Department of Neuroimaging, centre hospitalier national d'ophtalmologie des Quinze-Vingts, Paris, France.
Department of Neuroimaging, centre hospitalier national d'ophtalmologie des Quinze-Vingts, Paris, France.
J Fr Ophtalmol. 2023 Sep;46(7):726-736. doi: 10.1016/j.jfo.2023.01.009. Epub 2023 May 18.
To evaluate the extent of signal abnormality in impaired ocular motor nerves using high signal and spatial resolution MRI sequences and to discuss the involvement of inflammatory or microvascular impairment in patients with diabetic ophthalmoplegia.
We conducted a retrospective study of 10 patients referred for acute ocular motor nerve palsy in the context of diabetes mellitus from September 15th, 2021 to April 24th, 2022. 3T MRI evaluation included diffusion, 3D TOF, FLAIR, coronal STIR and post-injection 3D T1 SPACE DANTE sequences.
Ten patients were included: 9 males and 1 female aged from 46 to 79 years. Five patients presented with cranial nerve (CN) III palsy, and 5 presented with CN VI palsy. Third nerve palsy was pupil-sparing in 4 patients and pupil-involved in 1 patient. Pain was associated in all patients with CN III deficiencies and in 2 patients CN VI deficiencies. In all patients, MRI sequences ruled out mass effect and vascular pathology, such as acute stroke or aneurysm. Eight patients presented with STIR hypersignals, some with enlargement of the involved nerve. The diagnosis was confirmed through a post-injection 3D T1 SPACE DANTE sequence, which showed extended enhancement along the abnormal portion of the nerve.
High-resolution MRI evaluation of diplopia in diabetic patients is used to rule out a diagnosis of acute stroke and contributes to the positive diagnosis of ocular motor nerve impairment, possibly combining the influences of inflammatory and microvascular phenomena. Dedicated MR imaging should be included in the initial diagnosis and longitudinal follow-up of patients with diabetic ophthalmoplegia.
利用高信号和空间分辨率 MRI 序列评估受损眼动神经的信号异常程度，并探讨炎症或微血管损伤在糖尿病性眼肌麻痹患者中的作用。
我们对 2021 年 9 月 15 日至 2022 年 4 月 24 日期间因糖尿病急性眼动神经麻痹而就诊的 10 例患者进行了回顾性研究。3T MRI 评估包括弥散、3D TOF、FLAIR、冠状位 STIR 和注射后 3D T1 SPACE DANTE 序列。
共纳入 10 例患者：男 9 例，女 1 例，年龄 46 至 79 岁。5 例患者表现为第 III 颅神经麻痹，5 例患者表现为第 VI 颅神经麻痹。第 3 对颅神经麻痹中 4 例瞳孔不受累，1 例瞳孔受累。所有第 III 对颅神经缺损患者均伴有疼痛，2 例第 VI 对颅神经缺损患者也伴有疼痛。所有患者的 MRI 序列均排除了肿块效应和血管病变，如急性中风或动脉瘤。8 例患者出现 STIR 高信号，部分患者受累神经增粗。通过注射后 3D T1 SPACE DANTE 序列可明确诊断，该序列显示异常神经段的延伸性强化。
对糖尿病患者复视进行高分辨率 MRI 评估，可排除急性中风的诊断，并有助于阳性诊断眼动神经损伤，可能同时合并炎症和微血管现象的影响。在糖尿病性眼肌麻痹患者的初始诊断和纵向随访中，应包括专用磁共振成像。
