Department of Neurology, The China-Japan Union Hospital, Jilin University, Changchun, China.
Department of Neurosurgery, The China-Japan Union Hospital, Jilin University, Changchun, China.
J Int Med Res. 2024 Jan;52(1):3000605231208570. doi: 10.1177/03000605231208570.
The differential diagnosis of isolated ophthalmoplegia includes a range of pathologies. In this case, a 26-year-old man of Han nationality presented with ophthalmoplegia. Neuroimaging revealed an atypical focal lesion in the interpeduncular fossa. Initial systemic workup indicated intracranial infection, but there was no evidence to support a diagnosis of other autoimmune diseases (e.g., myasthenia gravis or multiple sclerosis). Neuroimaging follow-up over the next 3 years revealed progression from atypical solitary lesions to multifocal lesions in the white matter of the brain. Key immunological markers were observed in cerebrospinal fluid during follow-up, suggesting the evolution of multiple sclerosis. Ophthalmoplegia with a focal lesion in the interpeduncular fossa was an unusual set of symptoms indicating multiple sclerosis onset. The findings in this case suggest that infection is an important but overlooked factor involved in the pathogenesis of multiple sclerosis. Upon initial detection, atypical lesions should receive sufficient attention and patients should undergo systematic screening to identify infection and its associated immunological abnormalities.
孤立性眼肌麻痹的鉴别诊断包括一系列病变。本例为 26 岁汉族男性，表现为眼肌麻痹。神经影像学显示中脑导水管周围非典型局灶性病变。初始系统检查提示颅内感染，但没有证据支持其他自身免疫性疾病（如重症肌无力或多发性硬化症）的诊断。接下来 3 年的神经影像学随访显示，病变从非典型单发病变进展为脑白质多灶性病变。随访过程中观察到脑脊液中有关键免疫标志物，提示多发性硬化症演变。中脑导水管周围有局灶性病变的眼肌麻痹是一组不常见的症状，提示多发性硬化症的发生。本例结果提示感染是多发性硬化症发病机制中的一个重要但被忽视的因素。在初次发现时，非典型病变应引起足够重视，患者应进行系统筛查，以确定感染及其相关免疫异常。
