罕见病例：桥脑中脑结合部背盖损害导致单侧 Cogan 型前部眼肌麻痹、上视麻痹和共济失调
A rare case of unilateral Cogan's anterior internuclear ophthalmoplegia, upgaze palsy and ataxia caused by dorsal tegmentum lesion at pontomesencephalic junction.
机构信息
Queen Elizabeth Hospital, Sabah, Malaysia.
Universiti Malaysia Sarawak (UNIMAS), Kota Samarahan, Sarawak, Malaysia.
出版信息
BMC Ophthalmol. 2021 Feb 25;21(1):105. doi: 10.1186/s12886-021-01868-9.
BACKGROUND
Cogan's anterior internuclear ophthalmoplegia (INO) is characterized by INO with inability to converge and commonly thought to be due to rostral midbrain lesion. A lesion outside midbrain that causes unilateral Cogan's anterior INO combined with upgaze palsy and ataxia are rarely described.
CASE PRESENTATION
A 67-year old male presented with left Cogan's anterior internuclear ophthalmoplegia (INO), left appendicular ataxia and bilateral upgaze palsy. A Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) brain showed a left dorsal tegmental infarct at the level of pontomesencephalic junction.
CONCLUSIONS
This case highlights the clinical importance of Cogan's anterior INO in combination with upgaze palsy and ataxia, and report possible site of lesion in patients with such constellation. Clinicians should consider looking for cerebellar signs in cases of Cogan's anterior INO, apart from just considering localizing the lesion at the midbrain.
背景
Cogan 的前核间性眼肌麻痹（INO）的特征是 INO 伴不能会聚，通常认为是由于中脑头部病变引起的。中脑以外的病变导致单侧 Cogan 的前核间性 INO 合并上视肌麻痹和共济失调很少见。
病例介绍
一名 67 岁男性出现左侧 Cogan 的前核间性眼肌麻痹（INO）、左侧附属肢体共济失调和双侧上视肌麻痹。磁共振成像（MRI）和磁共振血管造影（MRA）脑部显示在桥脑中脑交界水平有左侧背侧被盖梗死。
结论
本例强调了 Cogan 的前核间性 INO 合并上视肌麻痹和共济失调的临床重要性，并报告了具有这种特征的患者中可能的病变部位。临床医生在出现 Cogan 的前核间性 INO 时，除了考虑中脑病变外，还应该考虑寻找小脑体征。
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