的8例患者的改善评分与其他患者的评分无显著差异（=0.485）。
超过半数的iIONP患者在MRI检查中动眼神经有强化表现。其中少数患者脑脊液IgG合成率也升高，但未发现更多炎症证据。应用类固醇似乎除了使血糖水平升高外并无益处。
